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1277U SW ASSH AVENUE
Address)�?,��Q � � Permit No.
Flame of Occupant , ,k Permit :harge.,.______________ _
cnpn-';160� Joe-
------ -- Paid by___- ---
Date cr.1nnected —
Type o` Building 1 .L�= _ Inspection fee_
Service Rate o�'
— — — _ Paid by - --- bate�..__..------
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Contractor— d-/ Assessment Paid
Size of connection_-- `_
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City of Tigard Mechanical Permit �To Fee t _ �o
New Installelicon ;' Replace Relocation (] Aodition ❑ Altbration ❑
/ TOTAL_—... �
/ OWNER
Ar),)RESS a /q1 y6 til- r��� /�r�0X41, WORK ADDRES IL7 3D <e, ASIC AU.
PHnNE���� —�i 6 APPLICANTWd LHeat Input Input Rating jBTU Per Hour) '7S', rr,60 Vent Size Flue Size _/
FUEL OIL D GAS(9 ELECT Fj OTHER
ITEM NO. FEE ITEM NO. FEE
For l3suance of Permit _ 3.OU Air Condition Compressor 15 to 30 HP 10.00
New: Under 100,000 BTU �, 4.00 Air Handling 10,000 CFM 3A0
New- 100,000 BTU&over �— 5.00_ Air Handling Over 10,000 CFM
FIoor Furnace 4.00 —Evaporative Cooler — 3.00
Well• Floor - Suspended 4.00_ Range Vent Fan _ _ 2.00
In,.all Vents Only _ 2.00 —Vent System_ 3.00
Repair Heti&Cooling 4.00 Hood Commercial y� — 3._00
Air Conditiin Compressor Under 3 HP 4.00 Commercial Duct System 10.00
Air�Coo -'itiun Compressor 3 to 15 HP- 7.50 _
I,NSPECTDH'S COMMENTS.
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTP,AC"CORS
APPROVED BY DATE _ ISSUED BY �� D TE ^_-
RECEIPT NO.
774 Signature of Applicant
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