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16520 SW QUEEN MARY AVENUE
--KING CITY
CIT` GF TIGARD MECHANICAL PERMIT Receipt#
Permit #
Description
City of Tigard
Table 3A Mechanical Code CITY PRICE AMT
/�t --
13125 S.W. Hall Blvd. �„-,/ 1) P9rmit Fee -0- -U- 10.00
P.O. Box 23397 —
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 1 I Furnace to 100,000 BTU
incl.ducts&vents 6.00
Furnace 100,000 BTU +
2) incl.ducts&vents 7.50
Name of Development 3) Floor Furnace 6.00
incl.vent
Job Address Suspended heater,wall heater
Address 4) or floor mounted heater 6.00
Tax Lot Map No Vent not incl,in
Lot Block Subdivision 5) appliance permit 3A0
Name(or name of business) 6) Repir atg,f heating,r of nig 6.00
COO
Maiimg Address— phcn® Boiler or comp to 3 HP
Owrner 7) absorp.unit to 100,000 BTU 6.U0
City state �p Boiler or comp to 3 HP-15 HP
8) absc rp,unit to 500,000 BTU 11.00
Name Boiler-ir comp 15-30 HP
9) absorp.unit'/z-1 million 15.00
Melling Address Phor: °
Boller or Comp to ^ FO HP
10) absorp.unit 1 1.75 ml,'ion 22.50
Contractor coy state Zip Boiler or co np to 50 HP
11) absorp.unt 1,750,000 B'-U 31.50
State Registration No. City sue.Tax No. 12 Air handling unit to
10,000 CFM 4.50
I hereby acknowledge that I have read this application that the informationiven is 13) Air handling unit
g 10,000 CFM 4- 7.50
correct,that I am the owner or authorized agent of the owner,that prone submitted are in
compliance with State laws,that I am registered with the State Builders'Board,that the Non portable
numt•er given is correct.(It exempt from State registration please give reason below). 14) evaporate cooler 4.50
l r ; Vent fan connected
15) to a single duct 3.00
Ventilation system not
16) incluuud in appliance permit 4.50
Hood served by
17) mrchanical exhaust 4.50
isigrr afore(owner or agent)
Date Domestic type —I
Describe work Cl addition F1 alteration n repair [1 18) Incinerator 7.50
to be done residential ❑ non-residential C7 Commercial or industrial
Existing use of 19) type incinerPtor 30.00
building or properly_ 20) Other i.e.,woodstooe,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 ❑ natural gas [1 LPG Ll electric 11
22) More than 4-per outlet
OTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK 'Jit CON _ SUD TOTAL
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 180 DAYS AT ANY TIME AFTER -
WORK IS COMMENCED. TOTAL
Special Conditions_
-- --- ---- – Date Issued_� �_� by �_