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12915 SW KING RICHARD DRIVE I m H x 3 In n � �v I ��. Receipt# ..� CITY OF I`��GAR© A.XHANICAL PERMIT Permit# )- Description Table 3A Mechanical Code — CITY PRICE AMT City of Tigard 13125 `:'.W. Hall F' J. 1) Permit Fee 0� 0- 10.00 P.O. Box 2.339 / 2) Supplemental Permit 3.00 Tigard, OR C 223 639-4175 1) Furnace to 100,000 BTU 6.00 _ _incl.ducts&vents _ Furnace 100,000 BTU + 2 7'50 incl.ducts&vents Np.-,a of Development 3) Floor Furnace 6.00 incl.vent _ _ Joh Address 4) Suspended heater,wall heater 6.00 Addressor or ficor mounted heater Tax Lot hI j)No - — ) Vb`nt not incl.In 3.00 Lot Block Subdivision 5 appliance permit - Name ler name of business) — 6) Repair of heating,refr ig., 6.00 cooling,absorption unit ��-- OwnerIdallingAddresa ^hong Boiler or comp to 3 HP T 6.00 t .-- ) absorp,unit to 100,000 BTL) � l1 ' y, Cityi8leM zip — 8) Boiler or comp to 3 HP-15 IIP 11.00 r: ( ab_or i.unit to 500,000 BTU - _ _-- - -- - 9 Bci erorcomp 15-30 HP 15.00 Name j ; ` I ) absorp.unit 112-1 million _ Contractor �� s 4r p� 10) Boiler . comp to 5-iOmill o P 22.50 g - absorp.unit 1 -1.75 million Matlln Addros City store p .\r, 1 1 Boiler or comp to 50 HP 3 i `0 ( ( 1 [ ) absorp.unit 1,750,000 BTI i State Registration No. City Bus.Tax No 12) Air handling unit to 4.50 10,000 CFM I hereby acknowledge that I have read this application that the Information gluon is 13) Air handling unit 0 CFM + 7.50 correct,that I am the owner or authorized agent of the owner,th10,00 at plans submitted are in 10OO -- -- - compliance wit'i State laws,that I am registered with the State Builders Board,that the 14) Non portable 4.50 number given is correrl.(If exempt from State registration please give reason below) evaporate cooler 15) Vent fan connected 3.00 to a single duct i -- - 16 Ventilation system not 4.50 included in appliance permit- 17) ermit_t7) Hood served by 4.50 mechanical exhaust Siynehire(owner or agent) —� Date 16} Domestic type 7.50 Describe work _I addition C] alteration F1 repair F incinerator - - to be done I asidential El non-residential ❑ 1611 Commercial or industrial 30.00 Existing use of type incinerator _ _ - building or properly 20) )ther i.e.,woodstove,water 4.50 - Proposed use of hbater,solar,clothes dryers,etc — — building or property_^ _ - - 21) Gas piping one to four outlets 2.00 Type of fuel- oil I I natural gas I I LPC; I I electric f ' - 22) More than 4-per outlet NOTICE SUB-TOTAL THIS PERMIT BECOMES NULL. ANG VOID IF WORK OR CON- STRUCTION AUTHORIZED IS NOT C01"JIMENCED WITHIN 180 I—_ 4%SURCHARGE DAYS, OR IF CONSTRUCTION On WORK IS SUSPENr)rr' OP PLAN REVIEW 25%OF SUB-TOTAL P,BANDONED FOR A PERIOD OF 160 DAYS AT ANY TIME AFTER - WORK IS COMMENCED. TOTAL Special Conditions_-.... -.-_-...__T.___ r ) by Date leeued {� 1 '�� -- INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Ph : 639-4175 Type of Inspection Aon -j Date Requested Time P.M. Address Per # Owner Builder tolt The followl'ps Building Code deficiencies are required to be corrected: ----------............. ........................ ALPresented to _ '�Appwved Inspector Disapproved Date OA I CALL FOR REINSFECTION yes 0 NO