11520 SW 91ST AVENUE 11520 SW 91st Avtnue
MinU'11-16-NICAL. PEAMI-T
CITYOFTIGARDPEAM11' NO. : MI A90139
1 r one" DAIIE 1./26 89
COMMt NITY DEVELOPMENT DEPARTMENT
11125 S W.Kill Blvd-P O.Box 23397,Tigaid,Oregon 97223.(503)631-4175
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This permit is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes zoning regulations
ar 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 N
ordinances. The issuance of this permit foes not we've restrictive F"r.No
covenants Contractor and subcontrRctcrs shall hat--. - tirrent city
business lax permits. This permit will expire and �,ecome null and
void It work is net started within 180 days or it work Is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the pertnittPe to assure
all required inspections are requested and approved
Permittee Signature
1:01:'! INLiPEUTION 6.39 �l I
Issued By --
SEPARATE PERNVTS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TIGARD MECHANICAL PERMIT Permermiit pt
#
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P # � 7 o
Description
Table 3A Mechanical Code CITY PRICE AMT
City of Tigard
1312'..) S.W. Hall Blvd. 1) Permrt Fee - _ -0__ 0 10.00
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit �_- _ 3.00
639-4175 1) Furnace to 100,000 BTU t.00
incl.ducts&vents -
2) Furnace 100,000 BTU +
incl.ducts&vents
Name of Development 3) Floor Furnace 6.00
incl.vent
.Job Address 4) Suspended heater,wall heater 6.00
Address L 3 ,7`? or floor mounted heat ir
Tax Lot Map No. 5) Vent not incl.in 3.00
Lot Block Subdivision appliance permit
Name or name of business) 6) Repair of heatinc refr ig., 6.00
!� cooling,absorption unit
Mailing Address Phone 7) Boiler or comp to 3 HP 6,00
Owner 12- absorp.unit to 100,000 BTU
City/State zip 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU
Name � '_i 9) Boiler or comp 15-30 HP 15.00
absorp,unit 1/2-1 million
Melting Addrest Phone 10) Boiler or comp to 30-50 HP 22.50
1�o�Zc e. ly;•�i�?' absorp.unit 1 1.75 million
Contractorlry�stata zip 11) Boller or comp to 50 HP
c
it ,fie_ll.c ��of (a , ' _ absorp.unit 1,750,000 BTU 31.50
of
State Registration No. City Bus,Tax No. 12) Air handling unit to 4.50
10,000 CFM
Air handling unit 7.50
I hereby acknowledge that I have read this application that the infortration given is 13) 10,000 CFM +
correct,that I am the owner or authorized agent of the owner,that plans aubmihed are In --
compliance with State laws,that I am registered wit'i the State guilders'Board,that the 14) Non portable 4.50
number given is correct pt exempt from State real,Gdiic�please give reason below). evaporate cooler
15) Vent fan connected 3.00
to a single duct
Ventilation system not
16) 4.50
included in appliance permit
Hood served by 4.50
Y" 17) mechanical exhaust —
Signature(owner or agent) `- — _ _ bate 18) Domestic type 7.50
Describe work f] addition L) alteration Cl repair (AIncinerator
to be done residential ❑ non-residential ❑ 19) Commercial or industrial 30.00
_ type incinerator
Existing use of _
building or properly '' — 20) Other i.e.,woodstove,water 4.50
heater,solar,clothes dryers,etc.
Proposed I se of -- -
building or property 21) Gas piping one to four outlets "; 2.00
Type of fuel- oil F1 natural gas L-1 1_PG C] electric (71
22) More than 4-per outlet
TILE — SUB-TOTAL4,4'1/,-
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CO V-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 160 SaIO AI.t3URCHAROE
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
_-_- —� — Ddtt issued by.�
Address � � ____�L . , Permit No.__
Namc of Occupant Permit charge _
C
Paid
Date connected__.J / �!
Type of Building OL&Z&ytig____ Inspection fee----
Service
ee_ _Service Rate__ � /l j� ✓ ___ Paid by Date___
Contractor _ Assessment v Paid
Size of connection