Permit CITY OF TIGARD MECHANICAL
. 42 DEVELOPMENT SERVICES �*m�°m~m~��x n�nu~n�n ��u~nx�n���~�� PERMIT
' .:10,4- All, 13125 SN/ Hall G/vd., Tigard, OR97223 (503)63y-4/7/ PERMIT #.......: MEC99-0039
- 4 DATE ISSUED: 01/26/99
~ RCEL: 1S133DD-12900
SITE ADDRESS...: 11849 SW 126TH PL ~��
SUBDIVISION....: VILLAGE AT SUMMER LAKE PARK 4 ZONING: R-4.5
BLOCK..........: LOT.............:166 JURISDICTION: TIG
- - ----- -- - ____-______
CLASS OF WORK..:OTR FLOOR FURN....: 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
:WOD 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..: 1
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.: 0
FURN >=100K BTU: 0 > 10000 cfm: 0
Remarks: Installation of wood stove.
Owner: ---------- FEES -
JERRY COURSOLLE type amount by date recpt --
11849 SW 126TH PL PRMT $ 25.00 DEB 01/26/99 99-312431.
TIGARD OR 97223 5PCT $ 1.25 DEB 01/26/99 99-312431
Phone #:
Contractor: -
THOMAS BISHOP
4578 SW 103RD AVE - -----
$ 26.25 TOTAL
BEAVERTON OR 97005-2170
Phone #: 644-7868
Reg #..: 000546
------- REQUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained in the Woodstove Insp ___.
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. Al} 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. ATTENTION: Oregon law requires you to follow rules __
adopted by the Oregon Utility Notification Center. Those rules are ___
set forth in OAK 952-^*1-0010 through OAR 952-001-0080. You may _ _
obtain copies of these rules or direct questions to CAC by calling _
(503)246-9187. ___ _______ __ ___-
_ �� ��������`
-- - --- --
Issue 111 L- . 11--Lt . Permittee Signature: /',� /��` '
Ill
.
+ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p.m. for inspections needed the next business day
+ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
CITY OF TIGARD RECEIVEtMechanical Permit Application Plan Ch
pp caon Recd B A
13125 SW HALL BLVD. Commercial and Residential Date Rec'd / --6714'79%' TIGARD, OR 97223 p L 2 6199 --6714'79%' Date to P.E.
(563) 639 -4171, x304 - y f q i �d 0 Date to DST
• COMMUNI DE VELOPMEN T Permit# i-l.�c.cl`l ?
Print or Type
• Incomplete or illegible applications will not be accepted Called ---
Name of Development/Project Description
Table 1A Mechanical Code Qtv Price Amt
Job Street Address Suite# A) Permit Fee 10.00
Address 11 0 tiq . r&a:PI 1) Furnace to 100,000 BTU '
including ducts & vents 6.00
Bldg# y/State Zip 2) Furnace 100,000 BTU+
including ducts & vents 7.50
. Name (or name of siness) 3) Floor Furnace
Owner e0 (,l Y l J E i(( • including vent 6.00
Mailing Address a 4) Suspended heater, wall heater
' / P, i l S 0 or floor mounted heater 6,00
` 5) Vent not included in appliance permit
Ctty/State Zip Phone 3.00
i eta l d q'f2 3 _ 'kW CHECK ALL `Boiler Heat Air
Na or name of business) THAT APPLY: or Pump Cond Qty Price Amt
Comp .
6) <3HP;absorb unit to
Occupant Mailing Address 100K BTU 6.00
Sq rn Q. 7) 3 -15 HP :absorb unit
City/State Zip Phone 100k to 500k BTU 11.00
8) 15-30 HP; absorb .
Contractor unit .5 -1 mil BTU 15.00
Name i , •, 9) 30-50 HP; absorb
I t7YYt �i S, A0 p COvt si yucQ t®v■ ■' q unit 1 -1.75 mil BTU 22.50
Prior to permit Mailing Address & 10) >50HP; absorb unit
issuance, a copy /J 5 o�S a...43 ea i1(.(Y >1.75 mil BTU 37.50
of all licenses /state Phone 11) Air handling to 10,000 CFM
are required if ea U 2 (,,� 0v\ 41� �j an g unit
[ -ci 4.50
expired in COT Oregon Const. Cont. Board Llc.# Exp. Date 12) Air handling unit 10,000 CFM+
database _ 5 ��___�___, ___ 7.50
Architect Name . 13) Non - portable evaporate cooler
4.50
or Mailing Address 14) Vent fan connected to a single duct
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
New 0 Repair 0 Replace with like kind: Yes 0 No 0 7.50
Residentia'F 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 '1'57
21) Clothes dryer, etc.
4.50
Type of fuel: oil 0 natural ga LPG 0 eleptnc 0 22) Other units
L0000 4.50
I hereby acknowledge that I have read this application, that the information 23) Gas piping one to four outlets
given is correct, that I am the owner or authorized agent of 2.00
the owner, that plans submitted are in compliance with Oregon State laws. 24) More than 4 -per outlet (each)
.50
Signatu o Own /Agent Date
Minimum Permit Fee $25.00 SUBTOTAL 1 4 C
G� era
X7/2( - / -5 - r7%
5% 2 * --1c-
Contact Person/Name Phone PLAN REVIEW 25% OF SUBTOTAL `S - T
Required for ALL commercial permits only
Ica d VA vk 1-1 e.:( vL-k- -,.._ 6.2.67-465,z TOTAL ,, ...:.; _ : , r:
*State Contractor Boiler Certification required
**Residential A/C requires site plan showing placement of unit .
: mechperm.doc rev 07/20/98
6/19/00 Activities for Case #: MEC99 -00039
2:05:15 PM
0*
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECA007 Application received 1/26/99 DEB MAIL DRA 1/26/99
kei
MECA008 Create Permit 1/26/99 DEB DONE DRA 1/26/99
MECA799 Final Inspection DRA 1/26/99
MECA720 Woodstove Insp 1/26/99 DRA 1/26/99
MECA750 Misc. Inspection 1/26/99 DRA 1/26/99
MECA060 (F) Issue permit 1/26/99 DEB DONE DRA 1/26/99
MECA845 Request inspection research 6/8/00 JMT DONE No Hold JMT 6/8/00
MECA880 Expired by limitation 6/11/00 HAP DONE No Hold AKJ 6/11/00
I ! Page 1 of 1 1 1
f .