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Permit , t - CITY OF TIGARD MECHANICAL DEVELOPMENT SERVICES PERMIT PERMIT # • MEC97 -0219 '13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 06 / 26 / 97 PARCEL: 1S136CB -02200 SITE ADDRESS...: 11220 SW 82ND AVE SUBDIVISION ° RANCH VALLEY ZONING: R -4.5 BLOCK LOT °3 JURISDICTION: TIG CLASS OF WORK° °:REP FLOOR FURN • 0 EVAP COOLERS: 0 TYPE OF USE -SF UNIT HEATERS..: 0 VENT FANS...: 0 OCCUPANCY GRP ° °:R3 VENTS W/0 APPL: 0 VENT SYSTEMS: 1 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: 0 <= 10000 cfm: 0 GAS OUTLETS. : 1 FURN > =100K BTU: 0 > 10000 cfm: 0 Remarks : replace electric water heater with gas water heater Owner: FEES BRYAN S HADDIX type amount by date recpt 11220 SW 82ND PRMT $ 25.00 TAT 06 /26/97 97- 296522 TIGARD OR 97223 5PCT $ 1.25 TAT 06/26/97 97- 296522 Phone #: 684 -2697 Contractor: OWNER $ 26.25 TOTAL Phone #: Reg #.. 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 Duct Inspect ion approved plans. This permit will expire if work is not started Final Inspect ion within 180 days of issuance, or if work is suspended for more than 180 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 - 001-'.' You may . obtain copies of these rules or direct questions to O11NC by calling (503)246 -9187. Issue By: , n ��, _ ,it, Permittee Signature: / i�siUi(% ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 6:00 p.m. for inspections needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ • Plan Check # CITY OF TIGARD Mechanical Permit Application Recd By 13125 SW HALL BLVD. Commercial and Residential Date Rec'd TIGARD, OR 97223 Date to P.E. (503) 639 - 4171 x304 Date to DST Print or Type Permit# wl rC17 -h2/1 f Incomplete or illegible a plications will not be accepted called Name of Development/Project Description Table 1A Mechanical Code oTY PRICE AMT - Job Street Address Suite* A) Permit Fee -0- -0- 10.00 Address 11 Z,W S uJ ( 32 7J Bldg* City/Statep 1.) Furnace to 100,000 BTU 6.00 _ 1Cf -R n q 72.23 including ducts & vents Name (or name of tusina ) 2.) Furnace 100,000 BTU+ 7.50 Owner 1 t y 1./ S. N / t. ix including ducts & vents Mailing Address 3.) Floor Furnace 6.00 1 (la) C v LL) 71 (v-Ain including vent CiyiState a 7 marb Phone 4.) Suspended heater, wall heater • 6.00 '� I ar A R b O g I (o y 4 -[ �/ p / 7 or floor mounted heater Name name of business) 5.) Vent not included in appliance permit 3.00 Occupant Mailing Address _f 1V n 1 6.) Boiler or comp, heat pump, air cond. 6.00 to 3 HP; absorb unit to 100K BUT Ciy /stare Zip Phone 7.) Boiler or comp, heat pump, air cond. 11.00 3-15 HP; absorb unit to 500K BTU - Contractor Nave 5 n Q - 8.) Boiler or comp, heat pump, air cond. 15.00 (Prior to ' " 15-30 HP; absorb unit.5 -1 mil BTU" issuance Mailing Address 9.) Boiler or comp, heat pump, air cond. 22.50 applicant 30-50 HP; absorb unit 1- 1.75mi1 BTU" must provide all CityrStare Zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50 contractor > 50 HP; absorb unit 1.75 mil BTU" license Oregon Const. Cont. Board tic.* Exp. Date 11.) Air handling unit to 10,000 CFM 4.50 - information for COT COT Business Tax or Metro S Exp. Date - 12.) Air handling unit 10,000 CFM 7.50 database). Architect Name 13.) Non - portable evaporate cooler 4.50 or Mailing Address 14.) Vent fan connected to a single duct 3.00 Engineer City /State Zip Phone 15.) Ventilation system not included in ( 4.50 appliance permit Describe work New 0 Addition 0 Alteration 0 Repair 0 16.) Hood served by mechanical exhaust 4.50 to be done Residential 0 Non - residential 0 Additional Description of work 17.) Domestic incinerators 7.50 CH"A N MA/6v - w Fr 1 h I , 14f' 1 18.) Commercial or industrial type 30.00 ©iv I 1 IZ(_ / ( ' f U �,-f Incinerator Existing use of 19.) Repair units 4.50 building or property 20.) Wood stove 4.50 Proposed use of 21.) Clothes dryer, etc. 4.50 building or property 22.) Other units 4.50 Type of fuel - oil 0 natural gas 0 LPG 0 electric 0 23.) Gas piping one to four outlets 2.00 I hereby acknowledge that I have read this application, that the 24.) More than 4 -per outlets (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 Zc e o laws. Signature of Owner /Agent Date 'SUBTOTAL 5% SURCHARGE 125 Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL TOTAL �� Glo i:'dstlmechpmtdoc (rev 9 'Minimum permit fee is $25 + 5% surcharge "Residential A/C requires site plan showing placement of unit.