Permit CI TY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2000 -00476
rI =I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/6/00
PARCEL: 2S112BD-00700
SITE ADDRESS: 14655 SW 76TH AVE 033
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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
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 Insp
Phone: 503 -702 -8459 Final Inspection
Reg #: LIC 100271
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 Notification Center. Those rules are set forth in OAR
952-001 6 OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling 5 246 -9 8�9.
Issue Lp fea Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
,
A Mechanical Permit Application t.
� Date received: /2.– -ea Permit no.: ,'Y Q4'o'a ij -
$4' t :1.111. City o f Tigard
y g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
d t a .,5 �r
4,; YPE` OF'PERMIT
❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ' Multi - family ❑ Tenant improvement
❑ New construction 0 Addition/alteration /replacement • Other:
F
' :, .; , +`JOB SITE INFORMATION ,„ .1: ' ', ` t , ‘1' COMMERCIA
. `'. VALUATION"SCIIEDULE' 4.4
Job address: 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.:7% ,e1iL
/ /2 8 _o • 70 A pr of it. Value $
Lot: Block: Subdivision: *See checklist for important application information and
Project name: j residential permit fee.
urisdiction s fee schedu a or res
City /county. ; ,Z, 1 ,` ZIP: %s ,::1 &,2FAMILY ;DWELLINGPERMIT FEE W
Description and location of work on premises: /Z-% > 779- (_ AND COMA' IER1fCAL /Ii\'DUSTRIALTEQUIPMENTSCHEDULE
f). P7 ' rx7Z S > Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: ■ -
Is existing space heated or conditioned? ❑Yes ❑ No Air handling unit CFM
Air conditioning (site plan required) I=
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system I
:) MECHANICAL CONTRACTOR ik ■
. . , boiler permit no.:
HP Tons BTU /H
Address: Fire/smoke dampers/duct smoke detectors _ VM`a ZIP: Heat pump (site plan required) _
Phone f
Install/replacefurnace/burner BTU /H ■--
7 E I i � F ax: E -mail: Including ductwork/vent liner CI Yes la No
CCB no.: 1CJ "7 Install/replace/relocate heaters – suspended, ■--
City /metro lic.,no.: wall, or floor mounted
Name (please print): 5 CV F t_ CG' LI9 t')C Vent for appliance other than furnace =
CONTACT: PERSON .,, Refrigeration: ■ _ -
Absorpt BTU /H
Name: chiefs uke ff Chillers HP —_—
Compressors HP _
Address: S lc) 7 - Environmental exhaust and ventilation: ■ --
ZIP 71. c Appliance vent
Phone L „ ” 5 3 Fax: E-mail: Dryer exhaust ME
' ` OWNER Hoods, Type U IUres. kitchen /hazmat �_�
hood fire suppression system
M , I `( Exhaust fan with single duct (bath fans) FA__
Mailing address: , a 5 to . L Lei A Exhaust system apart from heating or AC MI
City: ZI (.- 7 Fuel piping and distnbutron (up to 4 outlets) ■--
Y� �� . L� � �� Type: LPG NG Oil
Phone,57)3oeY(L . �)) Fax, , i E-mail: Fuel piping each additional over 4 outlets _
ENGINEER ;::" Process piping (schematic required) =
Name: Number of outlets
Other listed appliance or equipment: ■ -
Address: Decorative fireplace
City: State: ZIP: Insert – type _
Phone: Fax: E -mail: Woodstove/pelletstove _
Other:
Applicant's signature: Date: Other:
Name (print): =—
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑Visa ❑MasterCard Notice: This permit application Minimum fee $ 7, .
o
� expires if a permit is not obtained t _ %) $ Ll/. ,..5----
Credit card number: w ithin 180 days after it has been
Expires Y State surcharge (8 %) $ ."5 • :
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount /D / 5 440-4617.(6/00/COM)