Permit CITY OF TIGARD MECHANICAL PERMIT Receipt#
13125 SW HALL BLVD. Permit # /JCC-9/ 0/23
P. O. BOX 23397 Description
T I GARD , OR 97223 Table 3A Mechanical Code CITY .PRICE AMT
(503)639 -4175 1) Permit Fee -0- -0- 10.00
Name of Development 2) Supplemental Permit 3.00
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Job Address / /` I I Furnace to 100,000 BTU 6.00
Address /3, f �j(/ i'r pbc dwy 1 ) incl. ducts & vents
j ?
Tax Lot Map No. ) Furnace 100,000 BTU + 7.50
2 incl. ducts & vents
Lot Block Subdivision
Name (or name of business) ' 3) Floor Furnace 6.00
incl. vent
Mailing Address Phone 4) Suspended heater, wall heater 6.00
Owner - or floor mounted heater
I Vent not incl. in
City/State Zip
5 ) 3.00
appliance permit
Name (or name of business) /— // 6) R of heating, refr ig., 6.00
�Y�1 /7!0/9 /2e74 Chi7G cooling, absorption unit
r �
Mailing Address phone 7) Boiler or comp to 3 HP 6.00
Occupant absorp. unit to 100,000 BTU
City /State Zip 8) Boiler or comp to 3 HP -15 HP 11.00
absorp. unit to 500,000 BTU
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Name 9) Boiler or comp 15 -30 HP 15.00
- absorp. unit 1/2 -1 million
Mailing Address Phone 10) Boiler or comp to 30 -50 HP 22.50
absorp. unit 1 -1.75 million
Contractor Zip 11) Boiler or comp to 50 HP 31.50
absorp. unit 1,750,000 BTU
State Registration No. City Bus. Tax No. 12) Air handling unit to 4.50
10,000 CFM
Air handling unit
I hereby acknowledge that I have read this application that the information given is 1 10,000 CFM + 7.50
correct, that I am the owner or authorized agent of the owner, that plans submitted are in
compliance with State laws, that I am registered with the State Builders' Board, that the 14) Non portable 4.50
number given is correct. (If exempt from State registration please give reason below). evaporate cooler .
15)
Vent fan connected 3.00
to a single duct
16) Ventilation system not 4.50
. included in appliance permit
17) Hood served by 4.50
mechanical exhaust
Signature (owner or agent) Date 18, ) Domestic type 7.50
Describe work ❑ addition ❑ alteration,Q repair ❑ incinerator
to be done residential ❑ non -resid ntia 19) Commercial or industrial 30.00
Existing use of type incinerator
building or properly 20) Other i.e., woodstove, water 4.50
Proposed use of heater, solar, clothes dryers, etc.
building or property • 21) Gas piping one to four outlets 2.00
Type of fuel — oil ❑ natural gas ❑ LPG ❑ electric ❑
' 22) More than 4 -per outlet . .
NOTICE SUB -TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 5% SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25% OF SUB -TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. TOTAL
Special Conditions
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• Date issued by
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