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CITY OF TIGARD MECHANICAL PERMIT Receipt#
,t
t Permit# � a' _— e'
Description
Table 3A Mechanical Code aTV PRICE AMT
City OP Tigard 1) Permit Fee -0- -0- 10.00
13125 S.W. Hall Blvd. — S -- -
P.O. Box 23397
Tigard, OR 97223 �C h 2) Supplemental Permit 3.00 -
639-4175Furnace to 100,000 R(U �'P�
� 6.OU
1) incl.ducts&vents Q GP2, Z 9.ld�
§ Furnace 100,000 BTU +
2) 7.50
incl.ducts&vents 3;Go95 ?-d/6 7 ^5
Name of Development Floor Furnace 6.00 a
9) incl.vent
! S ctor
�,,�J1 6.00
-� -
Suspended heater,wall he
Jeb Add s -T 4) or flour mounted heater
Address f` -
Tax I-ol Map No. _5) Vent not incl.in 3.00 �r
Lot Block Subdivision appliance permit_ - -- 4
Name(or name.ol business) 6) Repair of heating,ref r ig , 6.00 k
- / cooling,absorption unit_
Mailing Address Phone 7) Boiler or comp to 3 HP 6 OC
Owner absorp.unit to 100,000 B`U - _ b 1
cityistat, Zip 8) Boiler or comp to 3 HP-1 HP 11.0C
absorp.unit to 500,000 BTU
Name
Boiler or comp 15-30 HP 1500
1& - 9) absorp.unit 112-1 million -
s l r Boiler or comp to 30-50 HP
Mailing Address Ph ne 1 0) 22.50
-�
absorp.unit 1 -1.75 million
w"Tri ala- � •
ContractorCity/Slate Zip 11) Boiler or comp to 50 HP 31.50 ^
absorp.unit 1,750,000 BTU _
T�L�? Air handling unit to
Stale Registration No. City Bus.Tax No. 12) 10,000 CFM 4.50
Air handling unit 7.50
) I hereby acknowledge that I have read this application that the information given Is 13) 10,000 CFM +
correct,that I am the owner or authorized agent of the owner,that plans submitted are in
compliance with Stale laws,that 1 am -istered with the State Builders'Board,that the 14) Non portable 4.50
number given is correct.(ll exempt from State registration please give reason below). evaporate cooler
Vent fan connected r ' Z 3.00 I
15) to a single duct $ rrt /-F_F 3 31r'i.> I
---
------ __ Ventilation system not
16) 4.50
included in appliance permit
-- Hood served by 4.50
17) mechanical exhaust
Signature(owner or agent) — Date 18) Domestic type 7.50
Describe work addition ❑ alteration 1� repair ❑ incinerator
to be done — residential L] non-residential X 19) Commercial or industrial 30.00
Existing use of / type incinerator —
building or properly 1l(jcdL� �T 20) Otht�i.e.,woodstove, nlateT \ 4.50
Proposed use of �heater)solar,clothes dryers,etc. \
building or property L-��C 17/r com�, 21) Gas piping one to four outlets 2.00 ? O�
Type of fuel- oil I 1 natmal gas )d LPG O electric [I _ a
22) More than 4-per outlet f 'S� A!rA
NOTICE _ SUB-TOTAL 'J
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- — --
406 SURCHARGE
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 CON-
S&10
DAYS, OR IF CONSTRUCTION OR WORK 13 SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTE^ �— `TOTAL
WORK IS COMMENCED. L '
149•So l r/49 5 1
Special Conditions__—__--- __-- I 3 sir / rr� 7�
9.50 1.1
Ib43L
Date issued by_
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