10397 SW RIVERWOOD LANE-1 ADDRESS:
BUJ r L.
i:\records\microflm\ta rgets\building.doc
CITYOFTIFARD
CITYOF T16:ARD
COMMUNITY DEVELOPMENT DEPARTMENT oMax�u
13126 BW FWI Blvd. P.O.Boot 23397,Tigird,Omgon 97223(603)839.4176 i
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GAS PRESSURE. . . I_r, '
1\10. CA- 111\11 M--.. .
F•URN l 100K P RI e
1'telna1r'ks,
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HEC..1_ IIE:f1Tt P.11';
i 5550 scm, P i n z.Z Fl i-w
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Rey Ilk. . : 00-4,17
!his oersit is issued surbiect to the requiatlans contained to 0r;, 1 , a 1 rr :;ut" ►: r r,r
t+.ard Municipal Code, Rinte of :1T'e. Soeci3lty Cocfes and all othe, i
applicable law . All r,n, s will be don
e to accordancewith
3o roved dans. ynnrt will eM r, �
if wor.4 is net starter! —.
within 1901 days of issuance, or i( %ijrK is u nendpd For More
than l88 e3Vs,
Pe
7. 5'=.ttt8tj Fly :'
CITY OF TIGARD MECHANICAL PERMIT Receipt#
13125 SFi HALL BLVD. Permit M
P. O. BOX 23397 Description
TIGARD OR 9722.3 � � �L 1 � � Table 3A Mechanical Code QTY- PRICE AMT
r u -
(503)639-4175 -' 1) Permit Fee -0- -0- 10.00
Name of Development —.r
2) Supplemental Permit 3.00
Adare� 1 ) Furnace to 100,000 BTU 6.00
Address 1ss iC� '� , p;!, ,.1( LZ-1-1, ' incl.ducts B vents
Tax Lot Map No 2) Furnace 100,000 BTU i- 750
i
t.a Block Subdmsw incl.ducts&vents
Name(or rwne o1 business) 3) Floor Fumace 600
r incl,vent
Mailing Address Phone 4) Suspended heater,wall heater 6.00
Owner - or floor mounted heater _
i r w Vent not incl.in
City/State
Zip 5)
G g7zz3
appliance permit 3.00
a (or name)I business) 6) ReprAir of heating,refr 1g., 6.00
cooling,absorption unit
Malling Address phoria 7) Boiler or comp to 3 f iP a / f_ 6.00
Occupant -absorp.onit to 100,000 BTU A (-<
City/State Zip Ol Boner or comp to 3 HP-15 HP 1100
dbsorp.unit to 500,000 BTU _
Name 9) Boiler or comp 15-30 HP 15.00
absorp.unit'/,-1 million
areas Phone 10) Boiler or comp to 30.50 HP
Meiling 2?50
,. absorp.unit 1-1.75 million
Contractor
Boiler or comp to 50 HP
City/State Zip 11) 31.50
absorp.unit f,750,000 BTU
State Registration No. Coy Bus Tax No. r 2) Air handling unit to 4.50
10,000 CFM
Air handling unit
I hereby acknowledge that I have read this apnticabon that the infomration gwrn,s 13) 10,000 CFM + 7.50
correct,that I am Otte owner or aLdNxized agent M thit owner,that plans submitted are in ----- -
cornpfianoe with State lawn.that I am registered with the State Elailders'Board•that the 14) Non portable 4.50
number givon is correct.(It exempt from State registration please give reason b(krw) evaporate cooler
Vent fan connected
- " -------------- 15 3.00
to a single duct _
Ventilation system not
16) included in appliance permit 4.50
- - 17) Hood served by -- 4.50
mechanical exhaust
siglnature(C' W Owl
�.- - ----- owe 18) Domestic type 7.50
Describe work ❑ addition ❑ alteration ❑ repe', ❑ Incinerator
to be done residential ❑ non-residential C1 - 19) Commercial or industrial 30.00 _
Existing use of _ - type incinerator
building or properly__ __ 20) Other i.e.,woodstove,water 4.50
R oposed use of heater,solar,clothes dryers,etc. -
building or property 21) Gas piping one to four outlets 2.00
Type of fuel- oi! [-I natural gas [] LPG ❑ Plcctric ❑
----- - 22) More than 4-per outlet
NOTICE ti /e< ,v� SUB-TOTAL
i
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
0
ON- -
RTRUC'fION AUTHORIZED IS NOT COMMENCED WITHIN 180 5%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL`
ABANDONED FOR A PERIOD OF 160 DAYS AT ANY TIME AFTER —
WORK IS COMMENCED. TOTAL
Special Conditions
��- -- --- - -- —- -- Date issued _ _ by, �-
--, .�W 45
Cj-,'Y OF rIGORD ... PLCFztl-"T OF PAYMFN-f Rl�'U'C'lr'T NG. 92 ? 5
CHFICK AMOUNT s C*,�. 9-:215
NAME m.or.'N(',!, INC CASH AMOUNT s 0. 00
ADDRESS a 1'."#1550 SF PlA7ZA AVE PAYMENT DATE s OA 1.:d P
Gt.lPDIVI',310N
("LADIMMAS, (-,P 9 71,1151
PURPOSE OF PAYMENT AMM INT PAID PURPOSE.. OF F.:IAYMf:NT OMOLINT PO I n
MECHANICAL V'E 2.5. 00 ST. BUILD PFR
SENOR
10397 `:,W RTVFRW00D LN
T01-01- AMOUNI f-4110