Permit „. ,
_._ •, A Mecha nical Permit Application . , .
Date received: /a -a -oO Permitno.: lr/tid Sa GL747 "
A" 0t � 1 1! City f Tigard ,.:� , � b Project/appl. no.: Expire date: •
City nfTigard Address 13125 SW Hall Blvd, Tigard OR 97223 p
Phone: (503) 639 -4171 Date issued: • By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
"r • TYPE OF PERMIT ' •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial c Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement • Other:
• ,._ JOB SITE INFORMATION " ' ', : : COM MERCIA L ' VALUATION S
Job address: IMENVIMMIr 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.:-r; (bet L //2 $ —0.70 di profit. Value $ •
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee
City /county. :,s, t; .,' ZIP: 70)-� `1 i 2 FAMILY. DWELLING:: PERMIT,FEE'SCHEDULE
Description and location of work on premises: %L-> 7 y - - AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
f p.--7;4/ 17.1 5 , Fee(ea) Total
Est. date of completion/inspection: Description Qty. Res.only Res. only
Tenant improvement or change of use: HVAC: III
Airhandlingunit CFM
Is existing space heated or conditioned? ❑ Yes ❑ No Air conditioning (site plan required) -
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system El
: Boiler/compressors
St
., MECHANICAL CONTRACTOR bile m t ll
l HP Tons BTU /H
Sta boiler permit no.:
Business name
� • � ��� L �"
Address: Fire/smoke dampers/duct smoke detectors —
l ��� ZIP:C - t 7 Heat pump (site plan required) —
Phon '•7'C.Z ViS Fax: E -mail: Install/replacefurnace/burner BTU /H ■--
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: e7 7 Install/replace/relocate heaters- suspended, ■ -
City /metro Iic.,no.: wall, or floor mounted • Name (please print): 5 6UE E / € 00 Vent for appliance other than furnace MI
"
CONTACT PERSON r ,. Refrigeration: _
. ,';' Absorpt units BTU /H II
Name: ( 01/k.0 .
Chillers HP _
Compressors HP —
Address: S Lc) 7 - Environmental exhaust and ventilation: Ill
EMINEISMI ZIP: 7 2, - Appliance vent •
Phone:, t ? j ; 5 Fax: E-mail: Dryer exhaust Mil
O i Hoods, Type U IUres. kitchen/hazmat ■
hood fire suppression system
IMIMMIM PAIMINIIIIMIIIII Exhaust fan with single duct (bath fans) GM __
Mailing address: . , � 5 w .
L le _Y i amp Exhaust system apart from heating or AC
Fuel ptpmg and dtstnbutton (up to 4 outlets) ■
g /�
City: (� [� ZIP: 7.��Z Type: LPG NG Oil
Phone;5a /Yw - c r Fax i& , . A E Fuel piping each additional over 4 outlets MI
ENGINEER ; -, Process piping (schematic required) NM
Number of outlets -
Name: Other listed appliance or equipment: ■ -
Address: Decorative fireplace -
City: State: ZIP: Insert - type M_
Phone: Fax: E -mail: Woodstove/pelletstove -
Other: MI
Applicant's signature: Date: Other: 1.111 —
Name (print): 1.1—
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application T .50'
❑ visa ❑ MasterCard Minimum fee $ 7
expires if a permit is not obtained 2
Credit card number. E
Expires 180 wi thin 18 days after it has been — %) $ `� !
a ” ,
p State surcharge (8 %) .... $ 5 , Y
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ 4°x°
Cardholder signature Amount 4,9' g 440 -4617 (6/00 /COM)