Permit A CITY OF TIGARD MECHANICAL
d r. �^ DEVELOPMENT SERVICES PERMIT
' !+�-ilil 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 RE RM I T # • ME C98 -0495
• DATE ISSUED: 11/05/98
PARCEL: 15135DD -03301
SITE ADDRESS...: 11945 SW PACIFIC HWY #248
SUBDIVISION • HOFFARBER TRACTS NO.1 ZONING: C —G
BLOCK • LOT -002 JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •COM UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:B2 VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP • 1 DOMES. INCIN: 0
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: 0 (= 10000 cfm: 0 GAS OUTLETS.: 1
FURN )=100K BTU: 0 > 10000 cfm: 0
Remarks: Mec absorbtion unit.
Owner: FEES
20/20 EYE CARE type amount by date recpt
11945 SW PACIFIC HWY PRMT $ 25.00 DEB 11/05/98 98- 310601
SUITE 248 EXP6 ED 5PCT $ 1.25 DEB 11/05/98 98- 310601
TIGARD OR 97223 PLCK $ 6.25 DEB 11/05/98 98- 310601
Phone #:
Contractor:
ROTH HEATING
ROTH ZACHERY HEATING INC
PO BOX 1265 $ 32.50 TOTAL
CANBY OR 97013
Phone #: 503 - 266 -1249
Reg #.. 000140
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 952 -001 -0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
Issue P / it/L # P e r m i t t e e Signature: 4 C T S(/ `� cc_-
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Plan Check # IV C
CItY OF TIGARD Mechanical Permit Application Rec'd By P
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 0- Date to DST !1 m✓ O
Print or Type Permit # /; 7 ' ,,
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
— Ai 6IkC PLAZA- Table 1A Mechanical Code Qty Price _ Amt
Job Street Address Suite# A) Permit Fee 10.00
Address 1\ q45 sv+ acRic, ‘1Wy , 7-4S 1) Furnace to 100,000 BTU
including ducts & vents ( 6.00
Bldg# City /State Zip 2) Furnace 100,000 BTU+
J1 6S.6LP including ducts & vents 7.50
Name (or name of business) 3) Floor Furnace
Owner 161/46-k) Qlla_Z- p NiYv\% . Oiz (5- including vent 6.00
Mailing Address 4) Suspended heater, wall heater
ZOO or floor mounted heater 6.00
G� 0� 5) Vent not included in appliance permit
City /State nn�� Zip Phone 3.00
M\LAIJASY.A VIZ. p, 17 Z2,7_ 654-1116 CHECK ALL Toiler Heat Air
Name (or name of business) �^ THAT APPLY: or Pump Cond Qty Price Amt
Z I Lo E 1MLF Comp ..
Occupant Mailing Address 1bsorb unit to
\ ) ' 6.00 („ 00 K BTU
I 9As SW ,Qi�U \L 1A ' 7) 3 -15 HP;absorb unit
c ity/State Zip Phone 100k to 500k BTU 11.00
1 tGi<ieA 1 Oa- 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 15.00
Contractor Name p� 9) 30 -50 HP; absorb
-01- �'S 6 d' Y+ / C. unit 1 -1.75 mil BTU 22.50
Prior to permit iin A ddress 10) >50HP; absorb unit
issuance, a copy 1 • 1 >1.75 mil BTU 37.50
of all licenses City /State Zig Phone 11) Air handling unit to 10,000 CFM •
are required if CANsy 1 0 (70\ s 7 -64 , - 4.50
expired in COT Oregon Const. Cont. Board Lic.# Ex . Da 12) Air handling unit 10,000 CFM+
database 1 4004'3 97 I T 100 7.50
Architect Name 13) Non - portable evaporate cooler
4.50
or Mailing Address o O 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: YesX No 0 7.50
Residential 0 Commercial ' 18) Commercial or industrial type incinerator
30.00
Additional information or description of work: 19) Repair units
4.50
20) Wood stove
4.50
21) Clothes dryer, etc.
• 4.50
Type of fuel: oil 0 natural gas LPG 0 electric 0 22) Other units
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 1 2.00
the owner, that plans submitted are in compliance with Oregon State laws. 24) More than 4 -per outlet (each)
.50
Signature of Owner /Agent Date
,--- ei,i7L____ cl ... Minimum Permit Fee $25.00 SUBTOTAL / _
5% SURCHARGE t
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
1-00W'016'11- Required for ALL commercial permits only
®� C- ; TOTAL
■ *State Contractor Boiler Certification required
**Residential NC requires site plan showing placement of unit
I:\mechperm.doc rev 07/20/98
• OVER- THE - COUNTER (OTC) PERMIT PLAN REVIEW
COMMERCIAL MECHANICAL PERMIT CHECK LIST
Description of Project: `)Lie Z.et_ 4tC/
Class of Work: &6: Floor Furnace: Evap Coolers:
Type of Use: ,,‘/n Unit Heaters: Vent Fans:
Occupancy Grp: 6 Vents w/o Appl: Vent Systems:
Stories: Boilers /Comprsrs: Hoods:
Fuel Types - 0 - 3 HP. ( 1) Repair Units:
/ / / / 3 - 15 HP. Wood Stoves:
Max Input: Btu: Air Handling Units Cio Dryer:
Fire Dampers: < = 10000 cfm: Oth Units:
Gas Pressure: H / M / L > 10000 cfm: Gas Outlets: r
No. Of Units:
Furn < 100k Btu:
Furn > =100k Btu:
NOTES:
tv........ t..s ..........:.»
$ Permit Fee
Pas Line I ioo_; $,<- Plan Review
apical Inspection ' $ 1 5% State Surcharge
Cooling Unit Inspection $ Additional Permit Fee
Shaft Inspection $ Additional Plan Review Fee
Hood Inspection $ Inspection Fee
Fire Suppr Inspection $ Miscellaneous Fee
Duct Inspection
Fire Alarm Inspection
Fire Damper Inspection REMARKS:
Miscellaneous Inspection
Fire Alarm Inspection
final Inspection
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is \ovrcntr.doc (dst) 8/97
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