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14590 SW MCFARLAND BLVD
10
•
MASTER PERMIT
���y OF
T I G A R D
�+ • • PERMIT#: MST2000-00041
DEVELOPMENT SERVICES DATE ISSUED: 02/25/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4
SITE ADDRESS: 14590 SW MCFARI-AND 131-VE)
0'RIGINALPARCEL:
2S11013D-00200
SUBDIVISION: SHADOW H11.1_S ZONING: R-2
BLOCK: LOT:041 JURISDICTION: TIG
REMARKS: Modify sxisting basement into I edrooln.
BUILDING
REISSUE: STORIES: FLOOR AREAS _REQUIRED SETBACKS REQUIRED
CLASS OF WORN: ALT HEIGHT: FIRST: of BA&cMENT: of LEFT: OMOKE DETECTORS: Y
TYPE OF USE: SF F'OOR LOAD: SECOND: at GARAGE: at FRONT: F r KING SPACES:
TYPE-�r CONST. 5N DWELLINu UNITS: FINSSMENT': at RIGHT:
VALUE: 56,1000
OCCUPANCY GRr .XJ SDRM: 1 BATH: TOTAL: of REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES. D'SHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUBISHOWERS: nARr.^.E DISP: WATER HEATERS: WATER LINES: BCKFLW PRFVNTN: GREASE TRAPS:
OTHER FIXTURES.
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP t]HP: vEN r FANS: CLOTHES DRYER:
FURN>•100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 200 amp: 0 200 amp: WISVC OR FDR. PUMPORR!GATION: PER INSPECTION:
EA ADD'L 5005F: 201 - 400 amp: 201 - 400 amp: let WtO SVC/FDR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 WO amp: 401 600 amp: EA ADDL BR CIW. SIGNALIPANEL: IN PLANT
MANU HM/SVC/FDR: 001 - 1000 amp: 6014AMPS-1000v: MINOR LABEL:
1000+amp/volt
PLAN REVIEW SECTION
Reconnect only:
1=4 RES UNITS: SVC/FOR>a225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL _ S.COMMERCIAL
AUDIO S,STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNOSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPFIRP'G: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL.0 SYSTEMS:
Owner: Contractor: TOTAL FEES: S 207.01
VIRANOND,NONGNUJ RIVER RIDGE CONSTRUCTION 8 REThis permit is subject to the regulations Contained in the
Tigard Municipal Code,State of OR Specialty Codes•and
14590 SW MCFARLAND BLVD 13141 NE SAN RAFAEL all other applicable laws. All work wi!1 be done in
TIGARD,OR 97224 PORTLAND,OR 97230 accordance with approved plans. This permit will expire.f
work is not started within 180 days of issuance,or if the
LL work is suspended for more thnn 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
F.. Oregon Utility Notification Center. Yhose rules are set
N Reg 0: Ur. 137957 forth in OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direr;questions to
J OUNC by calling(503)248-1987.
M
_ REQIIIRcD INSPECTIONS
W Electrical Service Final inspection
,.I Electrical Rough In
Framing Insp
Misc.Inspection
Electrical Final
Issued By -� ���r^Q.-� PermitteR Sigr, re : t 11L
— - —
Call(503)639-4175 by 7:00 p.m.for an inspection n ceded the next business day
CITY OF TIGARD Residential Building Permit Application Plan Check#.a
_g i7
13125$ Recd By
W HALL BLVD. Alteration - Interior Only Date RecdUO
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. oc)
V 503-639-4171 Data to DST - '0a
F 503-684-7297 Permit#
Print or Type Caned I-;Z;Z 0 0
Incomplete or illegible applications will not be accepted
Name of Project n Name
Job ✓�, Vt j((A�� /Q.a..S/C&,t,C ----
Site Address Architect Mailing Address
Address
0 V_�� IH�D City/State Zip Phone
N4rqe
._.�
� ViVh^0rJ — Name
Owner Mail'n Addres
�I `" �1�^`'—�'� Engineer MailingAddrees
�.Stat ip �,! Pho
_ _ 1 qr t��R 7a) / -1-9-''��5 Clty/State Zip Phone
General Na a
Contractor I✓t4 /C�f��rb� � ,P,.► , � Describe work New O Addition O Alteration Repair O
Ilin Ad4re�5s ` / to be done: _
Prior to permit /jJ�� N t- Ja r\ )17 Add-'o I D scrip'on of'Vork: �~
issuance,a copy C' /Stat Zip Phone ^'� _ /
o^ •
of all licenses r� A ,) Ll 2
are required if Oregon Const. 'ont.Board Exp. atPROJECT 7 t7-
expired in COT Lir,.# / -3-7 9 5 1 /o�t� VALUATIO_N $ 6f
database e
Mechanical I Name — NEW CONSTRUCTION ONLY:
Sub- Sq. Ft. House: Sq. Ft.Garage
Contractor Mailing Address -- --
Prior to permit _
Indicate the restricted energy installation by the electrical
issuance,a copy City/State Zip Phone - subcontractor in the follow-ng areas
of all licenses Restricted Audio/Stereo
are required if Oregon Const.Cont.Board Exp.Date EnergyS sy tem Alarms
expired in COT Lic# mstallations Vacuum Irrigation
database S stem _ System
Plumbing Name (cher k all that Other:
Sub- apply)
Contractor Mailing Address Corner Lot YES f2O Flag Lot YES NO
check one check one
Has the Subdivision Plat recorded? NIA I YES NO
Prior to permit City/State Zip Phone
issuance,a copy SAiar Compliance T
of all licenses are Oregon Const.Cont.Board Exp. Date (Calculation Attached)
required if I_ic.#
expired in COT I hearby acknowledge that I have read this application,that the
database Plumbing Lic.# Exp. Date information given is correct,that I am the owner or authorized agent
of the owner,and that plans submitted are in compliance with
a _ Oregon State laws.
ficSignature �, wne�r/ ent Date/
Cn Electrical N;Trie�l C�ec � _ x fc--� M� ~ 3 0a
HSub- Mailing Address Contaci c�q�nNe Pit n #.7v
Contractor S(/J Teck Ck. & . FOR OFFICE USE ONLY:
C0 City/State Zip Phone Plat#: ,ll MaplTL#: I�
WPrior to peni,;t p ( 60J CT" a 5 Q -�'G0 x0
J issuance,a copy �� G( 1/� O
of all licenses are Ore on Co st.Cont Board Ex Date Setbacks: Zone: '�7 Solar:
required if Lic# 1 p� p n_ 2 r~
expired in COT A a1,joul Engineering Approval: Planning Approval: TIF-:--
database Electrical Lic.# .�y 7 Exo to
Electrical Supervisor Lic.# Exp. to
J � L7US UU Ji 4�) 5�
i formslsflntak.doc(DST)10/23/98
CITU' OF TIGARD BUILDING INSPECTION DIVISION MST ?ffi�-000 /
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
j� BUP
Date Requested GSD —AM--PM BLD _
Location _� L� l� � ' /� /1G� suite MEC _
Contact Person Ph i r_ PLM
Contractor Ph _ SWR
BUILVING ^ — Tenant/Owner ELC
Retaining Wall ELR
Footing Acress:
Foundation FPS —.
Ftg Drain SGN
Crawl Drain Inspection Motes:
Slab _ SIT
Post&Beam
Ext Sheath/Shear —
Int Sheath/Shear
Framing ---
Insulation
Drywall Nailing _ _ --
Firewall
Fire Sprinkler -
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 PART FAIL --
MECHANICAL
Post& Beam - ---- -- - ---- --- — —
Rough In
Gas Line -- -- - — - -- --- __ --
Smoke Dampers
Final - ----- s- _--- - ---
PA ART FAIL
IL LECTMMAQ_
(� a ----- -- ------------ -- �' -'
H Rough In
UG/Slab
Low Voltage
J Fire P:arm _ __ - -- --- __ ---- --- -- -.._-----
m �
SS ART FAIL
W
Backfill/Grading
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Bf sw -- ( J Unable to Inspect-no access
Fire Supply Line [ ] Please call for reinspection RE: . ___ _.—
ADA
APPIuacti;iidewalk Date Insp@CtOr Ext
Othar -
Firnd
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
?.4-Hour Inspection Line: 639-4175 Business Line: 6394171
BUP _
Date Requested _AM�PM _ BLD
Location C d Suite (!E -CO 9'j 1
Contact Person Ph 70(p.')- PLM
Contractor Ph SWR
morbiNr� Tenant/Owner ELC
e i rng aii ELR
Footing Access:- FPS
�-
Foundation i ' •�
Ffg Drain V ) ('
Crawl Drain InspeC SGN
-
Stab SIT
Post&Beam -
Fxt Sheath/Shear
Int Sheath/Shear _
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc. --
in
PART FAIL PITNI ----�"
GING
Post&Beam -
Under Slab
Top Out
Water Service
Si� ritary Sewer -- -- --- - - -----.-�._ -
Rain Drains
Final -----
PASS PART
MEQHANIUNC5
i,ost& Beam
Rough In
Gas I ine
Smoke Dampers
rna --- - - ---- -��_- _
tTM PART FAIL
IL
Service-
Rough In
h- UG/Slab ----- --- _ - -----..-_-.._,_.. _ -- ---- _
Low Voltage
:3 Fire Alarm
OD Final
(j PASS PART FAIL
J
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ j Reinspection fee of$ -� required before next inspection. Pay at City Heil, 13125 SW Hall Blvd
Catch Basin [ j Please call for reinspection RF -. _ - j Unable to inspect-no access
Fire Supply Line
ADA 3i
Approach/Sidewalk Date 3130 100 Inspector �y� Ext
Other �--
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site,
CITY OF TIGARD BUILDING INSPECTION DIVISION ST17tre —'Mee //
24-Hour Inspection Line: 539-4175 Businesa line: 635-4171
r� � l� BUP
lt1 7 S ,Date Requested I _ AM PM _�� RLD
Location 1�5~�C' j 4� Ine� Suite MED
Contact Person -7 _ Ph S't,� 7D Z- PLM
JF
Contractor Ph SWR _
^- Tanant/Owner ELC
Retaining Wail ELR
Footing Access.
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes' —
Slab — _ _ SIT
Post&Beam -
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation
Drywall Nailing ----------- _�—____�.. _
Firewall
Fire Sprinkler
Fire Alarm
Susp`d Ceiling
Roof
in
PART FAIL
GING
Post& Beam
Under Slab
Top Out
Water Service
Sanitaiy Sewer
Rain Crains
Final
PASS PART FAIL
MECHANICAL
Post&Beam —
Rough In
Gas Line - - - --- --- _
Smoke Dampers
Final --
PASS PART FAIL
ELECTRICAL -.-- ^-- -� -
d. Service —
ix Rough In
}- UG/Slab --
U) Low Voltage
Fire Alarm
J Final
m PASS PART FAIL
(9SITE
Backfill/Grading --�-- —� —` —
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$^ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line i ]Please call for reinspection RE: � ( ]Unable to inspect-no access
ADA
Approach/Sidewalk (a r jig
Other Date Av`' _,!___,_�—.Inspector , CJ��_ Ext _
F nal
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC98-0046
DATE ISSUED: 01/26/98
13125 SW Hall Blvd., Nord,OR 97223 (503)6394171
PARCEL: 2SIlOBD-00200
SITE ADDRESS. . . : 14590 SW MC FARLAND BLVD
SUBDIVISION. . . . :SHADOW HILLS ZONING:R-2
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :041 JURISDICTION: TIG
Project Description; Add 11 branch circuits to an existing dwelling unit.
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS-----
( 1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IP,RIGATION. . . . : 0
EACH ADD' L 500SF. . . : 0 201 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FPR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS------- ---ADD' L INSPECTIONS---
0 — 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 — 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0
401 — 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 10 IN PLANT. . . . . . . . . . . . 0
601 -- 1000 amp. . . . . : 0 --------------------PLAN REVIEW SECTION----------------
1000+
ECTION----------------
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS.. . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR )= c'25 AMPS. . : CLASS AREA/SPEC OCC. -
Owner:
CC. :Owner: ---------------- - --------------- ___ ___ FEES
NONGNUS VIRANOND type amount by date recpt
14590 SW MC FARLAND BLVD PRMT $ 85. 00 GEO 01/26/98 98-302754
TIGARD OR 97224 5PCT $ 4. 25 GEO 01/26/98 98-302754
Phone #:
Contractor: ----------------- ----------------.--------------------------------
CHANDLER ELECTRIC INC f 89. 25 TOTAL
3521 SW CARSON ST
PO BOX 80696 ------- REQUIRED INSPECTIONS
PORTLAND OR 97280-1696 Underground Cove Flect' l Final
Phone #: 245-7774 Elect' 1 Service
Reg #. . : 000949
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 181
days of issuance, or if work is suspended for more than 181 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952(d11 1111 through OAR 952-01-1987. You may obtain a copy
of these rules or direct questions to OIK by calling (513)246-1987.
a. Permittee Signature: �?Zof- Issued By:
CA
L --__.-----------------
.------
OWNER INSTALLATION ONLY----__.-------_________—._—_------.
� The installation is being made on property I own which is not intended for
ED sale, lease, or rent.
t7 OWNER' S SIGNATURE: DATE:
lu
_.._. ___.____--------------_CONTE 'TOR I NSTALLAT 70N ONLY---------------------------- -
SIGNATURE
--------------------_---____SIGNATURE OF SUPR. ELEC' N: DATE:
LICENSE N0: 6
�1S_
++++++++++++++++++++++++++++++++++++++++.•-++++++++.+++++i++++++++++++.4++++++++++
Call 639-4175 by 7:00 p. m. for an inspection neoded the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
rd
Community Development ELECTRICAL PERMIT APPLICATION
13125 SSV Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # 4F 4C 2E—Ooy4-
Phon6 1,503) 639-4171 Date Issued
CITY OF TI(;RA6tD FAX (503) 684-7297 Issued by
TDD No. (503) 684-2772
Inspection (W3) 639-4. /5
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development_"_ n I Number of IneW.tions per permit allowed --
AddressS1 0!5'w4772>-V�7 �4✓/►� Service included Items Cost(ea) Sum
City/State/Zip 7 L Z Z-7 4s• Residential-par unit 4
1000 W it or lase $11000
onaName (or name of business) e Each addt ere f eq It or '
portion$Mored $2500
Commercial❑ Residential LH' — Limned Energy -- $2500 ---
Each Manul'd Home or Modular 2
Dwelling Service or Feeder $ea DO
2a. Contractor installation only: 4b.Services or Feeders
Installnhon,alteration,or relocation 2
Electric Contractor t c zoo amps or Mss $ec 00 2
201 amps to Oro amps $80 00 2
Addie s 401 amps to eco amps $12000
2
city State Zip 801 amps 10 1000 amps $18000 2
Phone No. 7 YS-7771( over 1000 amps or voMe $340.00
Contractors License No.-2j__LTIZ4 Reconnect only W 00
Contra )r's Board Reg. No. ?� Y o� 4c.Temporary Services or Fssders
W Dig *SS'g f Installation,allerahon,or relocnimn 2
Signature of S pr. Elec'n k 200 amps or less W 00 2
201 amps to 400 amps $7500 2
License No. YS Phone NoZ,(j6-]]_'j !j_ 401 amps to NO&trips $10000
Over 000 amps to 1000 Vona
2b. For owner installations: see W above
4d.Branch Circuits
Print Owner's Name _ Naw,alteration or extension per panel
Address a)The fee for branch circuits with
City _ State Zippunchoss of senlce or Aeed4r he. 2
Each branch c-mirt _ $500
Fhone No. b)The fee for branch circuits without
The installation is being made on property I own which is purchase of service or AkxW Me. �- 2
rim$branch nalbranch
$35 00
not intended for sale, lease or rent Erich addnimnal branch cireud $.500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan '?eview section (if required): Each pump or crigation circle $4000 2
Each sign or outline lighting $4000
Signal circud(s)or a limited energy 2
Please ehe.,w appropriate Item and enter tee In section SB. panel,alteration or extension $40 00 _
CL 4 or more residential units in one structure Mmnr Labels(10) $10000
Service and feeder 225 amps or more
System over 600 volts nominal 41. Each additional inspection over
— the allowable In any of the above
Classified area or structure Chapter
5it>g special occupancy _—
�C as described in N.E.C. Cha ter 5 Per hour ton $3500
P Per hour $5500
J In Plant $5500
m Submit 2 sets of plans with application where any of the above
apply. Not required for temporary consituction services. 5, Fees: /
W So. Enter total of above fees $ J
-t NOTICE
5%Surcharge(.05 X total fees) $ Z
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb.Enter 25%of ine A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal E
COMMENCED n frust Acccunt 0 $
Qalance Due $ AMEAS
.oR+bame.,•,.i.o,xm re
CITY OF TIGARD BUII.,DING INSPECTION DIVISION
24-liour Inspection Linc: 639-4175 Burincss Phonc: 6394171 _` //
II NOVA
Datc Requested: _ ` 7 - _ _— CP_M,�
MST:
Location: y S(.(J ,��, BUP:
Tenant: Suite: Bldg- MEC:
Contractor: Phone: 777J PLM: G
(homer: hone ELC:
ELR:
BUILDING BLDG(con't) 6VLUMBING MECHANICAL XL&CTBIGAL___ > SITE
Site Po". eam Post/Beam PosUBeam Cover/Service Sewer/Storm
Footing Roof Undl-l/Slab Rough-In Ceiling Water Line
Slab Framing Top out (Sas Line Rough-In U0 Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Rsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Appmv Approved
Appr/Sdwlk Not Approved Not Approved Not Approved L n ved Not Approved
FINAL FINAL FINAL FINAL
1.tlI t,r4 d- l Yl l- f I,G7�l4
11apof (�&�2 7
mot0- See
At L
T va o c"-/ 0
L
n
u
C1 Call for reinspection Reinspection fee of Srequired before next inspection 0 i finable�'o inspect _
Inspector:` Date: �D Page_— of
CITY OF TIGAR D MMIANICAL
DEVELOPMENT SERVICESPE RM T
PERMIT'MTT it. . . . . . .
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 MITE 13r)LIEDz 11 ".2,
PARCEL : 2311 013D -0011`00
I JUPT!-MAICTION. TIC
17
EVAP Cool-ERG: 0
IINT"- 1FATIE-W3. 0 VENT FnNS. . . . 0
V!-NT'7 W/C� X:1-1.. ." 0 V E=N T S N'13)T E MS): 0
'/C0Mr'M-S30,Rc- Hnnns. . . . . . . : o
N C 'N-. 0
I)OMP.,. '
COMM. INCIN: 0
15, 30 1 ';'. PEPnIP UNITS: 1b
7 Ij
12! 0th !-!r'. . . .. .
V,
4 1 V ('1_0 DRYEM 0
MR 73' OTLIF';1 t.JNITS). a I
looeo Fol, . 0
t by dat E rpLpl,
PRMT `5. 0 0 DRA It /l."/97
1)PA I 1 0 07
20. 253 TOTAL
R E 0.U I RED T NGPFtT I ON^
buf: Et tc 4 t,
i ca I Ir1s,Fi
Elate of Die, Spe�iall�j '.,Aos ar-. C�t E ri ,o lnspLnction
i'l t1f dw; iP accc--Ga"%,e " ii riapect i or
t-h A.: eAp i I i- WGI_t is not s�artef
is ;�iSppneed for scre
-a, 'E1.101- jou tc Follow rules
�n :uitv. `,!,ose vIes we
7' S!74C' N-'?, YLI 18y
F ru I F.I :t ur
t t in at ur a
4-1 4 4 -f 1 4 {..q...{.4 ++.4 •f f.4.d + .4.+++ 4-4-4-+i +4
m,. Fc.,' i nspc�.tions deader' the Tle)<t i ne s s day
q..,-.1.,4 1.+4 + (-4-++ F•+++-4 +4,f-+4-+++4 +-4 4-4 -1 4 1 +..F 4 4 + 1 1 -0 1 4 E.4 f- +..+ +..1.+-4 4..C..j -1 4 J-j
Plan Ch
CITY OF TIGARD Mechanical Permit Application Recd Br
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E.
(503) 639-4171, X304 Date to DST�2�
Print or Type Permit 0
Incomplete o_r illegible applications will not be accepted Called
Name of DevelopmenvProlect Description
Table 1A_Mechanical Coate QTY PRICE AMT
Job Street Address Table
Permit Fee -0 0 10.00
Address 14 5 90 S w Me Rt Nea
BbaN CRY/ P 1.) Furnace to 100,000 BTU 8,00
7-1 Q y 7 2 N including ducts&vents
Harr»(a nen»Of bu-riass) 2.) Furnace 100,000 BTU+ 7.50
owner V I KA N U iU n, ^I U N(y,N 0 S including ducts d vents
Mailing Adana 3.) Floor Furnace
8.00
1 V�; `f 0 SW M c FA RGA Au, R Lir tS includin vent
4,) Suspended heater,wall heater 6,00
T I C1,A (It b Y 7 22 S'yg_10 71 o:floor mounted heater
Name(or name of business), 5.) Vent not included in appliance permit 3.00
Occupant Mailing A,hes- 6.) boiler or comp,heat pump,air Gond. 6.00
to 3 HP;absorb unit to 100K BUT-
CMylSta s Zlp TTinp» 7.) Boiler or comp,heat pump,air coed. 11.00
L _3.15_H?:absorb unit to 500K BTU"
Contractor Nam 8.) Boiler or comp,heat pump,air coed, 15.00
15-30 HP;absorb unit. -1 mill BTU"
Prior to permit Maung Address 9.) Boiler or comp,heat pump air coed. 22.50
issuance,a copy 30.50 HP;absorb unit 1.1.75mil BTU"
of all licenses City/State tip Phone 10.) Boiler or comp,heat rump,air coed. 37.50
are required if >50 HP;absorb u,A 1 75 mil BTU"
expired in COT Oregon Conies.Cont.Board Lic.x UP Dete r 1.) Air handling unit to 10,000 CFM 4,50
database
Architect Nan» 13.) Non-portable evaporate cooler 4.50
cv 14- 7&
Or Marling Address 1:j Vent fan connected to a single duct 3.00
Engineer caytState Zip Phone 15.) Ventilation system not included in 4.50
appliance permit
Describe work New O Addition O AReration Repair O 16.) Hood served„,mzchanical exhaust 4.50
to be done Residential O Non-residential O
Additional Description of work: 17.) Domestic incinerators 7.50
w C d
18.) Commercial or industrial type 3000
_ Incinerator
Existing use of 19.) Repair units 4.50
building or property
20.) Wood stove 0_50
Proposed use of 21.) Clothes dryer,etc. 4.50
building or property _
Q" 22.) Other units ! 4.50
� 1
V) Type of fuel.oil O natural gas LPG O electric O 23.) Gas piping one to four outlets 2.00
I hereby acknowledge that I have road this ap7llcation,that the 24.) More than 4-per outlets(each)-, 50
J information given is correct,that I am the owner or authorized agent of
m the owner,that plans submitted are in compli nce with Calgon State QTY.SUBTOTAL
laws. _
W Signature of Owner/Agent pate 'SUBTOTAL
y 7 5%SURCHARGE
Contact Pilirson Name Phone PLAN REVIEW 25%OF SUBTOTAL
til- 1<iii IU O N b �[`I2i4) S 9 -/O7sr -�� TOTAL
i:\mechpmt.doc (rev 9 "Minimum permit fee is S25+5%surcharge
"Residential A/C requires site plan showing placement of knit.
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