Permit A CITY OF T D MECHANICAL
— . 0 � g� � i DEVELOPMENT SERVICES PERMIT #PERMIT • MEC98 -0439
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/30/98
- -
4:41e110) PARCEL: 2S1O3CC -00500
SITE ADDRESS...: 13825 SW 121ST AVE
SUBDIVISION • 4Z) ZONING: R -4.5
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •SF UNIT HEATERS..: 1 VENT FANS...: 0
OCCUPANCY GRP..:R3 VENTS W/0 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.: 1
FURN < 1OOK BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =1O0K BTU: 0 > 10000 cfm: 0
Remarks : Mechanical alteration to residential dwelling.
Owner: FEES
DEREK ANDERSON type amount by date recpt
13825 SW 121ST AVE PRMT $ 25.00 DLH 09/30/98 98- 309607
TIGARD OR 97223 SPCT $ 1.25 DLH 09/30/98 98- 309607
Phone #:
Contract or:
G P & W SYSTEMS INC
732 MARBLE RD __— _.---- ._. - -_ —
$ 26.25 TOTAL
WASHOUGAL WA 98671 -9601
Phone #: 360 - 835 -3516
Reg #.. : 001081
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 Final Inspection
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 -0080. You say
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
Issue By: / Permittee Signature: 'Y/L/ /n
.d.a.i
/910/04/69-77o
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + ++
Plan Check # ' ' '
CITY OF TIGARD M echianical Permit Applicat Rec'd By - t-
13125 SW HALL BLVD. Comm e rcial and Residential Date Reed
TIGARD, OR 97223 Date to P. E .` '""
(503) 639- 4171, x304 ,
Date to DST •
Print or Type Permits , f . (' '�° '
Called
Incomplete or illegible applications will not be accepted
Name of DevelopmenUProject Descnptlon
Table 1A Mechanical Code QTY PRICE AMT
Job Street`Address suite# A) Permit Fee -0- -0- 10.00
Address i 3825 $c) , ZJ -
Bidga City/state zip 1.) Furnace' to 100,000 BTU 6.00
7,.3 . q7 �Z 3 including ducts & vents
Name (or name of business) U 2.) ` Furnace 100,000 BTIJ+ 7,50
Owner /1(.Q l'S0'►1 including ducts & vents
Mailing Address 3.) Floor Furnace 6.00
�ys.� 3 - - including vent
cityt5tate zip Phone 4.) Suspended heater, wall heater / 6.00
5 - or floor mounted heater
Name name of business) 5.) V n ot included; in appliance permit 3.00
Occu pant Maili Addres 6.) `Boil or comp, heat pump,! air co 6.00
to 3 HP absorb unit to 1001( BUT**
City /State zip Phone 7,) ` Boiler o r comp, heat pump,' air cond 11.00 .
3.15 HP absorb unit to 5001( I TU"
Contractor Name 8.) Boiler or comp, heat pump, air coed. 15.00
p S � 15 30 HP; absorb unit.5 -1 m BTU'"
Prior to Perm Ma�iing Address 9.) Boiler or comp, heat pump, a cond. 22.50
issuance, a copy f 7 / j ' I d a � r ! . ! 30 -50 H absorb unit 1- 1.75mil BTU"'
of all licenses City /state Zip Phone .35 1 Boiler or comp, heat pump, a cond. 37.50
are required if° /,( /u{ r f Ay 4 7f $ 5.3 14 > 50 HP; absorb unit 1.75 mil BTU*"
expired ini COT Oregon Const. C . Board Lic.# Ex to 11.) Air handling unit.to 10,000 CFM 4.50
database /08/7(. ,�9!
Architect Name,+, .1115 , / 13.) Non portable evaporate cooler 4.50'
Mailing OF 14. Vent fan connected to a s duct 3.00>
Engineer Cityrs zip ' Phane 15.) Ventilation system not included in 4.50'
appliance permit
Describe work Ne Addition 0 Alteration 0 Repair O 16 Hood served by mechanical exhaust 4,50
to be done Resial 0 Non - residential 0
Additional Description of work: 17 )„ Domestic incinerators 7.50
18. )' Commercial or industrial type 30.00
Incinerator
Existing use of 19.) Repair units 4.50
building or property
20.) Wood stove
Proposed use of 21.) Clothes dryer, etc. 4.50
building or property
22.) Other units /�, ICpe rife / 4.50 y�?
Type of fuel - oil 0 natural gasiif LPG 0 electric 0 23.) Gas piping one to four outlets 2.00; 2
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
laws.
Signatu Owner /Agent Date *SUBTOTAL
5 °A SUR / k
Conta on Name Phone PLAN REVIEW 25% OF SUBTOTAL
5211,,, p e/tp ,.7Gd -V3S- 3s :. � To'rA .. -...__
cUnechp oc {rev 9 ' Minimum perm fee i s $25 + 5% surcharge
"`Residential A/C requires site plan shawirg placement of uni
5/10/00 Activities for Case #: MEC98 -00439 EXPIRED
1:17:54 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECA007 Application received 9/30/98 DLH RECD DLH 9/30/98
MECA008 Create Permit 9/30/98 DLH DONE DLH 9/30/98
MECA799 Final Inspection DLH 9/30/98
MECA705 Gas Line lnsp 9/30/98 DLH 9/30/98
MECA715 Mechanical Insp 9/30/98 DLH 9/30/98
MECA725 Heating Unt lnsp 9/30/98 DLH 9/30/98
MECA060 (F) Issue permit 9/30/98 DLH DONE DLH 9/30/98
MECA845 Request inspection research 3/28/00 JMT DONE No Hold JMT 3/28/00
MECA880 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00
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