Permit ti
• 1
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City of and MECHANICAL PERMIT Planck/Rec. #9s- .27�a ¢
s- • -
• 131 SW Hall Blvd. APPLICATION Permit # MEC9s' O.j4 : "
PO Box 23397 Q ��
Tigard, OR 97223 �� I ✓�
(503) 639 -4171
- Name a Development .. Description
j 3L-J1 -
SW � I kri Table 3A Mechanical Code QTY PRICE AMT
Job 0./(d Pr 812-1 1) Permit Fee -o- -o- 10.00 .
Address LP
2) Supplemental Permit 3.00 -
(« of Walesa) l Furnace to 100,000 BTU
111�� I 1 Wl Ci 1 1 16 \ ) 1
1) incl. ducts & vents
f 6.00 t
Owner I" WI UV l I t Phone Furnace 100,000 BTU +
14almo Address 2) incl. ducts & vents 7.50
zp �� ���_, / Floor Furnance •
If � 3) incl. vent 6.00
«.» t fame of ) Y Suspended heater, wall heater
4) or floor mounted heater 6.00 .
Mirg#kk. Phone Vent not incl. in - •
OCCUP1nt 5) appliance permit 3.00 •
Corstato Lp Repair of heating, refrig.
6) cooling, absorption unit 6.00 •
v Cb I i 1 lJ :r lo I ) t Boiler or heat pump, air cond. .
� 7 to 3 HP absorp unit 10
e to 100K BTU 6.00
/_, 1 •+•v ph..... Boiler or comp, heat pump, air cond.
a C ti or r) �t$9. V 20L t " 8) 3 -15 HP absorp unit to 500K BTU 11.00
COrltr Or , - Boiler or comp, heat pump, air cond.
9) 15 -30 HP absorp unit .5 -1 mil BTU 15.00 •
s p. No. Coy ate. Tax No. ' - Boiler or comp, heat pump, air cond.
2 1
(Iii 10) 30.50 HP absorp unit 1 -1.75 mil BTU • 22.50
I hereby acknowledge at I �ave re ad this application, that the • - Boiler or comp, heat pump, air cond.
information given is correct, that I am the owner or authorized agent _ 11) > 50 HP absorp unit 1.75 mil BTU 31.50
of the owner, that plans submitted are in compliance with State Air handling unit to
laws, that I am registered with the Construction Contractors Board, 12) 10,000 CFM 4.50
that the number given is correct.. (If exempt from State registration, - Air handling unit •
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
` `1 Ventilation system not •
CI;1 Q {�, `V qs 16) included in appliance permit 4.50
Signature (own« « \ v V � oa Hood served by . 17) mechanical exhaust 4.50
Describe work new 0 ddition alteration 0 repair 0 Commercial or industrial .
to be done residential non esidentiat 0 18) type incinerator 30.00 • .
Existing use of Other i.e., woodstove, water .
building or property 19) heater, solar, clothes dryers, etc. 4.50
1
Proposed use of 20) Gas piping one to four outlets
1 l 2.00 �
building or property
21) More than 4 -per outlet ..0
Type of fuel - oil 0 natural gas LPG 0 electric Q
NOTICE
Minimum Fee $25.00 SUBTOTAL.
PERMITS BECOME VOID IF WORK OR CONSTRUCTION • -
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR . 5% SURCHARGE 1,2-C7
IF CONSTRUCTION OR WORK IS SUSPENDED OR .
•
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL .
AFTER WORK IS COMMENCED.
TOTAL
Special Conditions
Date issued by
ko MECHPMT
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