11930 SW LINCOLN AVENUE 11930 SW f .-NCOLN AVENUE
W 1W
XWUMUA� A
MECHANICAL
OF T'VA RD (C7r ,f!Y Z(r, 'ARD PEPMI1'
COMMUNITY DEVELOPMENT DEPARTMENT �-IERMII #. . . . . . . . MEC9 1--0053
13126 SW H211 Blvd. p.0 Box k3397,TjWrd,oregm 97k23 (6j13)°391176
1930 514 LINCOLN AV PARCEL: 16135DZ-0090t/
ITE ADDRESS A . 1 11 A ZONING.' P-12
,L;LADIVISION. .. - - : 'rIGI)REVILLE PnRK
OLCICK. . . . . . . . . . LOT. . . . . . . . . . . . . :8
EVAP COOLERS:
LfAbb GFWORK. . 3ADD FLOOR FURN. . . . VENT FANS. . .
YPE. OF 1j4=E. . . . :SF UNIT W:ATERC-33- - -
VENIS '-,'/0 APDL: VENT SYSTEMS:
]CCUPANCY GRP. R3 POILERS/COMPRESSORS HOODS. . . . . . . :
I INCIN:
)TORIES. . . . . . . 0-3 HP- - - - DOMES.
rUEL 3-15 HP. - - - COMML. IL NC 1 N
/G(-)S! REPAIR UITS:15-30 HP
MAX INPUT' BTU 30-50 HP. - - -. . - - WOUL)SIOVES-
F-I RE DAMPERS?- - 50+ HP. . - - CLO DRYEP.S- - :
GAS PRESSURE. . . PIP VIONDLING 1.1N I T C3 OTHER UN I T5.
00. OF' <= 10000 cfm * GAS OUTLETS.
TURN ( 100K BTU:
) =1001!. 3'TU- > 10000 cfm -
Remarks : OcIdilly hot tl-lb/gas
----------------- FEES
Owner: am(-qjnt by Oats e 1,
MIIJ,F MILES PAYM $ 17. 33 JLH 04/01/91
11930 SW LINCOLN
PRIAT f 16. 50
TIGARD OR 97 '23 FjPr.T $
Phcne #-.
Co
L)E 1'17"MPLE (L
19_1 t,,W OVERTON S-1
.?-1GRJL(4ND OR 91;:'09 q l7. 3 TOTAL
Phone #:
Rea #. . : 02510
REQUIRED INSPECTIONS
this issued su,iject to the regulations contained in the Firial Inspertion
it Ore. Specialty Codes and all other
Ti4ar:'ruricijoal Code. Stite Of
aoplicable_laws. All work will be lone in accordance with
Aoproved plans, This per2it will expire if tqurk is nt�t started
within
IN days of issuance, or if work is ;,isr,rdpd for more
,han 184 days.
,--mittee SignatilrP ,
tssijed By .
Call for inspection
CITY OF* TIGARD RE' IFIT OF PAYMENT RECEIPT NO. :91 450
CHF-.',CK AMOUNT - 0. 00
NAME a HERRING, JAW'S 0061-1 AWN INT --, 17. 33
ADDRESS s PAYMEr*r DATE i IA41 Al/91
SUBD I V 15 I ON c
1 19.30 SW L I NCOL.N
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE Or-' PAYMEV-i AMOUNT' PA I D
MECHANICAL PE 16. 50 Sr BUILD PER 0. 83
HOT TUB
TOTAL AMOUNT PAID 17. 33
MECHANICAL PERMIT Hecelpt# �—
CITY OF TIGARD -
13125 SW HALL BLVD. Permit #
c.�
P. C�. BOX 23397 I J / �I Description
TIGARD, OR 97223 l /A a(J Table 3A Mechanical Code CITY PRICE AMT
(503)639-4175 V� 1) Permit Fee 0 -0- 10.00
Namn of Oevelopmeni 2) Supplemental Permit 3.00
Job Address 1 Furnace to 100,000 BTU 6.00
i
Address /1�'�� ) incl.ducts&vents
l-/ .�1 �G2�C'0 K�
Tax Lot Map No. ) Furnace 100,000 BTU +
Lot Block subdivision incl.ducts&vents _ 7.50
Name(or name of businesv 3) Floor Furnace 600
16l _ / incl.vent
Owner M 'lingAddress `5� ` 4) or floor mounted heaterSuspended heater, )heater 6.00
City/state ZIP 5) Vent not incl.in 300
appliance permit
— -- ` ap d � ,1 Repair of heats ref i
Name(or name of iness) 6) p ng' q" 6.00
cooling,absorption unit _
Mailing Address Phone 7) Boiler or comp to 3 HP 600
Occupant l absorp.unit to 100,000 BTU _
City/Slate zip 8 Boiler or comp to 3 HP-15 HP 1100
absorp.unit to 500,000 BTU _
Name 9 Boiler or comp 15-30 HP 15.00
1 i� A(/AR I Ptt d ) absorp.unit 1/2-1 million
Mailing Address Phone 10 Boiler or comp to 30-50 HP 22.50
��(��L t C�I fqtZ ) absorp.unit 1-1.75 million
C(lnlroilpr /���( ! _
`� /Slate Zip 11) Boller . comp to , HP 31.50
/ 2 C� q72 2 3 absorp.unit 1,750,000 BTU
(��Q�`� ' State Registration No. Clty Bus.Tax No. 12) Air handling unit to 4.50
V 10,000 CFM
�J Air handling unit I hereby acknowledge that I have read This application that the information given is 13) 10,000 CFM + 7.50 I
correct,that 1 am the owner or authorized agent of the owner,that plans suhmined are...
compllarKm with State laws,that I am registered with the State&!itdbm'Board,that the 14) Non portable 4.50
number given is corroct.(II exempt from Slate registration please give reason below). evaporate cool gr
- - - - ------- 15) Vent fan connected 3.00
to a single duct
--- -- ) Ventilation system Ilot
16 included In appliance permit 4'50
�_JC _ --- -- 17) rAood s4rv,ad by s -— 4.50
��$�S!_ -�/ mechani^a'exhaus}
Signa a(owner or agent) / DateDomestic type
Describe work Cl addition ❑ aiteration O repair El
incinerator 7.50
to be done residential ❑ non-residential ❑ 19) Commercial or industrial 30.00
Existing use of type incinerator
building or properly_ _ — 20) Other i.e.,woodstove,water 450 �O
Proposed use of heater,solar,clothes dryers,etc.
building or property _._ 21) Gas piping one to four outlets 2.00
Type of fuel- oil l na„iral gas ❑ LPG ❑ electric ❑
22) More than 4-pe.outlet /
NOTICE
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 5%ISURCHARQE
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 COMMENCED. TOTAL
Special Conditions —_
Date issued __— by
1
Address 'S� 14_1e:.r/`i/YI Permit No.`
Name of(2cct:pant Permit charge
-- Paid by,_.._ ---- --
Date connected
Type of Building_s8%)�lC�d Inspection fee --- --
Service Rate_ Q (/ _ Paid by _ __
c
Contractor. Assessment 3 _Paid
Size of connection