Permit - `
CITY T MECHANICAL
' DEVELOPMENT SERVICES
P ERMIT # : MEC96 0367
° � � N~ « �Ja /J/��SN/Ma0Bhvi 7��r�ORy?�� ��M�y�4/7/ ^ ^ ^ ^ ^ ^ ^ —
Blvd., Tigard, ' ' DATE ISSUED: 10/25/96
PARCEL: 2S112CA-04200
SITE ADDRESS,: 15235 SW 79TH AVE
SUBDIVISION,...: DURHAM ACRES . ZONING: R-4.5
BLOCK..........: LOT -29
I
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CLASS OF WORK..:ALT FLOOR FURN....: 0 EVAP COOLERS: 0
TYPE OF USE....:SF . UNIT HEATERS: 0 VENT FANS...: 0 '
OCCUPANCY GRP..:R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES - 0^ BOILERS/COMPRESSORS HOODS.. . . . . . : 0
FUEL TYPES 0-3 HP - 0 DOMES. INCIN: 0
:/GAS/ / / 3-15 HP : 0 COMML, INCIN: 0
MAX INPUT: 0 BTU 15-30 HP....: 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE...: 50+ HP - 0 CLO DRYERS..: 0
NO. OF UNITS---- AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 100K BTU: 1 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN >=100KBTU: 0 , - ' > 10000 cfm: 0
Remarks: Installing a gas furnace
Owner: FEES — --
JEFFERY GIBBONS type amount by date recpt
15235 SW 79TH PRMT $ 25.00 DST 10/25/96 96-285748
, 5PCT $ 1.25 DST 10/25/96 96-285748
TIGARD OR 97224
Phone #: 684-7810
Contractor: ---- — `
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN OR 97062 ' ` ' -'' . . . . .
Phone #: $ 26.25 TOTAL
Reg #..: 005193 ,
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 Final Inspection .
approved plans. This permit will expire if work it not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
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Permittee Signature: d~ ��r _' __ w _ -
Li �� __
Is sued By: �y __-_- ___- __-___-__.
y - Call for inspect'iom. — 639-4175
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CITY OF TIGARD Mechanical Permit Application Plan
d yam'`#
1312a'3* HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
•
Print or Type • Pe rmit MG -- cq6 - d 7
Incomplete or illegible applications will not be accepted Called
Nana or Development/Protect Desaiption
Table 1A Mechanical Code MY PRICE AMT
Job Street Address Stated A) Permit Fee -0- -0- 10.00
Address
B CtylState Zip B) Supplemental Permit 3.00
Nana to name or truamess) 1.) Furnace to 100.000 BTU
Owner �1 c� ( / b);10/4S incl. ducts & vents
Amass +�. 2.) Furnace 100.000 BTU + 7.50
, 5 SLu 7g incl. ducts & vents
-^/ zip Phone 3.) Floor Furnace 6.00
. -r, cttc 4 97d - d -4 i _ &frY -/ 7/0 did. vent
tor name a ts4i ess) 4.) Suspended heater. wan heater 6.00
S ci. rr i- . or floor mounted heater
Occupant "n9 Address 5.) Vent not ind in
3.00
apps pe ITA
CityiState rip Phone 64 Boiler or comp, heat pump. air cond. 6.00
Name to 3 HP; absorp unit to 100K BTU
7.) Boller or comp. heat pump. air card 11.00
,4r(o w � , 3-15 HP; absorp unit to 500K BTU
Contractor MaitI q " Dress 8.) Boiler
,• `` - r comp, heat pump, air cond. 15.00
/0330 Sc_49 - 7 Jc �T .k! • 15-30 HP: absorp unit .5.1 nil BTU
Attach copy 9 , zip 9.) ' Ph o n e Boller or comp. heat pump, air cond. 22.50
Current Licenses y i' � VI (AR 69',51-i565 30-50 HP; absorp unit 1 -1.75 mil BTU
.Oregon Carus. Cont. Board t.ic.s Esp 10.) Boder or comp, heat pump, air cond. 37.50
00619,3 /1 I f & > 50 HP: absorp unit 1.75 mil BTU
COT Business Tart o Metros Oafs 11.) Air handling unit to 4.50
Oeoo o7 H 76Q a/o/AO 10.000 CFM
Architect Ni1 12.) Air handling unit 7.50
10.000 CTM +
or Ma Andreas 13.) Non portable
4.50
evaporate cooler
Engineer Cay,state Ztp - Phone 14.) Vent fan connected
3.00
to a single duct
Describe wort New 0 Addition 0 Alteration 0 Repair 0 15.) Ventilation systern not 450
to be done Residential 0 Non - residential O included in appliance permit
Additional Deription of Wait r 16.) Hood served by
Cli48 eCA ✓ e. -O e�q,S c V (t -C-C O.nC\ mechanical exhaust 4.50
8GS 1 )1 1� ,
t 7) Domestic incinerators 7.50
, Existing use of 18.) Con nercial or industrial -
building or party 30.00
type incinerator
19.) Clothes dryers, etc. 4.50
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Proposed use of 20) Other units - 4.50
, building or property
•
Type of fuel - oil 0 natural gas 0 LPG 0 electric 0 21) Gas piping one to four outlets 1 2.00
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 r�
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL
laws.
Si n
gnature of OwedA era / � �� ..-9-6 SUBTOTAL 4,00
®���� 5% SURCHARGE 4s-
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
TOTAL
'tdstlrnechpmt.doc 'Minimum permit fee is 525 + 5% surcharge
Rev 7/96
° N '_- , 22�� 0
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing 40231110
PIbg.Und /FIr /Slab Plbg. Top Out Insulation
Post/Beam Struct. 0 Rough -in Gyp. Bd. -Bldg.
San. Sewer an) Appr /Sdwlk Reins.
Other: l I ��
Date: A.M. P.M. ntry:
Address: 1 Z 33
Tenant: Ste: MST:
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0/Own: 0 �"I ?L U BUP:
MEC:
PLM:
v ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
. 7 " 'Atl- 4-rj‘cl
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/ ,.,?...e.„,— ,--2.4„,-_,
e ...e,..6, .(„6-7--- /\...e "...,1....1 ("
Inspector: / `�' Date: 2--Z-` 7 /
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO