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CITY OF T IVA' RD C ORMON PIF.'.11:110114' NO .
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 972 (503)639-4175 13 1.IV.D 9/2*7/613
-T--11IM PM -_N(708:1.906
AW)FO."t.35 . /195 BK :
TAX MAP/I UT
I ANT') USE !
1 (311' 51 ZU." : i rt.'m : NO •
W014K ALIEPAIJU)IN FL34NAOF 0.00K AIN FIANDLP' < 1-0
USE. I*YV-1E SING,11-E F"AM11 y FURNACE :I.00K+ AIP' *P J.()K
C(INS1, I'YF)F-' : Fl 00A FURN1^4�E I-.::VAP .COOLL
01CCUP (3111.) I.-IFAIEP VEN V F AN
VEN'11' Vl;.;:N'l - 5YG1'k;:M
NO- SIORI.ES13LAi '(:)MP 1N(:':l:NEQA1*0R(0UM
Dw EKLL. .UNI T5 15----30HP :ENC INEPATUA(00M
I YPE 30-501-11P PIEKPAtR UN115
MAX . INPUT' DL14 COMP 150+11-11-*1 01'11-11EP t.
F 1PE.: DMI"IRS"? PPT.W.-P OU'll E.TS
W(of) 510VEF UNI...Y
0
WPi.:34MV11, $10 . 00
N 0 1 1:V U.F4 L 3'.ZZ I E'.
I::'() B(I X 4?3 0 Psi AN A I--.'V I FIJ
ra TIL-)APE) (31:4 F T XI ORE,5 $41. 50
PHONE (303) P-46 5655 ':i'TAI F 'TAX 1111 . 73
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This permit is issued subject to the regulations contained in Title 14 PECEIP'T NO.
of the TMC. State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and it Is hereby INGPECIJONS
agreed that the work will be done in accordance with the plans and
spectfications and in compliance with all applicable codes and FINAL.
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax vermits This permit will expire and become null and
void it work iz not started within 180 days,or it work is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Permit e lure
C>'Z
Issued By
VOP INSPEU-TION 639-41-75
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
IIII.;i i Y ur- i IUAKU IVILGNANIGAL PERMIT
Permit1#n
9U�
Description
Table_3A Mechanical Code OTY PRICE AMT
City of Tigard 1) PenttitFee -0- -0- 10.00
13125 S.W. Hall Blvd.
P.O. Box 23397 2) Supplemental Permit 3.00
Tigard, OR 97223 _
639-4175 1) Furnace to 100,000 BTU 6.00
incl,ducts&vents
Furnace 100,000 BTU 1
2 incl ducts&vents 7.%
Name of Devr,lopment3) Floor Furnace
_ .00
incl.vent _ 6
Job Addres - — 4) Suspended heater,wall heater 6.00
Address or floor mounted heater
Tax Lot Ma No. 5) Vent not incl.in 3'00
_ Lot Block Subdivision appliance permit
Name(or name of business 6) Repair of heating,refr ig., 6.00
L �—�- cooling,absorption unit
M Ing Address Phone 7) Boiler or comp to 3 HP 600
Owner 8 T absorp.unit to 100,000 BTU
City/State Zip 8) Boiler or comp to."t HP-15 HP 1100
absorp,unit to 500,000 BTU
Ne 9) Boiler or comp 15-30 HP 15.00
absorp.unit 1/2-1 million
+1Boiler or compto 30-50 H P
Mailing Address Phone 10) 22.50
absorp.unit 1 -1.75 million -
ContractorCity/Slate Zip ^ 11) Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No City Bus.Tax No. 12) Air handling unit to 4.50
10,000 CFM
I hereby acknowledge that I have read this application that the infori Iallon given is 13) Air handling unit 7.50
10,000 CFM +
cared,that I em the owner a authorized agent of the owner,That plans SLvnitted are In —
compliance with Slate laws,that I am register I with the State Builders'r 3ard,that the 14) Non portable 4.50
number given is crxred (If exempt from Slate registration please give reason below). evaporate cooler
- —_ 15) Vent fan connected 3.00
to a single duct
— - -- - --- 16 Ventilation system not 4.50
Included in appliance permit
t J ' 17) Hood served by 4.50
Aj_D hL mechanical exhaust
Signature(c or agent) Date 18) Domestic ype 7.50
Describe work ❑ addition ❑ alteration O repair Cl incineratoi
to be done_ residential ❑ non-residential 1 Commercial or Industrial
Existing use of - 19) type Incinerator 30.00
building or prcNeny 20) Other I e.,woodstove,water 4.50
Proposed use o1 -
heater,solar,clothes dryers,etc.
building or property 21) Gas piping one to four outlets 2.00
Type of fuel- oil [I natural gas 1-1 LPO O electric FI J
22) More than 4•por outlet
NOTICE
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S%p 406 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMNEN(.ED. TOTAL
Special Conditiois
Date issued . ---C__f7.D_ .__.by "�`�