Permit 4--.A CITY OF T MECHANICAL
��"''' DEVELOPMENT SERVICES PERMIT
° '' `I II
,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # • MEC98 - 0112
DATE ISSUED: 04/10/98
PARCEL: 1S136DA -00100
SITE ADDRESS...: 11308 SW 68TH PKWY
SUBDIVISION • ZONING: MUE
BLOCK . LOT • JURISDICTION: TIG
CLASS OF WORK.. :ALT FLOOR FURN : 0 EVAP COOLERS: 0
TYPE OF USE :COM UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:B VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP : 2 DOMES. INCIN: 0
:GAS 3 -15 HP : 0 COMML. INCIN: 0
MAX INPUT: 1500000 BTU 15 -30 HP : 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: Y 30 -50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: M 50+ HP : 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 1O0K BTU: 2 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =1O0K BTU: 0 > 10000 cfm: 0
Remarks : Mechanical TI. Must obtain a restricted engery permit for the CO2
sensors.
Owner: FEES
PROVIDENCE type amount -by date recpt
4805 NE GLISAN PRMT $ 36.00 GEO 04/10/98 98- 304836
PORTLAND OR PLCK $ 9.00 GEO 04/10/98 98- 304836
5PCT $ 1.80 GEO 04/10/98 98- 304836
Phone #: PLCK $ 50.00 GEO 04/10/98 98 -3048
36
Contractor:
FULLMAN SERVICE CO LLC
5805 SW HOOD AVE
$ 96.80 TOTAL
PORTLAND OR 97201 -3716
Phone #: 224 -5221
Reg #.. : 122310
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Heating Unt Insp
approved plans. This permit will expire if work is not started Duct Inspect ion
within 1 days of issuance, or if work is suspended for more Fire Damper Insp
than 180 days. ATTENTION: Oregon law requires you to follow rules S. D. Shut—down
adopted by the Oregon Utility Notification Center. Those rules are Misc. Inspection
set forth in OAR 952 - 0014810 through OAR 952-801 -0880. You may Final Inspect ion
obtain copies of these rules or direct questions to OUNC by calling
(583)246 -9187.
Issue y: , Permittee Signature: 4
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
'+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Plan Check -3 r 7(0 G
CITY O. TIGARD Mechanical Permit Application Recd By
1312 61 i r} ALL BLVD. Commercial and Residential Date Recd -
TIGARD, OR 97223 � t Date to P E... L 4
• (503) 639 -4171, x304 , D ate to DST _I_ ge
U - Permit tt NEC' 9P- 6/ 42_,
Print or Type Called 4 -0 OM
Incomplete or illegible applications will not be accepted
co n ' e of OeveiopmenuProtect Description
n �U FI y I d cn ( L TAY Wall C.(,� It/ Table 1A Mechanical Code QTY PRICE AMT
Roon SI-- Street Address Suiten A) Permit Fee -0- -0- 10.00
Address 050 k Sw a g m
• Bldgs City/State . Zip B) Supplemental Permit 3.00
T A rk .
me (or name of business) 1 . ) Fu rnace to 100.000 BTU 6.00
Owner
✓(dfi' 1-fry, (fig, Cslic} -rrnS incl. ducts & vents
Mailing Address 2.) Furnace 100,000 BTU + /� 7.50 K.6
"1 �(() � j vie A i I V n ind. ducts & vents (✓
pity/State Zip Phone 3.) Floor Furnace 6.00
Vov - noln Q( 0 /\ incl. vent
Name (or name of business) 4.) Suspended heater. wait heater 6.00 .
or floor mounted heater
Occupant Mailing Address 5.) Vent not incl. in 3.00
appliance permit
City/State Zip - Phone 6.) Boiler or comp, heat pump, air cond. 6.00
i to 3 HP; absorp unit to 100K BTU
Contractor N e 7.) Boiler or comp, heat pump, air cond. 11.00 r),9`
(Prior to ribiA /,t,J S.(,&t/ ((-() 3-15 HP; absorp unit to 500K BTU
issuance mailing Address 8.) Boiler or comp, heat pump, air cond. 15.00
applicant �j ,� o C c ( 111)0(.1 15-30 HP; absorp unit .5 -1 mil BTU r
must provide all 94y/State Zip Phone 9.) Boiler or comp, heat pump, air cond. 22.50
contractor 'Van 6thd Q 1 0710 ( 124.5421 30-50 HP; absorp unit 1 -1.75 mil BTU ,
license Oregon Const. Cont. Board Licit Exp Date ✓ 10.) Boiler or comp, heat pump, air cond. 37.50
information i ?i 23/ g i ll ' of > 50 HP: absorp unit 1.75 mil BTU
for COT COT Business Tax or etno a Exp. Date 11.) Air handling unit to 4.50
database). Iii 10 Eli l g 8 10.000 CFM
Architect Name 12.) Air handling unit 7.50
FZ 1 ( -1 M Tan.nn ) 10.000 CTM +
or ailing Address 13.) Non portable 4.50
nn- S E Al/1 St . evaporate cooler
Engineer by /state /1 ,pp //�� Zip - Phone DNS. 14.) Vent fan connected 3.00
} V OK I\ "1 7 ZI `I 9/N UCj�O to a single duct
Describe work New 0 Addition 0 Alterationa Repair 0 15.) Ventilation system not 4.50
to be done Residential 0 Non - residential 0 included in appliance permit
Additional Description of work 16.) Hood served by mechanical exhaust 4.50
17) Domestic incinerators 7.50
Existing use o �� / ,,,, �, c 18.) Commercial or industrialtype 30.00
budding or property C Lor-C�WuLJC- rOie:n1L.� incinerator
19.) Repair units 4.50
Proposed use of �.„.- ' • 20) Woodstove 4.50
building or property
21) Clothes dryer, etc. 4.50
Type of fuel - oil 0 natural gas ® LPG 0 electric 0 ' 22) Other units ; i /. J ,!, z.! 4.50
I hereby acknowledge that I have read this application, that the 23) Gas piping one to four outlets / 2.00 i] /)6
=rect. information given is rect. that I am the owner or authorized agent of �`;
the owner, that plans submitted are in compliance with Oregon State 24) More than 4 -per outlet (each) .50 .
laws.
3/1 /cif .
Signature of Owner /Agent Date QTY.SUBTOTAL
'SUBTOTAL c, 56 , 0 0
PO,V4 TALI V S 22y- 01/7,1 01/7,1 C ntact Person Name Phone 5% SURCHARGE Is"
PLAN REVIEW 25% OF SUBTOTAL cJ. D
TOTAL f Q /
i:\dst\rnechpmt.doc (rev 7/96) 'Minimum permit fee is 525 + 5% surcharg /(P
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