Permit A , CITY OF TIGARD MECHANICAL PERMIT
r ; DEVELOPMENT SERVICES PERMIT #: MEC2000 -00188
+�- '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/18/00
PARCEL: 2S104AA -02400
SITE ADDRESS: 12265 SW 127TH AVE
SUBDIVISION: BELLWOOD ZONING: R -4.5
BLOCK: LOT: 073 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of furnace with like kind.
Owner: FEES
RUTLEDGE, MARK R AND LEE ANN Type By Date Amount Receipt
12265 SW 127TH AVE PRMT DEB 5/18/00 $50.00 0002276
TIGARD, OR 97223 5PCT DEB 5/18/00 $4.00 0002276
Total $54.00
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441 II
t � EXPIRED `�
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 obtain copies of these rules or direct questions to OUNC by calling (503)246 -9189. �_
Iss a By: Permittee Signature: C.rl/�
I
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the n-xt business day
Plan Check #
CITY OF TIGARD Mechanical Permit ApplictEE tiCEIVED Rec'd By
13125 SW HALL BLVD. Commercial and Residenti /Cm Date Rec'd 5
TIGARD, OR 97223 (< < Date to P.E.
(503) 639 -4171, x304 MAY 1 5 201; Date to DST J f
Type Permit# Mf. n -o0 8T
Print or T
YP QTY DEVELOPMENT Called
Incomplete or illegible applications will not be accepted
Name of Development/Project Description
inn h 1(,_ /� L-k.1 tae, Table 1A Mechanical Code Qty Price Amt
Job Street Address 1 suns# A) Permit Fee ,, ' 16.00
1) Furnace to 100,000 BTU
Address I v� o� l S 3' co i :`7 including ducts & vents see footnote 1,2 1 9.65 C I. GS
Bldg# City/State Zip 2) Furnace 100,000 BTU+
including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace
Owner riAcir lc R L l sot (� including vent see footnote 1,2 9.65
Mailing Address 5 4) Suspended heater, wall heater
1 a (p 5 C� ' h or floor mounted heater
5) see footnote 1,2 9.65
oZ Vent not included in appliance per 4.75
City/State Zit) I Phone Check all that apply: *Boiler Heat Air
_ _qG r`�- G�. I `7 2 3.I 5 /O_ L42V) For items 6 -10, see or Pump Cond Qty Price Amt
N a.. _ (or name of tiusmess) footnotes 1,2 Comp
6) <3HP;absorb unit to
100K BTU 9.65
Occupant Mailing Address 7) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 - HP; absorb
unit .5 -1 mil BTU 24.15
N ame 9) 30 -50 HP; absorb
Contractor unit 1 -1.75 mil BTU 36.00
5 CC'Qf 14 ee t,v0 >: -1 j . ( C. 10) >50HP; absorb unit
Prior to permit Mailing Address v //�����
w€ >1.75 mil BTU 60.15
-/
issuance, a copy C' c ( SE � , )1 )Ct .� mo
c,te - 11 Air handling unit to 10,000 CFM
of all licenses City/State Zip Phone 7.00
are required if {ii ^} 0;2 TraCa a3 li - 733 / 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.75
database I LI t_{ I 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
4.75
Or Mailing Address
15) Ventilation system not included in
appliance permit 7.00
Engineer city /state Zip Phone 16) Hood served by mechanical exhaust
7.00 -
Describe work to be done: 17) Domestic incinerators
12.00
New 0 Repair 0 Replace with like kind: Yes f No O 18) Commercial or industrial type incinerator
Residential, Commercial 0 48.25
19) Repair units
Additional information or description of work: 8.40
20) Wood stove /gas FP /other units/clothe dryer /etc.
7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas p< LPG 0 electric O 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 /! SUBTOTAL . ,,oc,a
I hereby acknowledge that I have read this application, that the information fi% SURCHARGE S . CO
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only ` x��_
TOTAL ,
Signature of Owner /Agent Date b'
o Other Inspections and Fees:
!il `C �k, 1C� t 5 S ' C� 1. Inspect outs of normal bus hours (m charge -two
Contact Person Na4Th Phone hours) $50.00 per hour
�l 2. Inspections for which no fee is specifically indicated (minimum
S1 %r 1 5 � fit C oc 3 t1 - 7 3 3( charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge - one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechania
units. ` \ �r l' )\ *State Boiler Certification required
Ex i mires site plan showing placement of unit
I:\mechperm.doc rev 02/4/99
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