11756 SW 129TH PLACE I
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11756 SW 129th F.1
PITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST --- --
BLIP
Date Requested_ — Y—&;10 AM_ _PM _-- BLD
Location / / 4:;-& '
—r--- — �� _..�� ' _�_— Suite — - MEL: ']� 64� ���
Contact Person Ph _ _ _ PLM
Contractor Ph SWR -
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access* �-
FoundaiionJJ FFIS
/;�
Ftg drain _6 � —
Crawl ur-',n Inspection Notes: SGN
Slab �i T
Post&Ream --- - - --
Ext Sheath/Shear
Int Sheath/Shear - -
Framing
Insulation �/
Drywall Nailing L'!, I�/ '°a4'to I !/�:dvt L� ��ClC �1'ee_ (4: 23 - 1/1.
Firewall
Fire Sprinkler
Fire Alarm � � � �,� `ZZ� ?�C•t� G
Susp'd Ceiling rA / l IIA
Root -
Misc
Final ('
PASS FART- FAIII
PLUMBING
Post& b:.-:gym --
Under Slab
Top Out _ -
Water Service , a1� �ZLj
Sanitary Sewer ----
Rain Drains T_�"' 5.1� �• i G, �yC- �!L11�� �
Final --
PASS PART FAii..
ASL
Post& Beam - -- - - - ----- ------
-
Rou h In
Smoke Damper-
_ _ -----_
1 ` PART FAIL
ELECTRICALService
Rough
Rough In --
UG/Slab
Low Voltage
Fire Alarm
Final ----- - _ _
PAS'� PART FAIL __-
817E
Backfill/Grading ---- ------
Sanitary Sewer
Storm Drain )Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
CatchPlease call for reinspection RE
Fire Supply
Line I ) p Unable to ';,pect-no access
ADA
Approach/Sider alk Date "V Inspector G4
Other _-- _--- p — - _Ext
Final
PASS PART FAIL 00 NOT REMOVE this Inspectlon record from the job site.
CITY GF 'f IGA RD BUILDING INSPECTION DIVISION 41ST
24-Hour Inspection Uiiie: 639-4175 husin3, s Line: 639-4171 ( --
�,��!� BOF' _
[late Requested_ 3 � __AM-- PM BLD
Location I V-7 G
'Z 9 , �. Suite
Contact Person Y�(�� Q��)� Q. Ph ',:_' PLM
Cor;tactor — Ph SWR
BUILDING Tenant/Owners- �t �g�
Retaining Wall � ELF _
Footing ACce:;s:
Foundation FPS —
Ftg Drain SIGN
Crawl Drain Inspection Notes:
Slab —.-_._. _— _ SIT
Post&Eeam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Neilinq --- --- -- ------- _. -
Firewall
Fire Sprinkler -
Fbe Alarm
Susp'd Ceiling - - -- ---
Roof
Misc.
Final
PASS PART FAIL -
PLUMBING
Post&Beam _— --- -—- -------� _/ ---- --- -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains —.-- - - - - --- ------- - -- - --- - —
Cinal
PASS PART FAIT
Post& Beam -- - ---- ---- ---- ----- --- _ _- - — — —
Rough In
Gas Line --- ----- _._.- - -- - ----- --- -- --------
S oke Dampers
S PAR" FAIL
,arVICe
Rough In — -
UG/Slab - -- -- -- ----------._._-.. ----------
Low Voltage
FireAlarm - --------___- �_ ---- ... -- ---- ---------- --
PART FAIL _-_ __ __-.-- - - ----- ----_
tliik
SITE
Backfill/Grading -�-----'"-`-- - —�--•
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$-- _required before next inspection Pay at City Hall, 13125 gW Hall Blvd
Catch Basin
Fire Supply Line ( ] Please call for reinspection RF: — I ) Unable to rnspfct-no access
ADA
F pproach/Sidewalk Date � � —Inspector - rr' r Ext
,1,,Iler - —___ �_
Final
PASS PART FAIL_ DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 (Business Line: 639-4171 — -
13UP
- -__---Date Requested 3� - AM-- PM BLD
j ��J 12- Suite MEC %7�� -000 '�
Location --�- _-
Contact Person (YI Ph _ -_ - PLM
Contractor Ph --_ __.-.. SWR ---- --
BI Lir DING — Tenant/Owner _ ---, - ELC
Retaining weii ELIR ____ _ _•
Footing Access -
Foundation FPS _--
Ftg Drain SGN
Cra%vl Drain Inspection Notes:
Slab ------- �XX� � -C"`��.- - - - SIT
Post&Beam .:2 /,, - ----- --- -
Ext Sheath/Shear ---- --- -
Int Sheath/Shear
Framing -_- --- -- - - - -
Insulation
Drywall Nailing _ A& _o�`q /�v,4 L,4 b L�� �7�'=�i�= c �7 CC v ='�
Firewall
Fire Sprinkler 1"i�e,�s�`�_ `�� S'clj��!i�v L� i..l,',•����1,J _-
Fire Alarm
Susp'd Ceiling -
Roof
Misc:_- -- --— - - --------
Final
PASS PART FAIL - -- --- - - -
PLUMBING
Post& Beam --� -' --- - ------
Under Slab
Top Out - --
Water Service ---_ ------ -- ._- --_ ——.—_ ----------__
Sanitary Sewer
Rain Drains --
Final _
PASS RT FAIL
CHANICA --------_------------
f'ost& Beam ---------�-- -------- ---------..-_
Rough In
Gas Line --- -_- - ---------- - -- --- - - - -----
Smoke Dampers
Final
PASS PARf' IL
ELECTRICAL
Service ---__----
Rough In -- ------------------
UG/Slab --- -_ -- ----- -
Low Voltage
FireAlarm --- -- - -------------------.._--...------ ----
Final
PASS PART FAILSITE
Backfill/Grading --- — - —
Sanitary Sewer
Storm Drain ( [Reinspection fee of$--__--required before next inspection Pay st City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( J Please call for reinspection RE - [ �Unable to inspect-no access
ADA
Approach/Sidewalk
Other Date =w_. --G' ' Inspector Ext
Final
PASS PART FAIL 00 NOT REMOVE' this. Inspection record from the job site.
CITYOF TI GA,R Q __ MECHANICAL PERMIT
DEVELOPMENT SERVICES
PERMIT#: MEC2000-0003-,
13125 SW Hall Blvd.. Tigan.:, OR 97223 (50? DATE ISSUED: 2/29/00
SITE ADDRESS: 11756 SW 129TH PL j ( PARCEL: 1S133DD-01600
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2
BLOCK: ZONING: R-4.5
LOT:055 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN:
TYPE OF USE: SF EVAP COOLERS:
UNIT HEATERS:
OCCUPA14CY GRP: R3 VENT FANS:
VENTS W/O APPL: VENT SYSTEMS:
FUEL TYPES
STORIES: BOILERS/COMPRESSORS
-_— HOODS:
0 - 3 HP: 1 DOMES. INCIN:
MAX INPUT: 3 - 15 HP: COMML. INCIN:
FIRE DAMPERS?: BTU 15 - 30 HP:
30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: i OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/r,unit. Placement of a/c unit must Comply with standard setbacks.
Owner:
GRIFFIN, KENNETH R + ROXANNE M FEES
11756 SW 1291 H PL FPC
By Date Amount Receipt —
TIGARD, OR 97223 DEB ?-/29100 $4.00 00.32iC8F,
DEB 2/29/00 $50.00 00-321886
Phone:
To $54.00
Contractor:
D + R HEATING+ AIR COND
PO BOX 1292
27251 S DAVE RD
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
Reg #: I IC 84489 Final Inspection
This permit is issued Subject to the regulations contained in the Tigard Municipal COL+e, State of Ore.
Specialty Codes and all other applicable laws. All work will be dont
in aproved
plans. This permit will expire if work is not started within 180 days of issuance,
Or ifaccordance witoh kis upended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through U2-001-0080.
Ybu may obtain copies of the f� Cules or direct questions to OUNC by callih45031K9189
�-Issue BY
Permittee Signature:
Call (503)'639-4175 by 7:00 P.M. For inspections heeded ext business day
CITY OF TIGARD Mechanical Permit Application Recd
y
13125 SW HALL BLVD. Commercial and Residential Date Rac,d j- -0
TIGARD, OR 97223 �,�/ Date to P.E.
(503) 639-4171, x304 '(Zo 7 Date to DST
Print or Type
l�'� Permit#N'
Incomplete or illegible applications will not be accepted c;rned
If Name of Developmen'rProled Description
"I Table 1A Mechanical Code City Price Amt 1
Street Address _ uitca -- A Permit Fee _ 16,00
Job / 1) Furnace to 100,000 BTU
Address
� including ducts 8 vents see footnote 1,2 9.65
Ido# city/State 2ip 2) Furnace 100,000 BTU+ iv --
Including ducts&vents see footnote 1,2 12.00
Name(or name of business) 3) Floor Furnace
including vent see footnote 1,2 9.65
owner C ' /i 4) Suspended heater,wall heater
Moiling Address or floor mounted heater see footnote 1,2 9.65
% 5 Vent not included in appliance ermit 4.75
CK/State zip Phone Check all that apply 'Boiler Heat Ai;
W'd t-Z y%113 j� ijj�log For Items 6-10,see or Pump Cond city Price Amt
--- -- footnotes 1,2 Com
N (or nems of business)
6)<3HP;absorb unit to p�0
100K BTU _ 9.65
Occupant Mailing Address 7)3-15 HP;absorb unit
100k to 500k BTU 17.65
city/State 21p Phone 8)15-30 HP;absorb
unit.5-1 mil BTU _ _ 24.15
Contractor Name 9)30-50 HP;absorb
unit 1-1.75 mil BTU 35.00
10)>50HP;absorb unit
Prior to permitIng Address >1 75 mil BTU _� 60.15
iisuance,a copy r/ C 11 Air handling unit to 10,000 CFM
of all licenses cit Istat" zip Phone 7.00 _
are required If 0, / [1r 12)Air hanul!"q unit 10,000 CFM+
expired in COT of°�n C st.Cont.Board Lic# xp.Date _ 11.75
database Cry/ f% 4 13)Non-portable evaporato toiler
Architect Name _ _ _, 7.00
14)Vent fan connected to a single duct
or Mailing Address 4.75
15)Ventilation system not In:luded in
appliance permit 7.00
Engineer City/statep Phone 16)Hood served by mechanical exhaust
_ 7.00
.---z -t
Describe work to be done: 17)Domestic incinerators
12.00
New O Repair O Replace with like kind. Yes O No O 16)Commercial or Industrial type incinerator
Residential Commarcial o 48.25
19)Repair units
Additional Information or description of work. Y 8.40
n�e 6 ` Tev-1/11/� 20)Wood stovelgas FP/other units/clothe dryer/etc. 7.00
NOTE: For Commercial projects only;Units over 400 lbs require 21)Gas piping one to four outlets
structural gas colts. See footnote 1 3.7,5
Type of fuel: oil O natural gas LPG O electric O _ 22 More them 4- er outlet each) 75
Minimum Permit Fee_ $50.00 SUBTOTAL
hereby acknowledge that I have read this application,that the information %SURCHARGE '
given Is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL
the owner,that plans submitted are in compliance with Orcgon State laws _ Required for ALL commerclsl permits onl
TOTAL c' J
Signature of � Date
Other Inspections and Fees:
a 1. Inspections outside of normal business hours(mininum charge-two
016-hract Planson Name Phone hours) $50.00 per hour
1 2. Inspections for which no fee Is specifically Indicated (minimum
charge-half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes,additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure plans(minimum charge-one-half hour)$60.00 per hour
2. Provide drawings to scale showing existinn and proposed mechanical
units. _ 'State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
1:lrneehperm doc rev 02/4199
1
1
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CITYO F TI C A R D __ EL ECTRICAL PERMIT
DEVELOPMENT SERVICES PERPT#: E -00084
+! DATE ISSUED: 02//29/2029/20U0
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171
SITF ADDRESS: 11756.r,W 129TH PL PARCEL: 1 S 133DD-01600
SUBDIVISION: VILLAGE AF SUMMER LAKE PARK 2 ZONING: R-4.5
BLOCK: LOT : 055 .JURISDICTION: TIG
Proiect Description: Residential alteration
_RESIDENTIAL UNIT TEMP SRVC/FEEDERS �— MISCELLANEOUSv
1900 SF OR LESS: 0 200 amp: PUMP/IRRIGATIOW
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp• SIGNAL/PANEL:
MANF HM/ SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS
ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: 1 PER INSPECTION__
20 r - 400 amp: 1st W/O SRVC Or FDR: PER HOUR:
401 - 600 anip- EA ADD'I- BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES iiNITS: > 600 VOLT NOMINAL:
Reconvert only. _ SVC/FDR >=225,AMPS: CLASS AREArSPEC OCC:
Owner: `contractor:
GRIFFIN, KENNETH R + ROX.ANNE M ABC ELECTRIC CORPORATION
11756 SW 129TH PL 135 NE 9TH
TIGARD, OR 97223 PORTLAND, OR 97232
hone: Phone: 233-7551
Reg#: LIC 000002
SUP 12415
PLM "SEE"
ELE 26-2C
_FEES
--� Required Inspections
Type By Date Amount Receipt r Elect'I Service
PRMT BONv 02/29/200C $69.60 00-321881 I Elect'I Final
5PCT BON 02/29/200C _ $5.57 00-321081 I
Total $75.17 I ORIGINAL
This Permit is is%uad subject to the regulations contained in the Tgaid Municipal Code,State of OR Specialty Codes and all other applicable la pus
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 day%of issuance,or if work is
suspended for more than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Uti:ity Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987.
PERMITTEE'S SIGNATURE �1 N, �. ISSUED BY:
OWNER INSTALLATION ONLY
— _
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE_ OF SUVR. ELEC'N: DATE:-- _
LICENSE NO:
Call 639.4175 by 7:00pm for an Inspection the next business day
i
Foto-29-00 09 : 10A P . 02
CITY OF TIGARD Electrical Permit Application i`IanCheck# _
13125 SW H,4Lt, BLVD. Recd By Z�09 j F/4 V
TIGARD OR 97223 nate Recd
Date to P.F-
_ _
Phone (503)639-4171 x304 Date!to DST
inspection (503)639-4175 Print of Type Permd N
Fax (503) 598-1960 Incomplete or Illegible will not be accepted called
J. Job Address, 4. Complete Fee Schedule H,low:
Name of Development __ -- Number of Inspections per permit allowed
Name(or name of business) :L Service lncludod: Items Cost Sum
Address� _u�/�.�� �_ — aa. Residential•per unit
Glty/State/Zip_ r /'��)- 1000 sa ft nr INss $ 117 75 — 4
�L - � — Each Additional 500 sq,f1.or
U portion therouf S 213.75 _ 1
Commercial ElResidentialUmiled Energy S 00.00
Fnch Manurd I Ionia or Mud ular
2a, Contractor installation only: Uwurimq service or Feeder $ 72 75
(Prior to permit issuance.,applicant_n rnust provide contractor license 4b.Services or Feeders
informnuon for GOT data barn) Installation,aaurrlrwr or nelorallnn _
Elel'incal Contractor r 200 anfpa of leas _ $ t$4.2s 2
Add _ � 2M ampa to 400 arnpa � $ 85.50 � � 2
20 t r.mps to 1300 amps —_ $ 12R so -----
City _State_ Zip
97232 601 amps to 1000 amps — S 192 SU —
Phone No _ �1 _—_ Over 1000 amps or volts f 3h! is 2
Job No /%� —..----- -- Hucunrrrct only _. $ 53 50 _....�—- 2
Else Cont Ucp No _ �1_ Exp.Date . . 4c.Temporary Services or feeders
OR State CCB Reg r _�'�. Exp Dat , IrsImIlatmn alterahun or rouwtiuri
COT Business Tax o M ,to No Q Exp 111E 200 amps ur lyse; b 5350
/ 201 amps to 400 annpu — ); 50 25 �- 1
401 amps to 000 amps 1u0 00 2
Signature of S� � � Ova(600 arnpu to 1000 votes. -�
License No r Ex to soo^b^above.
jr 4d.Branca Circuits
Phone No �-u-•-�� -- NPw,Alteration or extenslerl pun panel
A)The too for brarrcii(jrcults
2b. For owner installation . with purchase nrservice or
feeder tee.
Print Owner's Name __-- Each branch ur�,wl 1_ $ a 35
Address u) I Ire lee Inr hrAnrh cirunts
— without purchaso of servmce
City ----_ State--_Zip — or feeder fee.
Phone NO —_ — First branch circuil $ 97 Sn
Each nddltional branoi circuli _— S 5 35 _
The Installation is beitlg made on property I own which Is not 4e.Miscellaneous
Inlended fur sale lease or rent (Service or feedur nut InrJudAd)
Lade pump of irrigation circle S 42 is
Uwners Signature _- - ---_. -- -- - Each sign or outline hptthny --- $ 4275
-" Slgnol rarcud(s)of a limned ern-fgy
3. Plan W-view section (if required):" panel,ellerAlion orexit)its wu 111U0
Miner Labels(1U) = 10000.00
Please check appropriate Ilern and enter fee in sactlon 68 41.Each additional inspaction over -
4 ur n mer rngrdp-nhnl units in one structure the allowable In any of thu above
— Servire end feeder 225 amps or more Per Ins cchun _ 50
no
S per Iwo S haIa
--- yvnua
—
It,Plant f 511 00
____Clae,ihcd,n:�ur shuuiure rnnlaming�perinl n,.�.n.roau�v a5 - -- —' --
dosrnhed in N L C Ulnmplcn 5 5. Fees:
go.Fnter Wtal ul auuve Iger.
Submit 2 sola of plans with application where any of tho above apply 139 SurchArne If 011 x tntul
Not roduirud for temporary const $nict(on services. Subtotal $ -
pT(CI: Sb. Ender 25%of Inns Be jut --'
('IAn Review II re air (Svc Ji S
Pi:RMiTS SECOMr-vUIU IF WORK On CONSTHUC I ION AUTHORIZ6U Subtotal $
IS NU I COMMENCED WITHIN 160 DAYS On Ir CONST MUC:TION On
WORK IS S USPENDFn nR ARANDONLU FOR A PFRIOD o1 100 nAYS ❑ Trutt Acceunl M��
At v.N r TIME AFI Llt WU11K r:;cnMMENCLU notal balance Due
i I i. I ,nu cI,•,air Ire, --- --
MECHANICAL PERMIT
CITY O F TIGARD
DEVELOPMENT SERVICES PERMIT#: MFC2000 0036,0
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 09/08/2000
PARCEL: 1 S 133DD-01600
SITE ADDRESS: 11756 SW 129TH FL
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 ZONING: R-4.5
BLOCK. LOT: 05.5 JURISLICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP rOOLEPS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WiO APPL: VENT SYC `=MS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
_
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG __ 3 - 15 HP: COMML. INCIN:
MAX INPUT: CITU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS'?: 30 - 50 HP- WOODSTOVEE:
GAS PRESSURE: 50 + HP:
CLO DRYERS:
F''r�N < 100K BTU: AIR HANDLING_ UNITS
FURN >=100K BTU- T <= 10000 cfm: OTHER UNITS:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas piping.
ON nor: _ — FEES--
GRIFFIN,
EES _GRIFFIN, KENNETH R + .OXANNE M Type By Date Amount Receipt
11756 SW 129TH PL PRMT CTR 09/08/20( $72.50 2720000000
TIGARD OR 97223 5PCT CTR 09/08/20( $5.80 272.000000C
Phone: Total $78.30
Contractor:
GEORGE MORLAN PLUMBING
9,306 SW TIGARD
(CCB EXP 6/2002) REQUIRED INSPECTIONS _
TIGt R1), OR 97223
Gas Line Insp
Phone:503-624-6895 Final Inspectian
Reg #:LIC 00002734
PLM 26-60p
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done In accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in ihc- Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC b� calling (503)246-9189.
Issue By: ` I Permittee Signature- - � I
Call (503) 639 4175 by 7:00 P.M. for Inspections needed the next business day
1 C,11Y OF TIGARD Mechanical Permit. Application Rec'dBy
131''S Soh' HALL. BLVD. COInmercial and Residential DateRec'd 9
I iGARD, OR 97223 01 Date toP.E,
(503; 639-4171, x304 Print or Type Date to DST
�lcomplete or illegible applications will not be accepted Cal Permit
# Q -Q0360
oo
Name of OevelopmenVPro)ed Description
/'_ ^ Table to Mechanical Code --Y Qty Price Total
\�1 suns r 1) Fumece to 100,000 BTU
Street Address v
Jots Including ducts&vents 14.00
Address I ! t 2) Furnace 100.000 BTU+
oldgaC ylState zip Includingducts&vents 17.40
I- 8 ( ( � 3) Floor Fumace
— Name(or n+rme of busines8 — including vent 1 14.00
5 � — 4) Suspended heater,wall heater
Owner or floor mountodheater 14,00
Melling Address
5) Vent not included in appliance permit --4680
CAy/Stele �-� —t1p Phony ---
0 Repair units 12.15
Check all that apply 'Boiler Heat Air
— — Nam•(or name of business) For items 7.10,see or Pump Cond city Price Total
footnotes 1,2 Com _
Me'Ing Address 7)<3HP;absorb unit to
Occupant t00KBTU _ 14.00
8)3-15 HP;absorb unit
CNylSide Zip Phone 100k to 500k BTU 25.60
_ 9)15.30 HP;absorb
Contractor N■mc unit.5-1 trill BTU 35.00
1n)30-50 HP;absorb
Prior to permit sans Address unit 1-1.75 mil BTU 52.20
Issuance,a ___� 11)>50HP;absorb unit>1.75 mil BTU
81.20
ceFy 12)Air handling unit to 10,000 CFM
of ail licenses gala zl Phone
�, o 10.00
ate required If (�
expired in COT orcgon oust.Conr--.11 Lica Esp.nate 13)Alt handling unit 10,0010 CFM+
database 17.20 Architect Name 14)Non evaporate cooler
10.00
. -- 15)Vent fan connected to a single duct
Or MailingAddrnu 6.60
16)Ventilation system not included in
EncJ►neer cny/sut• — zip Phone a plianw,permit 10.00 _
17)Hood served by mechanical exhaust
___ 10.00
Describe work to be done 18)Uomestic incinerators
17.40
New O Repair O Reuiace with like kind. Yes 0 No O 19)Commercial or Industrial type Incinerator
Residential• Commerr:;al O Modification O 89,95
Additional Information or descrlpd9n of world: I 20)Other units,Including wood stoves
10.00
NOTe: For Commercial projects only;Units over 400 lbs21)Gas piping one to four outlets.,located on the _15.40
roof,require structural talcs,prepared b licensed englnoer. _ 22)More(hen 4-per outlet(oath)
Type cf fuel• oil 0 natural gas O LPG O electric O 1.00
— — Minimum Permit Fee .6. 7,ya SUBTOTAL ,50
1 hereby acknowledge that I have read this application,that the -- - 896 SURCFIAROEAm
Information given Is correct,that 10m the cwner or authorized agent of --- PIAN RfVICW 2596 OF SUBTOTAL
the owner,that plans submitted are In compliance
with Oregon State Requlred for ALL commercial permits only
laws. --
Signature o1 Owner/Agent Date TOTAL
/' t Other Inspections and roes:1 Insped ons outside of nomml business hours(minimum charge-Mro hours)
Contact Pe ame Phone S12.S0 per hour
II 1 2 Inspections for which no fee is soedfically Indicated (minimum charge holt hour)
[Y
I I 1 r I h"��c_ — >;72 60 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
notrnteeoremmeretal Orolsrf+nnl
dsryecn
1. Provide fulls emetic of existing and p,-posed gas line and pressure. red hours ftZ.So per bout
•State Contrarior Boiler Cnrtlflutfon required
2. Pmvlde t;R H'nyit to scale showing existing and proposed mechanical •'Resnfenbai A1C requrra site plan showing placement of unit
units.
I\fists\formsvnechperm_rev doc e/29/00
7.00f31 (DIV91.1, A0 ,11,.1.13 0961 R65 £05 XVA 91:90 INA 00/90,80