Permit CITY OF TIGAR MECHANICAL
it , DEVELOPMENT SERVICES PERMIT
� L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 41$1, D S • 0 / 977 -0408
DAATTE PERMIT E ISSUED: 10/`0/97
PARCEL: 2S 1O3BC- -04900
SITE ADDRESS...: 12625 SW 124TH AVE
SUBDIVISION....: BROOKWAY 16ZONING: R -4.5
BLOCK........... LOT .............:003 JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR TURN....: 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 < 1OOK BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN ) =1O0K BTU: 1 ) 10000 cfm: 0
Remarks : Installing gas furnace and gas piping
Owner: -- FEES —
BRUCE SHULTS type amount by date recpt
12625 SW 124TH AVE PRMT $ 25.00 E+ 10/20/97 97- 300183
TIGARD OR 97223 5PCT $: 1.25 B 10/20/97 97- 300183
Phone #:
Contractor:
OWNER
26.25 TOTAL
Phone #:
Reg #..: 999999
-- - - - - -- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Final Inspection •
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- 001 -0010 through OAR 952101 -0080. You may .
obtain copies of these rules or direct questions to MN. by calling
(503)246 -9187.
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Issue By- , "--- Permittee Signature ( � f ��� ! .
+ ++++++++++++++++++++++++++++++++++++++++++++ +++ + + + + + + + ++ +++ + ++ ++ +± + + + ++ + + +- +++
Call 639 -4175 by 7:00 p.m. for inspectipns needed the next business day
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Plan Chec #
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW'HALL BLVD. Commercial and Residential Date Recd IV .--
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit # ft4 - 7-
Called
Incomplete or illegible applications will not be accepted
Name of Development/Project Description
/9Ai Table 1A Mechanical Code QTY PRICE AMT
Job Street Address J Suite# A) Permit Fee -0- -0- 10.00
Address t 2 Cp'Z,S Su 12 y T'+
Bldg# City/State Zip 1) Furnace to 100,000 BTU . ' 6.00
- T 4 q r G( CT 12, including ducts & vents I .
Name (or name of business) J 2.) Furnace 100,000 BTU+ 7.50
Owner IS RA) C E S H L LT 5 including ducts & vents 2 „$"0
Mailing Address 3.) Floor Furnace
6.00
1 o ZLi S W 12 %-1T"' to v E. including vent
City /State Zip Phone 4.) Suspended heater, wall heater 6.00
- 1' • 1 C ' q3 5"10-0373 or floor mounted heater
Name (o name of business) 5.) Vent not included in appliance permit 3.00
SCMQ
Occupant Mailing Address • 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorb unit to 100K BUT
City/State Zip Phone 7.) Boiler or comp, heat pump, air cond. 11.00
3-15 HP; absorb unit to 500K BTU"
Contractor Name 8.) Boiler or comp, heat pump, air cond. 15.00
0 t M Q 15 -30 HP; absorb unit.5 -1 mil BTU'"'
Prior to permit Mailing Address 9.) Boiler or comp, heat pump, air cond. 22.50
issuance, a copy 30-50 HP; absorb unit 1- 1.75mil BTU"
of all licenses City/State Zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50
are required if > 50 HP; absorb unit 1.75 mil BTU""
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.) Air handling unit to 10,000 CFM 4.50
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 Alteratiory Repair 0 16.) Hood served by mechanical exhaust 4.50
to be done Residential 0 Non - residential i'
Additional Description of work: 17.) Domestic incinerators 7.50
I N 5 0" �- V ( 18.) Commercial or industrial type 30.00
Z N AC E. Incinerator
Existing use of 19.) Repair units 4.50
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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 O atural ga -- LPG 0 ele 23.) Gas piping one to four outlets / 2.00 00
Z .
I hereby acknowledge t ve 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.
Signature of Owner /Agent Date `SUBTOTAL „ , 00
N Z u C t� J.,t,...m_(012.0/77 5% SURCHARGE 1, �� J '.
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
-T mo -. 73 0 _zg5 `'/
$RJ C.� SN uC�r5 M • 5- 90 -6373 TOTAL 2w-
i:\rnechpmt.doc (rev 9 *Minimum permit fee is $25 + 5% surcharge
- Residential A/C requires site plan showing placement of unit.
6/19/00 Activities for Case #: MEC97 -00408
2:00:07 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes N
MECA007 Application received 10/20/97 B RECD BON 10/20/97
MECA008 Create Permit 10/20/97 B DONE BON 10/20/97
MECA799 Final Inspection BON 10/20/97
MECA705 Gas Line Insp 10/20/97 11/17/97 KS PASS J *H 11/17/97 19 psi
MECA715 Mechanical Insp 10/20/97 11/17/97 KS FAIL J *H 11/17/97 1. Call for final electrical
inspection of new circuit for
furnace located in attic. 2.
• Electric water heater?
MECA060 (F) Issue permit 10/20/97 B PASS BON 10/20/97
MECA880 Expired by limitation 5/10/00 HAP DONE No Hold AKJ 5/10/00
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