11220 SW COTTONWOOD LANE 1
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11220 SW CCriPTONWCKDD LANE
CITY O F T I G A R D MECHANICAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)63P4171 PERMIT #. . . . . . . : MEC96-0396
DATE ISSUED: 11/14/96
PARCEL: 1S134AC-02654
S17L ADDRESS. . . : 1. 1220 SW COTTONWOOD LN
SUBDIVISION. . . . : ENGLEWOOD NO. 3 ZONING- R 4. 5
B1...00V1. . . . . . . . . . : LOT. . . . . . . . . . . . . :220
---------------------------------------------------------------------------
CLASS OF WORK. . :AL*r FLOOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRF:,. . :R3 VENTS W/O ADPL: is VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL 0-3 HP. . . . : 0 DOMES. INCIN: 0
- /GAS/ COMML. INCIN: 0
3-15 HP. . . . : 0
MAX INPUT: 0 BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . . : L 50+ HP. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS-- -------- AIR HANDLING UNITS OTHER UNITS. : 0
FURL' , 100K BTU: 1 <= 10000 c f m: 0 GAS OUTLETS. : 0
FURN ) =100K BTU: 0 > 10000 cfm: 0
Remarks : REPLACE OLD ELC FURNACE WITH NEW GAS FURNACE
Owner. ---------------------------------------------------- FEES
HENNINGSEN type amount by date recpt
11220 SW COTTONWOOD LN PRMT $ 25. 00 JMH 11/14/96 96-286520
5PCT $ 1. 25 JMH 11/14/ 36 96-286520
TIGARD OR 97224
Phone #: 644-2800
A--TEMP HEATING & COOLING
t6OOO SE EVELYN ST.
CLACKAMAS OR 97015 ---------------------------___------
Phone #: 650-5014 $ 26. 225 'TOTAL
Reg #. .. : 71878
REUUIRED INSPECTIONS
This pervit is issued subject to the regulations contained in the Gas Line Ins
Tigard Municipal Code, State of Dre. Specialty Codes and all other Mechanical I n s p
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This prrmit will expire if work is not started
within 188 days of issuance, or if work ii suspended for vore
than 188 days.
Pler-mittee Signati-it,e -
lssi.ied By:
Call for inspection 639-4175
Plan Check#
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd_,
TIGARb, OR 97223Date to P.E.
(503) 639-4171, x304 /SCC 9&"��qE DaletoDST_�-
Print or Type Permit#
Incomplete or illegible applications will not be accepted Called
-- -
Name moevebpmem/Proiec+ - - - Description -- - —
' Table 1A Mechanical Code QTY PRICE AMT
Job sneer Address - - Suite# A) Permit Fee - -- -0- -o- 10.00
Address
Bldg# City/Stale Zip B) Supplemental Permit 3.00
Name(or norm cd buarness) 1 ) Furnace to 100,000 BTU 600
d Owner FI. r ; c incl.duds&vents
( MaWng Address 2) Furnace 100,000 BTU+ 7.50
(11lind.duds&vents
cky/State hlne 3) Floor Furnace 6.00
1 ( (
f" P1 -` 1-) C. L,44- 1 incl vent
----- Nems jar.all or molar) 4.) Suspended heater,wall heater - - 6.00
I s A 9 b 4 L, or floor mounted heater
Occupant MakV Address 5.) Vent rvd incl.in 3.00 -
appliance iance permit
Citymiah Zip I Phorw 6.) Boiler or camp,heat pump,air coed. 6.00
to 3 HP;absorp unit to 100K BTU
7.) Boiler or comp,heat pump,air Gond. 11.00 J--
I'lp AEATIJI� � -L3-15 HP,absorp unit to 5WK BTU
Address M"V a 8.) Boiler or comp,heat pump,air Gond. 1500
IQ -T" 15-30 HP,absorp and 5-1 mil BTU
Attach copy of Zlp Pho+t 9) Boiler or comp,heat pump,air loond- 22.50
Current Licenses S, o IiLlr)T)-�7,p30-50 HP;abscrp unit 1-1.75 mil BTU _
nrepun Const.Cam Board t.ic# Exp,Dots 10.) Boiler or comp,heat pump,air Gond. 37.50
>50 HP,absorp unit 1.75 mil BTU
COT Bushes;Tax or Metm# FW Dela- 11.) Air handling unit to 4.50
_ 10,000 CFM
ArchHlect_ Name - - 12.) Air handling unit i 7.50
_
10,000 CTM+
or Melling Address --� �- -13) Non portable 450
_ evaporate cooler
Engineer cl1Y/Stare zip i Prone41) Vent wn connected 3.00
_
to a ning;e dud
ribe w
Desco_rk-New O Addition O Mlerabon V Repair G 15.) Ventilation system not 4.50
to be done Residential g Non-residential O included in appliance permit —
Additional Description of work --"- 16) Hood served by
mechanical exhaust 4.50
17) Domestic incinerators 7.50
Existing use of v V- — -�-v 18) Commercial or industrial 30.110
building or propwty-- _—�- _- pe indnerator
19) Clothes dryers,etc 450
Proposed use of 2tl) Other Units 450
building or property
Type of fuel-oil O natural gas LPG O electric O — 21) Gas piping one to four outlets 2.00
I hereby acknowledge that I have read this application,that the -� 22) More than 4-per outlet (each) 50
information given is correct,that I am the owner or authorized agent of _
the owner,that plans submitted are in compliance with Oregon State 'CITY.SUBTOTAL
laws - - -- --
Signab>tre of OwnedAyertt — Date 'SUBTOTAL
L r 5%SURCHARGE
Confart Person Name P,tune — PLAN REVIEW 25%OF SLrSTOTAL -
TOTAL ,.,..,•
i hdst4rlorhpmt doc 'Minimum permit tee is$25+5%surcharge
Rev 7/96
CC ,) ►1AET� "