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14370 SW HALL BOULEVARD
CITY OF TIGARD MC'r1fA>t1 r�c,�.
DEVELOPMENT SERVICES PF RM I -r
13125 SW Hog Blvd.,Tigard,OR 97223 (503)639-4171 1 , . . . . - loll:T-97--
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City of Tigard MECHANICAL PERMIT Planck/Rec. #
1312; swHall Blvd. API�LICATICJRI �
PO Box 23397 t-'ermit # r►f�C.q�-n0�
Tigard, OR 97223
(503) 639-4171
.:
Table 3A Mochanic:a(Code QTY PRICE AMT
, r
Address "�a�Gr. � iZLL�...—,..Z�._ 1) Parrnit Fee 0 -7- 10 OU
�i2 2) Supplemental Permit 3.00
umace to 10-0--,
_
1) incl.ducts A vents
Owner 000 BTU
2) InaFumduats aw 9 vents 7 6
oor urnance 50 ----
� 3) Ind.vent 6.00
uspend eater, w eater
d) or 11061'mounted heater 6,00
OccupFint vent not incl.to
5) appliance nennit 3.00
-
Num
6) Cnoling, rbc, .,8on unit 60o
:(y.1 — 0E3`,,&r or c.',,lea pump,air .con -
CQ ^ >) to 3 HP absorp unit to 100K 9TU G.UO
c1'e1'orcomp, eat pump,arr
Contractor '` f 6) 3-15 HP absorp unit to 500K STU 11.0o
?' a
or con tp`FieAt pump,air cond.
,23% 9) 15-30 HP abcerp unit.5.1 mil STU 7500
" " `' SOtler or comp, aat pump,etr ovn ,
-16�y� /i/D� 10) 30.60 I-IP abserp Unit 1.1.75 mil BTU 22.50
TFru►�y�UZZOw edge that I have res chis app reauon,that the Dollar or comp, eot Pump,a con "---�
Information given Is correct, that I am the owner or authonxed agent um
11) y 50 HP abserp unit 1.75 mal BTU 31.1'
of the owner,that plans submihed are in compliance wlth state '0
laws, that I em registered with the Construction Contractor's Board, Air hanrCF unit 16--
of
o
that the number given is correct. (It exem t from State► 1�1 10'WO(.FM -4S)
p egislration,
Please give reason below,) 1'r an Ing unit -
- 19) 10,000 CTM+ 7.5c
Jon portable
.. 14) evaporate cooler 4.50
ant tnn connect, --
1$) to a single dvw 3,00
oMu Teon`sy`stem nF37
16) included in appliAnoe permit :,50
•.... '" oc s 1'v y
17) mechanical exhaust
Describe wprk now 4.So
a dttion a tration repair c� mmereial e1'm ustrial to he done residential(� nvn•residential C1
Exinting use of 10) type incinerator 3000
building or propertytharT,woodstove,water
��•- �w-=1 — 19) he_ator,selar, clothes dryers etc. 4,50
Proposed use of '
building or property 2Q)Gas Piping one to four outlets 2,UU
'Type of fuel•oil Q natural gas < LPI;0 electric C21) Mere than 4-per cutlet
virumum Fere$25.00 5Vd rOTAt V �_
PERMITS Nrmoty E VOID IF WORK OR CONSTRUCTION '--
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,on " /
IF CONSTRUCTION OR WORK IS SUSPENDED OR 5 5UHCHAR(iE
ABANDONED F,)A A PERIOD OF 180 DAYS AT ANY TIME
AFTER WORK 1$COMMENCED• 1 t AN RCV1LW 251%OF SUHIOTAL
TOTAL
Special Conditions — i _ C V,
Date issued -- by
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