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11310 SW FAIRHAVEN STREET
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CITY
T` '`ARD MECHANICAL
OFOERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : MEC'3e-045e
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 10/1-2/98
PARCEL: 2SiO3DC-00822
SITE ADDRESS. . . : 1131.0 SW FAIRHAVEN ST ZONINU: R-3. 5
SUBDIVISION. . . . : VIRGINIA ACRE.3 NO. 2 JURISDICTION: TIG
BLOCK. . . . . . . LOT.. . . . . . . . . . . . . :015
--- .
CLASS OF WORK. . :AL.T FLOOR FURN. . . . : 0 EVAG COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. .R3 VENTS W/O APDL: 0 VE=NT SYSTEMS: 0
STORIE.S. . . . . • • •. : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : k.
0-3 HP. . . . : 0 DOMES. I NC I N: 0
FUEL TYPES 0 COMML_. I NC I N: 0
3-15 HP. . . .
MAX INPUT: 0 RTU 1.5--30 HP. . . . : 0 REPAIR UNITS: 0
30-50 HP. . . . a 0 WOODSTOVES. . : 0
FIRE DAMPERS?. . :
GAS PRESSURE. . . : �0+ HG. . . . : 0
CLO DRYERS. . :
N0. OF SS I TS----- -- A I P HANDLING UNITS OTHER UNITS. : 0
FURN ( 100K BTU: 0 (= 10000 cfm: 0 GAS OUTLETS. : 1
FURN ) =100K 1311_1: 0 > 10000 cfm: 0
Remarks : Add gas piping for a stovP insert.
---------_____._._____
FEES
Owner:
BOB CUMMINS type amount b date recpt
11310 S. W. FAIRHAVEN STREET PRMT f 25. 00 GEO 10/12/98 98-309916
TIGARD OR 97223 SGCT L 1. 25 GEO 10/12/9B 98--309916
1
Phone #: (503)639-3583
contractor: ----
OWNER EXPIRED ----------
$ R6. 25 f OTAL
1=hone #:
Req #. . : REG'UIRED IN5F'EC1'ICIN, -------
This permit is issued subject to the regulations contained in the Gas L_i i,e I n s p
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 180 days of issuance, or if work is suspended for more _._.._ __—--------•than 1B0 days. ATTENTION: Oregon law requires you to follow rules -
adopted by the Oregon Utility Notification Center. Those rules are
set forth isi OAR 952--001-0010 through OAR 952-gBA88. You may — —
obtain copies of these rules or direct questions to OUNC by calling -•---
(503)246-9181.
15 s .l e By
L++4 +++++•}+++++.+•++++•+++++•+•+•..4.+++•+•1-++++++++ . +++++•..+++++++++++++++++++++++4
39-4175 by 7:00 p. m. for inspections needed the nextb�_+siness day
++++++++++++++++++++++•++++++++++++++4•+++ +-•+
Permit 4:
Address:
'" zJ
Issued by: — Date:
—
Statement: Information Notice to Pir operty Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can he issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exemptfrom registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in a appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
I
.. I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is ———---—
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registers d with the Construction Contractors Board.
OR EXPIRED
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, i will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this,building permit of the
name of the contractor.
1 Hereby certify that the above inic►rmat ion is correct and that I have read and do understand the Information
Notice to Property Owners about Coostruction Responsibilities on the reverse side of this form.
/ / (Signature of permit applicant) (Date)
C (White copy to issuing agency permit file.
pink copy to upplic,"10
information Nd ice to Property Owners
About Constructio,, Responsibilities
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Plan Check#
CITY OF TIGARD Mechanical Permit Application Recd By —
13":5 SW 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#/yf? '
Incomplete or illegible applications_will not be accepted Called
r Name of Development/Project Description
k1�'`T � ^ y Table 1A Mechanical Code Qt Price Amt
JobStreet Address Permit Fee 10.00
SuMett A�—
Address - 1) Furnace to 100,000 BTU
i L✓ - trtrt'A��^F including ducts&vents 6.00
Bldgs City/stele Zip- 2) Furnace 100,000 BTIJ+
17hL,`,`) 2t ',"'jl ' inclua,ng ducts&vents _ 7.50
Name(or name of business) 1 3) Floor Furnace
including vent _ 6 00 _
Owner f)yt"��;/Z;' �. 4) Suspended heater,wall heater
Mailing Address or fluor mu rated heater _ 6.00 _
i![-) j t,u '4//L///lJrl.J 5) Vent not included in appliance permit
ray/Slate Zin Phone _ 3.00 _
7 ' CHECK ALL 'Boiler Heat An
-3 9s
Name(or nerWb of business) THAT APPLY. or Pump Cond Qty Price Amt
_ Comp_ _
6)<31AP,absorb unit to T
Occupant AlIng Address 100K BTU6.00
7)3-15 HP,absorb unit v
CRY/State Zip Phone 100k to 500k BTU — I _ 11.00
8) 15-30 HP,ahsorb
__.-.._.�. unit.5-1 mil BTU 15.00
Contractor
Name 9)30-50 HP,absorb
unit 1-1.75 mil BTU _ 22.50
Prior to permit &lalling,address 10)>50HP;absorb unit
issuance,a copy >1.75 mil BTU _ _ _ 37.50
of all licenses City/state Zlo Phone 11)Air handling unit to 10,000 CFM
are required if 4.50
expired in COT Oregon Const Cont.Board Lic M Exp Date 12)Air handling unit 10,000 CFM+
database 7.50
Architect Name 3)Non-portable evaporate cooler
4.50
Mailing Address 14)Vent fan connected to a single duct
o r 3.00
15)Ventilation system not Included in
Engineer City/State Zip I Phone appliance,permit 450 _
16)Hood served by mechanical exhaust
Desibe work to be done' _ 4.50
a
17)Domestic Incinerators
New!l' Repair O Replace witn nk4',Ind: Yes O No O 7.50
Residential(70Commercial O 18)Commercial or Industrial type incinerator
30.00 _
Additional Information or description of work: 19)Repair units +�
4.50 _
/i�u 1 /�� /,�J �/?i�/LrK i5'13 1.<�✓�• /�lI 20)Wood stove
1/ 4.50
i-x //li��T( 21)Clothes dryer,etc - —
_ 4.50
Tvpe of fuel: oil-i natural gas LPG O electric O 22)Other units
I hereby acknowledge that I have read this application,that the inforrnafiun 23)Gas piping one to foPr outlets
given is correct,that I am the owner or authorized agent of _ 2.00_
the owner,that plans submitted are in compliance with Oregon State laws 24)More than 4--per outlet(each)
_ .50
Signature of OwnerlAgent Wile
i Minimum Permit Fee E25.00 SUBTOTAL
5%SURCHARGE
Conlilict Person Name Phone PI AN REVIEW 25%OF SUBTOTAL
Required for ALL commercial permits only
'r/TAI.
'State Contractor Boiler Certification requited
-Residential A/C requires site(,Ian showing placement of unit
I Unechperm.doc rev 07/20198