12060 SW TIEDEMAN AVENUE-1 12060 SW `1'IEDEMAN .AVENUE
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City of Tigard Mechanical Permit
New Installation Replace Reloration U Addition ❑ Alteration DATE:
HEATING -`
CONTRACTOR -
OWNER
ADDRESS___ .�- __ -----------•- ___.- .108 ADDRESS-
PHONE
DDRESS PHONE --- APPLICANT _---- ..� — ---------7�� "2 -__
Heat Input Rating(BTU per Hour) _-_` _ Vent Size Flue
FUEL OIL GAS [] ELECT E] OTHER+
ITEM NO. FEE,. _ - EM ---V+ N0. FEE
or !ssuence of Permit _ ___- SEE BE W Each Air an Unit or Duct Ste 7.50+_
N_ew-up to & incl. 100,00_0 BTU.-_ UO Com_merci I Hoo stem _ 7.60
New 100,800 BUT, & over--_ 7.50 V Other C -I me Ea _ _ 4.60--
W_oodburning Stove_ - 4,50 - 1 Trip I spe 1 -4.50
Wei'-Floor- Suspended_ _ 6.00 kir C i - pressor - p to in•I.3 H.T. 8,00
Vent System w/Fan 4.50_ i- o es r- .t to 1 P.inc. - 11.00
Repair-Haat Cooling -� - -
CITY BUSINESS LICENSE REQUIRED BY AL I CONTRAC ORS OR JR-CONTRACTORS ! I
PERMIT ISSUANCE 10.00 Comments: __-• - - _
FEES __--
SUBTOTAL - � ------ %-..STATE ---' Issued By._._
2696 PLAN CHE _
TOTAL_....- REC. #
Sir ieture of!Applicant - - - -
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 799 DATE
PFRRIIT IS GIVEN TO ������ �
OF
TLi
TO CONNECT A
TO TILE ..TSTEM OF TIOARD SANITART DISTRICT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID .... .....................TIGARD gATMARrDiSTkICT
By
+A10i//s4,tigr
CONNECTION INSPECTED AND APPROVED
Date _ — ----- -
Superintendent
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i
Address..__/, i ooy 6' U. /�/E D�,y�,c�
— Permit No.
Name of Occupant_ %E Cosee- /`, permit charge! -PC-r,
--- Connection fe-& {I U?«5-0 �.
----- -- Paid by__
- - _ Date connected
7
Type of Building_ Z-j/,PCAlr a Inspection fee.--- �/C C t`
( r —
Service Rafe C'O Paid by _ f��/ Su',,, /Date 3/�
Contractor_-_--__ - Assessment_ Ped
_
Size o; ;;cnnection
-- L----_— /
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