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COMMUNITY DEVELOPMENT DEPARTMENT UATEK TS5kJE'D: 1. 1.8/alp
13115 S.W.Hall Blvd..P.O Box 25397,Tqard,Oregon 97223,(503)6394175
K 1 -'5W 71ST AVE_"
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NO. Z-31
This permit is issued subject to the regulations contained in Title 14 ............. ...........
of the TMC. State of Oregon Specialty Codes zoning regulations
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive N
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and t 11,11.
vnid.f work in not started within 190 days.o-if work Issuspended or
abandoned for a period of 180 days -.iny time after work has
commenced It shall be the responsibility of the permittee to assure
all required insrections are requested and approved
Pe,mItt.z ignature
ISSLIod By
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TIGARD MECHANICAL PERMIT Receipt # p
Permit#
Description
City of Tigard table 3A Mechanical Code oTY PRICE AMT
13125 S.W Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397 _
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 _
Furnace to 100,000 BTU
Incl.ducts&vents - i 6.00 `v
2) Furnace 100,000 BTU +
Incl,ducts&vents 7.50
Name of Development 3) Floor Furnace - —
o a incl.vent 6.00
Joh Address ---— —
Suspended heater,wall heater
Address rsx L _4) or floor mounted heater 6.00
ot Map No. 5) Vent not incl,in
_— tot Block Subdivislor appliance permit 3.00
Name(or name of business) — ReP air of heating,refr ig., -
t r.c- 6) cooling,abs 3rpticn unit 6.00
Owner Mailing Add:ass Phone 7) Boiler or comp to 3 HP
X 7G_t ZLd..' r absorp.unit to 100,000 BTU 6.00
City/State Zia 8) Boiler or comp to 3 HP-15 HP
absorp,unit to 500,000 BTU 11.00
Name Boiler or comp 15-30 HP '
9) absorp,unit 112-1 million 15.00
Maig Addressr/ 10) Boller or comp to 30-50 HP
Contractor fW t4� r absorp,unit 1-1.75 million 22.50
City/Stale Zip 11) Boiler or comp to 50 HP
absorp,unit 1,750,000 BTU 31.50
State Registration No. City Bus.Tax No. 12) Air handling unit to
S 041, 10,000 CFM 4.50
1 hereby acknowledge that I have read this application that the Inf,irmatlon given is 13) Air handling ur"
correct,that I am the owner or authorized agent of the owner,Ihnt pleas submitted are InF) o
10000 CFM 7.50
compliance with State laws,that I em reglaterad with the State Bullners'Board,that the
number given is correct(It exempt from state registration please give reason below Non portal;
rate c 4.50
— --- -- _-_- _ _ an connected
gle duct 3.00
tion syste t notd In appliance permit 4.50
erved by_ _ mechanical exhaust 4.50
Signature I( nor or agent) — Datei
Describe work - 18) Domestic type
17 addition ❑ alteration Incinerator 7.5
repair L] 0
to be done residential�- non_residential
Commercial o.industrial
Existing use of _ 19) type Incinerator 30.00
building or properly Other i.e.,woodstove,water
Proposed use of — heater,solar,clothes dryers,etc. 4.50
building or property
21) Gas piping one to four nutlets
type offuel- oil [I natural gas I LPG CJ electric f] � 2'00 2,c u
22) More than 4-per outlet
NQ_TLCE --
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- _ SUB-TOTAL 4 c0
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 _ 59SURCHARGE qp
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR -_ - - --
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTEq PLAFJ i1E1'Ir_-W 25%OF SUB-TOTAL
WORK IS COMMENCED _ TOTAL f 91D
Special Conditions
---- - -- Date Issued_� y