Permit MECHANICAL
CITY OF TIGARD PERMIT # PERM '
IT
MEC96-0115
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/01/96
13125 SW Hall Blvd. Tigard, Oregon 9722308199 (503) 639-4171
PARCEL: 28103BB-09900
SITE ADDRESS...: 12040 SW 122ND CT
SUBDIVISION....: YE—OLDE WINDMILL ZONING: R-4.5 •
BLOCK..........: LOT -20
CLASS OF WORK., DD FLOOR FURN....: 0 EVAP COOLERS: 0
TYPE OF USE.. :SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:A1 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.: 0
FURN < 100K BTU: 1 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN >=100K BTU: 0 1 10000 cfm: 0
Remarks: Furnace addition to 100K BTU and gas piping to four outlets.
Owner: -------- FEES
HENDERSON JOSEPH type amount by date recpt
12040 SW 122ND CT PRMT $ 25.00 CjS 05/01/96 96-278825
5PCT $ 1.25 CJS 05/01196 96-278825
TIGARD OR 97223
Phone #: 503-590-2938
Contractor: — --
GP&W SYSTEMS INC
732 MARBLE RD
•
WASHOUGAL WA 98671-9601 ---
Phone #: 360-835-3516 26.25 TOTAL
Reg #. : 108176
----- REQUIRED INSPECTIONS
This periait 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 sore
than 180 days.
Permittee Signature:
Issued By: roji r
Cal l for inspection — 639-4175
City o f Tigard MECHANICAL PERMIT Planck/Rec. # 96- (788
13125 SW Hall Blvd. APPLICATION Permit # MEr99 - -0 /Ls
Tigard, OR 97223
(503) 639 -4171
Name of Development Description
Table 3A Mechanical Code QTY PRICE AMT
Address ," ' y
Job 20�0 50 / 2c nd Cf. 1) Permit Fee -0- -0- 10.00
Address CSyJState
Tigard , 6� 7ZZ 2) Supplemental Permit 3.00
Nam ( name of busness) `e$/ Furnace to 100,000 BTU
1-11eldersa r P c Joseph 9.3$ 1) incl. ducts & vents 6.00 6
Maang e.a � a Furnace 100,000 BTU +
Owner ,` e - 2) incl. ducts & vents 7.50
ulyi a e ZS) Floor Furnance
3) incl. vent 6.00
Name for name of busies.) Suspended heater, wall heater '
J fph - Qa y Phone or floor mounted heater 6.00
q ess Vent not Incl. in
Occupant 5) appliance permit 3.00
Cdy /State Zw Repair of heating, refrig.
6) cooling, absorption unit 6.00
N or comp, heat pump, air coed.
7) to 3 HP; absorp unit to 100K BTU 6.00
mag Address 34364:3215. Boiler or comp, heat pump, air cond.
Contractor ?32_ rnCutbie Rd 15 %L. 8) 3 -15 HP; absorp unit to 500K BTU 11.00
l '' u ys t ate Boiler or comp, heat pump, air cond.
- i:SVI 03A- q ip"7/ 9) 15 -30 HP; absorp unit .5 -1 mil BTU • 15.00
State Regrsuatwnn o l_- City Bus. Tax No. Boiler or comp, heat pump, air cond.
1 V8 I7G rn�) 7U /c ,S- 10) 30 -50 HP; absorp unit 1 -1.75 mil BTU 22.50
I hereby acknowledge that I have read this application, tnat the Boiler or comp, heat pump, air cond.
information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of, the owner, that -plans submitted are in compliance with Air handling unit to
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State Air handling unit
registration, please give reason below.) 13) 10,000 CTM + 7.50
Non portable
14) evaporate cooler 4.50
Vent fan connected
15) to a single duct 3.00
Ventilation system not
�j � LI Zl 16) included in appliance permit 4.50
W" a[or'to rner or agent) �'-' • � a Hood served by
17) mechanical exhaust 4.50
De3G ioe work new U ad' .. o.. a teration v repair 0 crcial or industrial '
to be done residential non- residential 0 18) type incinerator 30.00
Existing use of Other i.e.. woodstove. water
building or property hnme..__ 19) heater, solar, clothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00 Z
building or property
21) More than 4 -per outlet (each) 2.00 _
Type of fuel - oil 0 natural gas LPG 0 electric Q �- -
NOTICE
- Minimum Fee 625.00 SUBTOTAL 25
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE ,• 23
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL J0
AFTER WORK IS COMMENCED.
TOTAL �-
Special Conditions
a6. a
1 S
1 d �G
/ / Date issued .S- - 96 by /7.--_S H:ILOGIMDSTSIMECHPMT V r1 I''2 U 1 e47 /'e tw i red -fb r- -1-1-1, Q ( s c3-5
Ser7//n /Pkund C6i «k, 9C
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -41.71
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Stru . ech. Rou • - - Gyp. Bd. -Bldg.
San. Sewer e�. I Appr /Sdwlk Reins.
Other:
iK
Date: 5 (c A.M. X P.M. Entry:
Address: 2 -
Tenant: Ste: MST:
X1 b ` a- 3 BUP:
Con /Own: M
f ,,� p, EC: O
3 ® — �3.�— 33 - y b /�X�" I PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: // ELR:
C � s - �� � , •s
Ins ector: 1 - -- Date: /'
ROVED DISAPPROVED /CALL FOR REINSP. CF CO
V6CUT?