10860 SW FAIRHAVEN WAY i
CITY OF
TIGA R D MECHANICAL PERMIT
DEVELOPWN i SERVICES PERMIT#: MEC2001-00082
13125 SW Hall Bled , Tigard, OR 97223 (503) 639-4171 DATE IARUE L: 317101
PARCEL: 2S103DD-00413
SITE ADDRESS: 10860 SW FAIRHAVEN S1
SUBDIVISION: FAIRHAVEN COURT ZONING: R-3.5
BLOCK: LOT: 005 JURISDICTION. TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES_ 0 3 HP: DOMES. INCIN:
LP() 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN c 100K BTU: AIR HANDLING UNITS CLU DRYERS:
FURN >-100K BTU: <= 10000 cfm_ OTHER UNITS:
> 10000 cfm: GAS OUTLETS: I
Remarks: Installation of gas fireplace and gas piping.
Owner: _ FEES
OAUER, CLAYTON D + DIANE E Type By Date Amount Receipt
10860 SW FAIRHAVEN I PRMT CTR 3/7/01 $72.50 272001000C
TIGARD, OR 97223 5PCT CTR 3/7/01 $5.80 272001000C
Phone: Total $78.30
Contractor: EXPIRED
ANCHOR FIREPLACE PRODUCTS INC
14175 SW GALBREATH OR
SHERWOOD, OR 97140-917U REQUIRED INSPECTIONS
Gas Line Insp
Phone:925-8888 Final Inspection
Reg #: I IC 102814
This permit is issued subject to the regulations contained in th(: Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All wof k will be d me in accordance with approved plans. This permit will expire if work is
not started within 180 nays of issuan.-e, or if work is suspended for more than 180 days. ATTENTION: Oregon law
Iequires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-00,-0080. You may obtain copies of these rules or direct quesfims�o OUNC by
calling (503)246-9'189,
Issue By: Permittee Signature
Call 1,503) 639-4175 by 7:00 P.M. for inspections ndeded the next business day
Mechanical Peti•mit Application
7receiv, Pcrrnu na:' s City of Tigard ,o.. 7 Expiredatc:Ctryoj7;gard Address: 13125 SW Hall Blvd,Tigard,OR 97223 —�_---
Phone: (503) 639-4171 Date issu:d: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
'ILI,PE 011' PERMIT
1 family dwelling or accessm N, U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Other:
Job address: j �L,(0. - Indicate equipment quantities in boxes below, Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead.
Tax map/tax lot/account no.: profit.Value$
Lot: Block: I Subdivision: •SLe checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee
City/county: ZIP: I
T, r
Description and Ipc tion of work on premises: r ( 1
Al1'Kl. t,k A � Pee(ea.) Total
Est.dateofcompletion/inspection: Descrlpdon (p}. Res.only Rm.onh
Tenant improvement or change of use: l
Is existing space heated or conditioned'?O Yes U No Air handling unit ---CPM--
Air conditioning srp an required)
Is existing space insulated'?U Yes U No Alteration of existing system
o er compressors
State boiler permit no.:
Business name: r Y� HP 'Tons BTU/H
Address: i. s:Li)' - 7—ireTsmokc amper, uctsmo .e detectors
City: I I Statc:!'k I ZIP ci tjq0 cal pump(site p an required)
Phone: _ Fax: ' !�! E-mitt. nsla rep aceurnac urner
Including ductwork/vent liner U Yes U No
CCB no.:
Instalrep ac re xatc sealers-suspen e ,
City/metro lic.no.: �lL�r(� wall,or Moor mounted
Name(Pleaseprint): ent for a��tliancc otI cr Ihan furnace
PERSONI Reffigeraillon,
Absorption wilts _ BTU/ll
Name: i Chillers------ HP
Addresr: Com ressors ____ HI'
Environmemall exhaust and ventilation:
City: _ Stnte: ZIP: Appliancevt;nt C1 C)c
Phone: Fax- r mail: ) erexhast — —
onr ,Ts ype I/II res. tTcTien/Fiazmat
c hood fire suppression system
Name: ij j�Nk. (U LL0_ - Exhaust fan with single duct(bath fans)
Mailing address: 4 �x aust s stem apart from healing or AC
State: 7.IP: Fuelpiping andistribution(up to outlets)
City
Plume:l I':n (' mail iypcLMND (Til
Fuel piping each a itiona over 4 outlets
Process piping(schematcequ
Number of outlets
t eerrlisTeTappliance or equipment:
Address__ s Dccurativefireplace
City: State: Insert-ty L
Phone: I'ua: I E-mail:
Woodslovellellct stove
Applicant's signature".1 _ Date: nl Ka
Name (print): _
No all)urivactions weeps credit cards,please call immlicn,m r...nmre inlbnnatism. Permit fee.....................$ = �` C
U visa U NltwerCard Notice:This permit application Minimum fee................� _ r
Credit card mnnher:
LL expires if a{ermit is not obtained Plan review(at _ %) $
— Fiapima within 190 days after it has been ��—
—. State surcharge(896)....$
rse
Nuof: oldrr u shown on cre t cud accepted as complete.
TOTAL .......................1;
Cardholder signature _ Amtwal EXPIRED 110-4617(6IOaCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOl'AL VALUATION: FEE: Description: Price Total
$1.00 to$5 ALU �_Minimum fee$72.50 Table 1A Mechanical Code City (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
Including ducts&vents 14.00
$1.52 for each additional$100.00 or BTU+Furnace 100,000
2)
fraction thereof,to and Including including ducts 0 vents 17.40
$10000.00. 3) Floor Furnace
$10,001.00 to$25,000,00 $148.50 for the first$10,000.00 and Including vent 14.00
$1.54 for each additional$100.00 or 4 Suspended heater,wall heater
fraction thereof,to aHyl including ) or floor mounted heater 14.00
$25,000.00. --
$25,001.00 to$50,000.00 $379.50 for the first$'25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional$100.00 or 6.80
fraction thereof,to and including 6) Repair units
12.'15
_
$50,00 '00.
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Buller Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. J footnotes below. Comp*
-'v 7) ,3HP;absorb unit
to 100K BTU 14.00
ASSU_MED VALUATIONS PER APPLIANCE: 8)3-15 HP;absorb
-- Value Tota! unit 100k to 500k B1 U 25.60
Deschlion: Cit Ea Amount g)15.30 HP;absorb
Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTU 35.00
ducts&vents 10)30-50 HP;absorb
Furnace>100,000 BTU Including 1.170 unit 1-1.75 mil BTU 52.20
ducts&vents 11)>50HP:absorb
Floor furnace inciudinq_vent_ 955 unit>1.75 mil BTU 87.20
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not Included in applicance X45 13)Air handling unit 10,000 CKi+
permit _ 17.20
Re air units 1 805 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 10.00
to 100k BTU 15)Vent fan connected to a single duct
3.15 hp;absorb.unit, 1,700 6.80
101k to 500k BTU 16)Ventilation system not Included in
15-30 hp;absorb.unit,501k to 1 2,310 appllance permit 10.00
mil.BTU ___L 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit 3,400 10.00
1-1.75 mil.BTU _ 5 725 18)Domestic Incinerators 17.40
>50 hp;absorb.unit,
>1.75 mil,BTU 19)Commercial or Industrial type Incinerator
Air handlingunit to 10,000 Cfm 656 69.95
Aly handnng unit>10,000 cfm __1_J 70 20)Other units,Including wood strwes
Non-portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21)Gas piping one to four outlets
Vent system not Included In 656 5.40
a Iianermlt 22)More than 4-per outlet(each)
se
Hood rved by mechanical exhaust 656 _ _ 1.00
Domestic incinerator 1 170 _ Minimum Permit Fee$72.50 SUBTOTAL: $
Commercial or Industrial Incinerator 4 590
Other unit,Including wood stoves, _656 - `- 8%State Surcharge $
Inserts,etc.
Oas piPlrig 1 4 outlets ,__ 360 25%Plan Review Fee(of subtotal)
Each additional outlet 63 _ Required for ALL commer;ial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION: -
QLher Inspections ons and Feer
1 Inspections outside of normal business hours(minimum charge-two hours)
$/2 50 per hour
2 Inspections for which no fee is specifically Indicated (minimum charge-half hour)
S72 50 per hour
3 Additional plan review required by changes,additione or revisions to plans(minimum
charge-one-half hour)$72 50 per hour
'State Contractor Boller Certification required for units>200k BTU.
"Residential A/C requires site plan showing placement of unit.
i:\dsts\bnns\mech-fees.doc 10/11/00
CITY O F TIGARD SEWER CONNECTION
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 PERMIT #. . . . . . . : SWR97-0262,
DATE ISSUED: 07/02/97
PARCEL: 2SI03DD--00428
SITE ADDRESS. . - : 1C8G0 SW FAIRHAVEN WAY
SUBDIVISION. . . . :FAIRHAVEN COURT ZONING: R-3. 5
P1--.00K. . . . . . . . . . LOT. . . . . . . . . . . . . : 10 JURISDICTION: TIG
---------------------------------------------------------------------------------
TENANT NAME. . . . . :MEL.V I N JOHNSON
USA NO. . . . . . . . . . : FIXTURE UNITS. . . :
CLASS OF WORN,. . . :AL.'T DWELLING UNITS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 0
INSTALL. TYPE. . . . :LTPSWR IMPERV SURFACE: 0 sf
Remarks : Installing sewer- line
Owner: FEES
MELYIN E JOHNSON type amomtnt by date t,er-pt
10860 SW FAIRHAVEN WAY PRMT $ 2200- 00 B 07/02/97 97-296720
TIGARD OR 97223 INSP $ 35. 00 B 07/02/97 97--296720
MISC $ 4505. 80 6 07/02/97 97-296720
Plione 0 : 639-2755
Contractor: -------------------------------
OWNER
Pl-iont- #: $ 6740. 88 TOTAL
Reg #. . - REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 189 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a 'Tap and Side Sewer" Permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952-00I-0010 through OAR 952-0001-0080. You may obtain copies of
these rules or direct questions to OUNC by calling (503)246-1987.
I ssi-ted by L Per-r4ttee Signature :
4 ++++++.+-f....................... .................................................4
Call 639-4175 by 6:00 p. m. for An inspection needed 1tie next business day
14+++4...................................4....................#.................
CITY OF TIGARD
DEVELOPMENT SERVICES F'L.LJPERMIT
F'ERM i T ##.. .. .. .. . . . : F'LM97-0256
13125 SW Hall Blvd., Tigard,0R 97223 (503)639.4171 DATE ISSUED: 07/02/97
PARCEL: 2SI03DD-00428
SITE ADDRESS. . . : 10860 SW FAIRHAVEN WAY
SUBDIVISION. . . . : FAIRHAVEN COURT ZONING: R -3. 5
BLOCK. . . . . . . . . . . L0T. . . . . . . . . . . . . : 10 JURISDICTION: TIG
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRF'. . :R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES----- --------- LAUNDRY 'TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 100
WATER CLOSETS. : 0 WATER LINE (ft) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Installing sewer- line
Owner: _.____.___._.___.._.___._.____ ___.____________________._..______._ FEES ------_-_-_--__
MELVIN E JOHNSON type amount by date r,er_pt
10860 SW FAIRHAVEN WAY PRMT $ 30. 00 B 07/02/97 97-296720
TIGARD OR 9722-2 5PCT $ 1.. 50 B 07/02:/97 97-296720
Pli o n e #: 639-2755
HOLL.ENBACH & HURD INC
3200 SW 174TH CIVF-
ALOHA OR 97006
Phone #: 591-•5987 $ 31. 50 TOTAL
Iley #. . 012180
--- -- REDUIRED INSPECTIONS --____-_-.
This permit is issued subject to the regulations contained in the Sewer- Inspection _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with _
approved plans. This permit will expire if work is not started
within 168 days of issuance, or if work is suspended for more
than 198 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set `orth in OAR 952-0111-8018 through OAR 952-1181-8188. You may _
obtain copies of these rules or direct questions to OUNC by calling
(513)246-1997. _
r
Issued By :. � , �-� �''._ -. Per
Signatur-•e :1�_�
+•+++++++++•h+i++++++.+.++++++.++++}+++-F++++++-F+++++t+++++t+++++++ft +++++++++f
Call 639-4175 by 6:00 p. m. for- an inspection needed the next business day
+-4-+++4....+t++-F....t.-F.............+t++t•t++.t++t+++++++t++t++4.............t+++
'TY OF TIGARD Plumbing Application Redo
0416 Recd
125 SIN HALL BLVD. Commercial and Residential Date to P E.
3ARD, OR 97223 Date to DST
3) 639-4171 Permit a t"Jl- 7
Print or Type Related SWR '
Incomplete or illegible applications will not be accepted
' if
Name ht DawAopnhenvPropd fI—MRES.QUolvldlral) ,2' TM :�•n.:1 AM
SInK 9.00
Job �A / -dyeY�&M pig Lavatory 9.00
Address Street Address Strtte9.00
� Tub or Tub/Shower Comb.
Q
wag a C. /State^ Zip Shower Only —� 9.00
G �( rJ 7.2-2 l Vrater CIo"t _ 9.00
9.00
Nente i h !t/ S U ' DhnwG&W
C-' l 1 t?. P. S U Garba" 9.00 `—
�itMt�r. 900
M.iting Adaress
l
08;c G r` 1 V f' A//' 4/a V'1"I !417-y W►ww fa16a,r"a
C 9tiatta 439 ZIP PltofN Floor Drain 2" 900
A ADq 7.2a 3� s� �` 9.00
Nartw 4• 9.00
Water Heater 9.00
Occupant Ma'arm Address I f Suite t yy Room Tray 9.00
Saty/state Zip Phone Up" ---- -- - _ 9.00
Other Furores(Speufy) -- 9.00
— - NameI _.. 9.00
L /i (i'V 11 U — — 9.00 -_
Contractor, Ad"" - "-' — 9.00
(PrW to issuand clty/Stete Zip Pftefte 9.00
appikhant roust 4 U h A b R --- — 9.00-
pmvdoar
e all omgon COML Cont.Bd L 7C.8 Exp.Oate — 9.00
contrstxors ---
Itcwtae Pttxftofrtq uc• t• Sehwe►-ist too' — 30.00 1` r
information 25.00 -�
for COT COT BLeatess Tax or Metro a F.xp.Dab /+ ,,.' 30.00
database?. r S ' LO(k IQ��Q� ` _ t l/ 1 l _ 25.00
Na" 30.00
Architect
L 25.00
Or MaAMAddress Swte E 11'ici�� 25.00
Engineer
CityrSta16 -- IiP Phone 9(tv bur�Ma �I �CJJ 2500
1500
escnbe work New O Addition O Alteration O Repar O �I 1(I/►n Aii —
bis done; Residential O Non-re.sMfMtfal 0 _9 00
•additional deuxipt on of wQ 1'
ax CLf:)) t;(7) 9 GO
4000
per/hr
hashing use of
�t i r\ ♦ } i] DOdhr
,udding or property -.— — - 30-00
9.00
-OPOsed use of
.ruildinq or property
.ww�w�t.u iu��'nf� �isw�eu��wr•r w r _a ` \v+r' T.tf-
re you Capp". moving or replanng any fixtures? res p No❑ *SUBTOTAL
f rtes see back of form)
hereby adtnowledge that I have read this applicatiDn,that the information _ 5% SURCHARGE
.,von is cometh.that I am the owner or authotued agent of the owner.and
,,at Diana subrrntted are in compliance with Oregon State Laws. PLAN REVIEW ZS%CF SUBTOTAL
t tura of O wnerfAgent 0416 qpy��orrr thtnaa 167 taW e>9
►� TOTAL
..onLCt Person Nafle Phone Mlni rrum permit tee a S25•S%surcharge.except Resdential f]sc><flow
Prevention Devote.which is S IS•5%surcharge
—..-- L`,phapp.doc 11,96 (dat)
'LEASE CQMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory _
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher _
Garbage Disposal
Washing Machine
Floor Drain 2."
3"
Water Heater
Laundry Roam Tray
Urinal
Other Fixtures (Specify)
:OMMENTS REGARDING ABOVE:
L`pimapp.doc 12,'96 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Linc: 039-4175 Business Phone: 6394171
Dale R^quested: A.M. 11.M. IAST:
Location: _ BLIP:
'Fenant. ite: Bldg: _ MEC:
Contractor:_ Phone: PLM:
owner: ��Phone: ,� fry 7 FLC:
ELR:
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL W SITE� �
Site Post/13eam Post/Beam 20gt/Ioeam Cover/Service Sewer/Storm
Footing Roof UndFUSlab Rough-In Ceiling Water Line
Slab Framing To Gas Line Rough-In Uta Sprinkler
Foundation Insulation <-"Twat. Hood/I)uct Reconnect Vault
13smt Damp Ihywall o—rrm Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire Spklr/Alm CrawIXound Dr Heat Pump Low Volt
Approved T_7P_Pr0vFPApproved Approved Approved
Appr/Sdwlk Not Approved pproved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
— Zr � — ----
O Call for reinspection D Reinspection fee of S -y_required before neat inspection O Unable to inspect
Inspector: _ _ ____ Date: 1- _ Page___�__of
I - 1
ALOHA SANITARY SERVICE
P.O. Box 309, BANKS, OREGON 97106 cil,,
644-2797 648-6254 639-5188S`-'
NAME: —
ADDRESS:
CITY: STATE: ZIP:
HOME: WORK: CELL:
JJOB SITE: - J1pr .1�_ _ — P.O*
PAID BY CHARGE 71 CH K CASH (J CREDIT CARD
Cl
DATE T _ ��' D AMOUNT
PU"'' SEPTIC TANK Ilz
rl LINE OPENING
n INSPECTION FEE
71 SERVICE CALL
71 LABOR, LOCATING, DIGGING & BACKFILL
71 MATERIAL
---THIS Is NOT A SEPTIC SYSTEM INSPFCTl0N I?F TAL
- - f�EN91 RKS - -
TYPE OF TANK: STEEL '-I CONCRETE rI PLASTIC 71 HOMEMADE
HORIZONTAL ,71 VERTICAL I-1 RECTANGLE 1 OTHER------
SIZE
THER_ ____SIZE OF TANK: 3501 500171 75071 100071 12501 150071 200011 300071
LID LOCATION: INLET 1-1 OUTLET !71 MIDDLE 1 ENTIRE TOP 'l
TANK CONDITION: GOOD 1 FAIR !1 POOR ',
FITTINGS: BAFFLES 1 CONCRETE 1 CAST IRON 1 PLASTIC "I
NEEDS NEW LID? 1 YES SIZE
GROUND COVER OVER TANK
COMMENT ON CONDITION OF DRAINFIELD ETC.
i
SIGNED BY �^! —� DATE
CITY a TIGARD MECHANICAL
DEVELOPMENT SERVICES PERMIT
PERMIT #, . . . . . . : MEC97-0098
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639.4171 DATE ISSUED: 04/15/97
PARCEL: 2S 103DD-0042E
STTE ADDRESS. . . : 10860 SW FAIRHAVEN WAY
SUSI?IVIS.ION. . . . : FAIRHAVEN COURT ZONING: R---3. 5
BLOCK. . . . . . . . . . . L.OT. . . . . . . . . . . . . : 10 JURISDICTION: TIG
------------------------------------------------------------------
CLASS OF WORK. . :AI_ T FLOUR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VFNT FANS. . . : 0
OCCUPANCY GRP. . :R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
9TORIFS. . . . . . . . .. 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL. TYPES------------- 0-3 HP. . . . : 0 DOMES. I NC I N: 0
:GAS 3-15 HP. . . . : 0 COMML.. I NC I N: 0
MAX INPUT: 0 BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0
NO. OF LIN I TS—------ --- AIR HANDLING UN T TEi OTHER L IN I TS. : 0
FURN < 101ZIK BTLI: 0 <= 10000 cfm: 0 OAS OUTI_.ETS. : I
FURN ) =100K BTLI: 0 > 1.0000 cfm: 0
Remarks- Installation of gas logs
Owner. -.___.__,---------------_._.__ _._-----------------_____-- FEES --------...___—__
MELVIN E .JOHNSON type aMOIAnt by date rer_pt
10860 SW FAIRHAVEN WAY PRMT $ 25. 00 DRA 04/15/97 97-293285
TIGARD nP 97223 SPOT # 1. 25 DPA 04/15/97 97-293285
Phone #: 639-2755
Contractor:
ARI....E MECHAN T.CAL... INC
PO BOX 71.76
SFAVER'fON OIC 97007
Phone #: 640--4141 $ 26. 25 TOTAL
Rr-q #. . 000691
------- REQUIRE:D INSPECTIONS
This perait is issued subject to thi regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Dre. Speciaity Codes and all other Mechan i(^a l Insp
applicable laws. All work will be done in accordance with Misr. Inspection
approved plans. This perait will expire if work is not started Final Tnspec:tion
within IN days of issuance, or if work is suspended for Bore
than IN days.
Permittee EinnAto.trro
T 5 st.ted 81'
Call for inspection - 639-4175
Pian Che -�-----
CITY OF TIGARD Mechanical Permit Application Recd By !�
13125 SIN HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E
(503) 639-4171, x304 Date to DST --
Print or Type Permit p � 7
Called
_
Incomplete or illegible.applications will not be accepted -
Name of UeveiopmeMProlect Description
,41 el 1 I - .0 U /1 ,4 Table 1 A Mechanical Code OTY PRICE
Job Streat AodiessSurtse A) Pen-nit Fee 0 -0- 1000
Address /(."y •�• r t� ,Zit,t`h.1.r�r w
eldga CiryiSute Zip 1 ) Fumace to 100.000 BTU 600
�(•'lR , CNY % J Zz including ducts&vents
Name for name of business) 2.) Furnace 100.000 BTU+ w� 750
including duds B vents
Owner r 1,; , t! !_• 3 �!� n J04 _
Mailing Address 3) Floor Furnace 600
(1W i ir'S s, )�tt F,1, 3 u arc ncludmg vent_
rityrsene ip Pn e 4) Suspended heater,wall heater 600
or floor mounted heater
N or name of busine.si 5) Vent not included in appliance permit 3.00
✓ 1)I C
Occupa, Mailing Address 6) Boiler or comp,heat pump,air cond. 600
to 3 HP absorb unit to 100K BUT *
covislile Zip Phone 7) Boder or comp,haat pump,air cond. 11.00
3-15 HP;absorb unit to 500K BTU"'
Confractor� NaR1e Al4 8) Boder or comp,heat pump,air cond 1500
nor to l>Ie' h4 f 11 r ('�J f 15-30 HP,absorb und.5-1 and BTU"
u", Mailing Address 9.) Boiler or comp,heat pump,air cond. 22.50
phcant �' 4•t` M _ 30-50 HP absorb unit 1-1 75md BTU"'
st provido all rtyiStmc Zip Phone 10.) Boller or comp,heat pump,air cond. 3750
contractor 3t •- f' fry, 7 .1 E '/!r >50 HP,absorb unit 1 75 m1 BTU"
license Oregon Const.Cant.Board Lige Exp Oste 11.) Air handling unit to 10,000 CFM 450
information / 'evo if 0 C•�ic. '* IF
for Cor COT Busiest Tax or Mayo a Fop Des 12.) Air handling unit 10,010 CFM 750
_database)
Architect Name 13.) Non-portable evaporate cooler 4.50
or Mating Address 14.) Vent fan connected to a single duct 3.00
Engineer CnpSiate� Zip Phone 15) Ventilation system not included in 450
I appliance permit
Describe work New O Addition O AfteratioRepair O 16) Hood served by mechanical exhaust 4.50
to be done Residential O Non-residential
Additional Description of work 17) Domestic incinerators 750
if- 18.) Commercial or industrial type 3000
�--t� Incinerator
Existing use of U 19) Repair units 450
building or property _
20► Wood stove 450
Proposed use of 21.) Clothes dryer,etc 450
building or property
22 1 Other units 450
Type of fuel-oil O natural gas O LPG 0 electric O 23.) Gas piping one to four outlets 2.00 p
I hereby acknowledge that I have read this application.that the V 24) More than 4-per outlets teach) 50
information given is correct.that I am the owner or authonzed agent of
the owner.thal plans submitted are in compliance with Oregon State QTY.SUBTOTAL
laws
Signature of Owner/AgentrJa "SUBTOTAL
t
Y �_ L /` .l 5°6 SURCHARGE 1
-far I
Contact Person Namr Phone PLAN REVIEW 25%OF SUBTOTAL
TOTAL �f
i lds0rnechpmt Toc (rev 4 Mlrnmum permit fee is S25+5%surcharge
"Residential A/C requites site plan showing placement of unit
CITY OF TIGARD BUILDING INSPELTiON NOTICE
Inspection Line: 639.4175 Business Phone: 639-4171
Footing Rain Drain Cover/ServiceFI-y��
Foundation Water Line Ceiling -Plumb.
post/Beam Mach. Sheor/Sheath Framing Mach.
Plbg.Und/Flr/Slab Plbg.Tap Out Insulation Elect,
Post/Beam Struct -k4�eaugt Gyp. Bd. -Bldg.
San. Sewer as Line Appr/Sdwlk Reins.
Other: — -- --
Date: _
C _ P.M. Entry:
` O 1
Address:
Tenant: —_ — ------_ _ Ste:_--.. MST:
BLIP.
Co _ MPLEMC
:�
ELC:
H7 --- �—
ELR: —
;rtr �• �L-
1. �L1
I�n►spec�to: _-_-__ _ �— Date:_ _
4✓APPROVEU -DISAPPROVED/CALL FOR REINSP, CF CO