11400 SW GREENBURG ROAD-1 11400 SW GREENBURG ROAD
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CITY OF TIGARD P7CHANICAL PERMIT' ReceiptPermit #
Description
Table 3A Mechanical Code OTY PRICE AMT
City of Tigard 1) Permit F->(, -0- 0- 10.00
13125 SW Hall Blvd.
P.O. Pox 23397
Tig&tri, OR 97223 2) Supplemental Permit 3.00
639.4175 Furnace to 100,000 BTU
1) incl.ducts&vents 8.00
Furnace 100,000 BTU +
2) incl.du-.ts&vents 7.50
Name of Development — 3) Floor Furnace 6,00
incl.vent _
Job AddressSuspended heater,wall heater
Address I I t 100 a� rr n bfa t t, 4) or floor mounted heater 8.00
Tax Lot Map No. Vent not incl.in
_ tot Block Subdivision 5) appliance permit 3.00
—
Name(or name of business)a) 61 Repair of heating,ref Ig.,I r ,.: I 8.00
r — cooling,absorption unit
Melling Address PhoneBoiler or comp to 3 HP
Owner 7) absorp.unit to 100,000 BTU 6.00
Clty/State ZipBoller or comp to 3 HP-15 HP
8) absorp.unit to 500,000 BTU 11.00
N me a Boiler or comp 15-30 HP
') 15.00
absorp,u••iit'/z-1 million
(� r r t cu it _ ) 22.50
Boiler or compto 3u-50 HP
�Iamng Address ) Phone 10
absorp.unit 1 -1.75 million -_
Con rector City,state Zip 11) Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No. C ty Bus.Tax No. 12) Air handling unit to 4.50
10,000 CFM
r.
I hereby acknowledge that I have read this application that the Information given is 13) Air handling unit 10,000 CFM + 7.50
correct.that I am the owner or authorized agent of the ower,that plane s.ibmitted arp In ---
compliance with State laws,that I am registered with the State Builders'Board,that theNon portat,le
number given is eo:rect.(if exempt14 from State registration please give reason below). ) evaporate cooler 4.50
Vent fan connected
- -- — ----- _ —---------------- 15 to a single duct 3.00
—- ----- ----- ---- 18) Ventilatio•t system not 4,50
Included in appliance permit
17) Hood served by 4.50
mechanical exhaust
Signature(own or agent) Date 18) Domestic type 7.50
Describe work ❑ addition O alteratior; repair f 1 Incinerator _
to be done residential r1 non-residential U 19) Commercial or Industrial 30.00
type incinerator
Existing use of -
building or properly ( _ - 20) Other I.e.,woodstove,water 4.50
Proposed use of
heater,solar,clothes dryers,etc.
--
building or property -- -- 21) Gas piping one to four outlets ! 2.00
Type of fuel- oil O natural gas LPG C 1 elft ctric Cl —�-
22) More than 4•per outlet
NQTI_E SUB-TOTAL 1
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF '80 DAYS AT ANY TIME AFTER --
WORK IS COMMENCED TOTAL 'I
Special Condftions
i
h.r /11 _
—— - Date issued by /