Permit CITY OF TIGARD
MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2000 -00474
�! DATE ISSUED: 12/6/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112BD -00700
SITE ADDRESS: 14655 SW 76TH AVE 011
SUBDIVISION: MARCIENE II ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS: 1
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of. bath fan.
Owner: FEES .
BRENDA REILLY Type By Date Amount Receipt
7524 SW ELMWOOD PRMT CTR ° 12/6/00 $72.50 2720000000
TIGARD, OR 97223 5PCT CTR . 12/6/00 $5.80 2720000000
PRM3 CTR 12/6/00 $31.25 2720000000
Phone: 503-246-7908 Total $109.55
Contractor:
STEVE REGALADO
13935 SE CALLAHAN RD
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 503- 702 -8459 Final Inspection
Reg #: LIC 100271
u
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
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 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility N • • tion Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You ay obtain copies of • -se rules or direct questions to OUNC b «_ (ling (503)246 -9189.
Issue y: � Vi _ ► • iPermittee Signature: /i /
Call (503) 6' 9-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
A Date received: /ft - te - Ce Permit no.: l ezzi
�'� City of Tigard �, i �_ -�. y g Projecdappl. no.: Expire date:
n Tigard Address 13125 SW Hall Blvd Ti OR 97223
City f g Date issued: By: Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
); =- 'f:,; {, , ,,.,,, . T YPE OF PERMIT, ' z
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial c. Multi- family ❑ Tenant improvement
LI New construction LI Addition/alteration /replacement • Other:
.4: ; _ .,JOB S ITE INFORMATION ;:.4 , , < ' COMMER - � ; �
CIAh VALUATION SCHEDULE � '
Job address: IffiallEarl Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: X12 $ -0,10 1 profit. Value $
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county. ,. , 1 - ' ZIP: " 7,4.. , E1 8: 2 FAMILY DWELLING.` PERMIT FE - SCHEDULE -"
>
Description and location of work on premises: %U "} 77 - c_ AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
f j i 17? {J S , Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: ■ - ®
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required) - --
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system MN
MECHA CONTRACTOR Boller/compressors
b eoomprer Ill
' Sta boiler permit no.:
Business name: lam `C - .te HP Tons BTU /H
Address: Fire/smoke dampers/duct smoke detectors _
M611-WIZMINIMEMEM ZIP:C _ Heat pump (site plan required) - --
Phone}Zi nstall/replace furnace/burner BTU /H ■--
, 7C Z it/5 Fax: E E mail: Including ductwork/vent liner ❑ Yes LI No
CCB no.: 1 2e7 7 Ins tali /replace/relocate heaters - suspended, ■--
City /metro lic..no.: wall, or floor mounted
Name (please print): 5 CUF" (E - ' 4-49 00 Vent for appliance other than furnace i
CONTACT' PERSON Refrigeration:
'` � ' '' Absotp[ionunits BTU /H
Name: olti,ef5 - 811 -f4- Chillers HP —
Address: ' Sec) 7 Compressors HP E
Environmental exhaust and ventilation:
EM ZIP: 0 71 Z ' Appliance vent
Phone; -,'_ - '- � ,? . ��
. � Fax: E-mail: H exhaust : ==
- OT`ER Hoods, Type U I Ures. kitchen/hazmat
hood fire suppression system
� I Q (l Exhaust fan with single duct (bath fans) / __
Mailing address: 5 co . L 46 - 0 / i Exhaust system apart from heating or AC Ell
Fuel piping and distribution (up to 4 outlets) ■
City: - -.i) MEM ZIP: 7A.Z Type: LPG NG Oil
. Pho ne,5Z 3or'Yk.' (./ Fax3b ifo , . A E-mail: Fuel piping each additional over 4 outlets _
ENGINEER Process piping (schematic required) =
Number of outlets
Name: Other listed appliance or equipment: ■ -
Address: Decorative fireplace
City: State: ZIP: Insert - type -
Phone: Fax: E - mail: Woodstove/pellet stove _
Other: Mi
Applicant's signature: Date: Other:
Name (print): Mil
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application Minimum fee $ 72 •
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: s w ithin 180 days after it has been — %) $
Expires y State surcharge (8 %) $ 5 , Y (.1)
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ `
Cardholder signature Amount /0 9` 5 440 -4617 (6/00 /COM)
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