Permit CI1Y OFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT ME PE I CAL
PE R R MM I T
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PERM I T # • MEC94 -0280
639 -4171 DATE ISSUED: 10/05/94
PARCEL: 2S111BD -03100
SITE ADDRESS...: 09770 SW PEMBROOK ST
SUBDIVISION • CLOUD CAP ZONING: R -3.5
BLOCK LOT •13
CLASS OF WORK.. :ALT 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:
/WOD/ / / 3 -15 HP....: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP - REPAIR UNITS:
FIRE DAMPERS ?..: 30 -50 HP • WOODSTOVES..:1
GAS PRESSURE...: 50+ HP • CLO DRYERS.. :
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.:
FURN < 100K BTU: <= 10000 cfm: GAS OUTLETS.:
FURN > =100K BTU: > 10000 cfm:
Remarks: WOOD BURNING INSERT AND LINED CHIMNEY
Owner: FEES
ROD AUGUST INE type amount by date recpt
9770 SW PEMBROOK ST PRMT $ 25.00 JF 10/05/94 —
SPCT $ 1.25 JF 10/05/94 —
TIGARD OR 97224
Phone #:
•
Contract or:
TOM BISHOP
12195 SW CANYON RD
BEAVERTON OR 97005
Phone #: 644 -7868 $ 26.25 TOTAL
Reg #.. : 54696
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 F i n a l Inspect ion
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.
Permittee Signature: ZnIZY,c L •
Issued By: / „ ��
Call for inspection — 639 -4175
City of Tigard t MECHANICAL PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION Permit # /YICG�/Lf -
PO Box 23397 _ Tigard, OR 97223 ‘ - G
(503) 639 -4171 C'/4cyr, 71 v,.
Nano d o.v.lop«
mu 07 '.---' Description
Table 3A Mechanical Code QTY PRICE AMT
Addnw
Address
C? 10 SW Imb Ya'k 1) Permit Fee -0- -0- 10.00
A ess
T Q axc ate— Q7aa L 2 ) Supplemental Permit 3.00
w.. �y» a bosom 4) ` Furnace to 100,000 BTU
1 ?c.c k A UC9 U St t y Q 1) incl. ducts & vents 6.00
Adis. U Furnace 100,000 BTU +
O 1790 & ?Q w ) ono l 518.76)1 2) incl. ducts & vents 7.50
• Floor Fumance
3) incl. vent 6.00
N+ t (o U rn• Y q ,�� Suspended heater, wall heater
4) or floor mounted heater 6.00
Mang Adxkoss Phone Vent not incl. in
Occupant SA M L 5) appliance permit 3.00
�» LP Repair of heating, refrig.
6) cooling, absorption unit 6.00
Nam. Boiler or comp, heat pump, air cond.
Q Yv. Z∎ 5\'109 l.0v16Av'rtc.i10►ti 7) to 3 HP absorp unit to 100K BTU 6.00
axing Ackkosa Boiler or comp, heat pump, air cond.
Contractor ! 5 5L) �M y y &' 6 -C/t 5 8) 3 -15 HP absorp unit to 500K BTU 11.00
Boiler or comp, heat pump, air cond.
'i QP > 9) 15 -30 HP absorp unit .5 -1 mil BTU 15.00
Saito R*t.Don No. el Sus. Tax No. Boiler or comp, heat pump, air cond.
s yepe bas 10 30 -50 HP absorp unit 1 -1.75 mil BTU 22.50
I hereby acknowledge that I have read 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 Contractor's 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
• Ventilation system not
at f IS- 9 16) included in appliance permit 4.50
sew. (o•n^N or agora) de D Hood served by
. 17) mechanical exhaust 4.50
Describe work new Q addition Q alteration 0 repair 0 Commercial or industrial
to be done residential fig, non- residential 0 18) type incinerator 30.00
Existing use of Other i.e., woodstove, water
building or property 19) heater, solar, dothes dryers, etc. 4.50 y, 50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property
21) More than 4-per outlet
Type of fuel - oil 0 natural gas 0 LPG 0 electric 0
NOTICE
Minimum Fee $25.00 SUBTOTAL 00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION .'
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE f , as -
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 0914015-.
Special Conditions
Date issued by
.c PcumO.v