Permit Plan Check # ��S - l' � C
,3F`TIGARD Mechanical Permit Application Recd By g q�q
$ 5 SWPHALL BLVD.
ARD, OR 97223
Commercial and - aeslde.,ntial Date Reed W
h
Date to P.E. $( I� 1 ( a (p
13) 6394171, x30 / �' t 12
Incomplete Date to DsT
Print or Type �� ( Permit# �1E'b
/ lete or illegible applications Called
p g pp s will not be accepted
Name of Develo menuPr �r 1 fN Vuf �D�
D escr i p t ion
�� Table 1A Mechanical Code QTY PRICE AMT
Job Street Address Sorter/ A) Permit Fee -0-. -0- 10.00
Address /692. 0 SGv 72
Bld - C 1 i r ty/ f St � ate �,.�p�/� , Zip s B) Supplemental Permit 3.00
Name (or name of business) / 1.) Fumace to 100,000 BTU 6.00
Owner ,3(ftJ jff //,f/ M , - incl. ducts & vents -
Mailing Address 2.) Fumace 100,000 BTU + 7.50
3 f 39 Ai la sr h j D incl. ducts & vents
Ci /State Zip 1 Phone 3.) Floor Furnace 6.00 •
` o4 972& 5719 2676 incl. vent
amee (or name of busyness - 4.) Suspended heater, wall heater 6.00
,'/)c'5 hotness)
or floor mounted heater 6
Occupant Mailing Address -7� 5.) Vent not incl. in 3.00
/6922 Sui /.Ad appliance permit
.. City /State . Zip Phone 6.) Boiler or comp, heat pump, air cond. 6.00
77 /-J i /oR to 3 HP: absorp unit to 100K BTU ' L _ •
. N ame 7.) Boiler or comp, heat pump, air cond. 11.00
r CC/ HO7& C0/411,-at � .23/16. 3-15 HP; absorp unit to 500K BTU
Contractor Mailing Address 8.) Boiler or comp, heat pump, air cond. 15.00
33/5 NW Z 15-30 HP; absorp unit .5-1 mil BTU
Attach copy of City/Stpte Zip Phone 9.) Boiler or comp, heat pump, air cond. 22.50
Current Licenses 'f 764jPQ �• Q 7.Z 10 223 30-50 HP: absorp unit 1 -1.75 mil BTU
Oregon Const. C O Board lie.# Exp. Date 10.) Boiler or comp, heat pump, air cond. 37.50
/ Q� 10 -f. > 50 HP; absorp unit 1.75 mil BTU
COT-Business Tax or Metro # Exp. Date 11.) Air handling unit to 4.50
C� 10,000 CFM Z / G
-
Arc Name /' • 12.) Air handling unit 7.50
LA- ,ey 6ete/&C 10,000
Or Mailing Addre 13.) Non portable 4.50
790 A/- YAltraliiie Mu. evaporate cooler
Engineer c /State Zip Phone 14.) Vent fan connected 3.00 •
I OPIIC Agrf. 31„o-25,/-923 �f to a single duct
Describe work New, Addition 0 Aeration 0 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
A na er te-�t,€' /�t� 64/64/4e, 4 ry57&777 mechanical exhaust 4.50
spc irJ y T17f 'cog- c owe. Xi &A/t. 17) Domestic incinerators 7.50
, 'Tie• -- (oxE S (oo F r7()
Existing use of , JNTTS o n. >eA -rC/� , r E 18.) Commercial or industrial 30.00
building or property type incinerator
r7„,--_--,-?_,,,T7- / r / 19.) Clothes dryers, etc. 4.50
,
Proposed use of 20) Other units 4.50
building or property
Type of fuel - oil 0 natural gas LPG 0 electric 0 21) Gas piping one to four outlets ' 2.00 2--_
I hereby acknowledge that I have read this application, that the 22) More than 4-per outlet (each) .50
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL
laws.
Signature of Owner /Age Date 'SUBTOTAL z 7 ■
/ / S' _& - �, 5% SURCHARGE 7 G�
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL /
/ W paw - 7-2-3-d7/393 TOTAL z
i:ldstlmechpmt.doc *Minimum permit fee is $25 + 5% surcharge
fi:/96 --
CITY OF T MECHANICAL
� DEVELOPMENT SERVICES PERMIT
. 1 A! i I i'�I PERMIT # • MEC96 -0285
!4. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 DATE ISSUED: 07 / 09! 98
PARCEL: 2S113AD -01700
SITE ADDRESS...: 16920 SW 72ND AVE
SUBDIVISION • ROSEWOOD ACRE TRACTS ZONING: C —G
BLOCK • LOT •030 JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE :COM UNIT HEATERS..: 1 VENT FANS...: 0
OCCUPANCY GRP..:M VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 1 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP • 1 DOMES. INCIN: 0
: /GA 3 -15 HP • 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP • 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: N 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: 0 <= 10000 cfm: 2 GAS OUTLETS.: 1
FURN > =1O0K BTU: 0 > 10000 cfm: 0
Remarks : Tenant Improvement: duct work for HVAC split system for computer room
Owner: FEES
BINGHAM INVESTMENTS type amount by date recpt
3939NW ST. HELENS RD PRMT $ 33.00 B 07/09/98 98- 307225
PORTLAND OR 97210 PLCK $ 8.25 B 07/09/98 98- 307225
5PCT $ 1.65 B 07/09/98 98- 307225
Phone #:
Contractor:
CLIMATE CONTROL HEATING
3315 NW 26TH AVE
$ 42.90 TOTAL
PORTLAND OR 97210
Phone #: 223 -4393
Reg #..: 000006
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Final Inspection
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 188 days of issuance, or if work is suspended for more
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 - 001-0010 through OAR 952 -081 -0880. You may
obtain copies of these rules or direct questions to DUX by calling
(503)246 -9187.
Issue By: L MAIVV tee Signature: i
... / 0
f —,/
++++++++++++++++++++++++++++++++++++++++++++++++ + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++