Permit 4 CITY OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC1999 -00155
-I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417.1 DATE ISSUED: 4/13/99
PARCEL: 2S1 11 AC -01300
SITE ADDRESS: 14590 SW 92ND AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT: 054 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Remarks: Installation of gas insert into existing fireplace and associated gas piping.
Owner: FEES
HESKETH, DUANE Type By • Date Amount Receipt
14590 SW 92ND PRMT DRA 4/13/99 $25.00 99- 314472
TIGARD, OR 97224 5PCT DRA 4/13/99 $1.25 99- 314472
Total $26.25
Phone: 639 -5463
Contractor:
1 7 5 CsoJyv o
— b AN ..2.1--c)i) ay Q`7005-- REQUIRED INSPECTIONS
Mechanical Insp
Phone: (.Q 4(4 - 1.a9 Gas Line Insp
Reg #: Misc. Inspection
g S� �� `� p SI•'
• Final Ins ection P
This permit is issued subject to the regulations contained in the 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 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You m obtain opies of these rules or direct questions to OUNC by calling 503)246 - 91.89.
Issue y: . !„ 4 ' t .% „. I r. - Permittee Signature:
Call (50 ) 639 -4175 by 7:00 P.M. for inspections needed the ne t business day
•
it
i'
• Plan Chevy#
CITY OF TIGARD RECERM chanical Permit Application Recd B -,"`�„
13 SW HALL BLVD. Commercial and Residential Date Recd y
TIGARD, OR 97223 APR 13 1999 Date to P.E.
(503) 639 -4171 x304 Date to DST • COMMUNITY DEVELOPMENT Print or Type Permit # Mir-
_ Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
•
Job Street Address /j" Suite# A) Permit Fee ' , ,e'e; 10.00
Address /9:90,560 9a - 1) Furnace to 100,000 BTU
including ducts & vents 6.00 .
Bldg# City /State Zip 2) Furnace 100,000 BTU+
including ducts & vents 7.50
Name (or name of business) i i 3) Floor Furnace -, •
Owner DUt,C&,y /Og es k including vent 6.00
Mailing Address / / 4) Suspended heater, wall heater
q �.! C or floor mounted heater 6.00
4/5,0 S(,.c.7 / - 5) Vent not included in appliance permit
tty /State Zip v l Phone 3.00
/ og97 09_9%3 CHECK ALL *Boiler Heat Air
Nam or ame of business) THAT APPLY: or Pump Cond- Qty Price Amt
Comp
- - 6) <3HP;absorb unit to
Occupant Mailing Address • - - 100K BTU 6.00
• 7) 3 -15 HP;absorb unit
City /State Zip Phone_. 100k to 500k BTU 0 11.00
8) 15 -30 HP; absorb
' unit .5 -1 mil BTU 15.00 -
Contractor Name/ 9) 30 -50 HP; absorb
L— S unit 1 -1.75 mil BTU 22.50
Prior to permit Mailing Address l • 10) >50HP; absorb unit
issuance, a copy ' 667 ` � or I CS/ >1.75.mil BTU 37.50
of all licenses C' 67-7,5,3 tate / ' Phone /f !� 11) Air - handling unit to 10,000 CF
are required if (9 je c/ 6 / 4.50
expired in COT or 9 Copst. Cont. Board Lic.# Exp. Date. 12) Air handling unit 10,000 CFM+
database �5 /� - I 7.50
Architect Name . . 13) Non - portable evaporate cooler
,.gin -� , r,,, 4.50
or
Mailing Address 14) Vent fan connected to a single duct>a�;) r' (l � , J
3.00
15) Ventilation system not included in '
Engineer City /State Zip Phone appliance permit 4.50
. -. - 16) Hood served by mechanical exhaust .
Describe work to be done: - 4.50
17) Domestic incinerators -
.. Nevpe Repair 0 Replace with like kind: Yes 0 No 0 7.50
Residentiatlie Commercial 0 - - • 18) Commercial or industrial type incinerator _
30.00
Additional information or description of work: 19) Repair units
4.50
20) Wood stove
_ 4.50
21) C1 es dryer, etc.
4.50
Type of fuel: oil 0 natural ga4 LPG 0 electric O 22) Other units e7 ,SJ _
,��• / 4.50 /
- I hereby acknowledge that I have read this application, that the information 23) Gas piping 4 e to four outlets ' • �� �
given is correct, that I am the owner or authorized agent of 0 2.00 • '
the owner, that plans submitted are in cam•liance with Oregon State laws. 24) More than 4-per outlet (each) •
. .50
Signature" • ••• r rAgent Date _ . ;',..
Minimum Permit Fee $25.00 SUBTOTAL �
�• � �� 97 5% SURCHARGE - : O / id s
• tact Pers. • 'a ` Phone . PLAN REVIEW 25% OF SUBTOTAL /
• ' Required for ALL commercial permits only �O'
Yom_ �®Y®9 TOTAL r 610
*State Contractor Boiler Certification required
* *Residential NC requires site plan showing placement of unit
I:\mechperm.doc rev 07/20/98
CITY OF TIGARD
EXPENDITURE REQUEST
This form is a multi -use form. Appropriate receipts and documentation must be attached to this
form. Approved request due Monday 5:00 PM to A/P for checks by Friday (week opposite
payroll only).
VENDOR NO.: DATE: 4/14/99
PAYABLE TO : Hesketh, Duane C REQUESTED BY: Debbie Adamski
Hesketh, Violet M
14590 Sw 92nd Ave
Tigard OR 97224
01VIISCEMNEOUS EXPEN0000,Mil r „12.n t
Date _; Description ; ;Ii voice :No., etc. Account No . Amount
4/14/99 Refund for overpayment of permit
fee on MEC1999 -00155
Receipt #99- 314472
Miscellaneous '000- 451000 $6.25
.J411
TOTAL $6.25
Mileage 32.5
APPROPRIATION BALANCE: AS OF: PURCHASING:
APPROVALS:
(IF UNDER $50) Section Manager/Professional Staff _
(IF UNDER $2500). Division Manager
(IF UNDER $7500) Department Manager
(IF UNDER $25000) City Manager
(IF OVER $25000) Local Contract Review Board