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15292 5W ALUERBROOK PLACE
CITY CSF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171
'OPT
its pR"rit i� issued subject to the regulation: —fv nf' it
-igard 1i nicipal Catte, State of Ore. 9ptctalty Caries and all
:7plicable laws. All work will ae done in accordance with
+;proved p'. r- This pe-sit will expire if *PO i; rel c'ar`el
itl— 19Q days a° issuance, or if work is ,usper�pe r�, voro
`►ar !P" days, 0"W.104t Oregon law requiret yc., tr: f0hw —lir.
loptre bi ine [Iregon Utility Ratification Centv, 'hoer
4} fcrlll :, 1AR V-41-010 through (ti#R .
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CITY0F TIGARD Mechanical Permit A lication Plan Check
P p Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd L �i
TIGARD, OR 97223 Date to P E._
(503) 639-4171, x304 Date to DST_ _
Print or Type Permit# nr-
Incomplete or illegible applications will not be accepted called
NArtle of Development/Project Description
-fable 1A Mechanical Code _ Qt Price 4mt
Street Address Suite# A) Permit Fee _ 10.00
Job 11 1) Furnace to 100,000 BTU
Address i �� L kJ 44,B'� 'k I {7
_ Including ducts&vents see footnote 1,2 ! 6.00
Bldgr CRyfStata Zlp 2) Furnace 100,000 BTI +
including dL.cts&vent., see footnote 1,2 7.50
Name(or ame of business) t 3) Floor Furnace
Owner \r e c_ int udin vent see fuotnote 1,2 600
___
Mailing Ad - 4) Suspended heater,wall heater
II II or floor mounted heater _see footnote 1,2 600
Ftry �. `� IA-erG'uC k_ f' 5) Vent not included in appliance pe,mit
C"/Stale Zip Phone _ 3.00
Check all that apply *Boiler T-Heat Air
Name."((bbr name of bus fess) For Items 6-10,see or Pump Cond Qty Price Arr'
footnotes 1,2 Comb
6)<3HP,absorb unit to
Occupant Mailing Addre/aa ���-.A ^ L 100K BTU _ _ 600 _
-fry—r"� --_ 7)3-15 HP,absoib unit
CRY/stale Zip Prone 100k to 500k BTU 11.00
8)15-30 HP;absorb
unit.5-1 mil BT_U _ 15.00
Contractor Name 9)30-50 HP;absorb
unit 1-1 75 mil BTU _ _ 2250
Prior to permit Mailing Address 10)>50HP,absorb unit
issuance,a copy I o I- ,'' 40 1. >1.75 mil BTU __ t _ _ 37.50
of all licenses CNylstate c Zi Phone 11)Air handling unit to 11`1^" CFM
are required if -!l -{'2 I �1 ! ___- _ 4.50
expired in COT o C at.Cont Board tic N Exp go,^ 12)Air�andling unit 10,000 CFM+
_ database 'V,i`i ___ _ - _ 7.50
APchiltect Name 13)Non-portable evaporate cooler
4.50
or Mailing Address — _ 14)Vent fen connected to a single duct
3,00
15)Ventilation system not included in_
Engineer CRY/Stale honelqpp liance permit _ _ 4.50
16)Hood served by mechanical exha��t�
---- 4.50
Describe work to be done: - -- -
r���C t `�1`j (I 1 t 17)Domestic incinerators
New D Repair O Replace with like kind. Yes O No O 1.50
Residential' Commercial O 1 B)Commercial or Industrial type incinerator
30.00_ _
Additional Information or description of work: 19)Repair units
4.50
20)Wood stove
NOTE: For Commercial projects only;Units over 400 lbs.require 4 50
structural gas talcs 21)Clothes dryer,etc.
Type of fuel: oll O natural gas LPG O electric O 4.50
22)Other units
I hereby acknowledge that I have read this application,that the information _ _ 4.50
given is correct.that I am the owner or authorized agent of 23)Gas piping o, to four outlets 1
the owner,that plans submitted are in compliance with Oregon State laws. See footnote 12.00
?A)More than 4-per outlet(each)
Signature oy d#%gent Date
Minimum Permit Fee$25.00 _ SUBTOTAL S
Cdntact Person me ' Phone 25
_ _T cp �1 r� ( �r, 5"/o SURCHARGE
r '� PIAN REVIEW 25%OF SUBTOTAL
roonotes for commercial proJobts only: r I Required for ALL commercial ermits off_
1 Provide full schematic of existing and proposed gas line and pressure TOTAL lr7
2 Provide dra Nings to scale showing existing and proposed mechanical
units "State 'ontractor Boiler Certification required
-Residential A/C requireb site plan showing placement of unit
I Umechperm doc rev 0214!99
CITY OF Ti aARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - -- — --
/ / Cy BUP
� 3"0 _Date Requested----- _J_ // jD `~ _AM PM _�y� BLD
Location � - G ,Ei� ri /�� l Suite MEC
r - -
Contact Person � --- Ph ,�-7��- 5 �j PI-M _
Contractor /j` f4� ,/— t�n Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain -
SGN
Crawl Drain
Inspection Notes:
Slab
Post 8 Beam �--- l � � � -� - SIT
Ext Sheath/Shear - {� _'Oe) -- -'0 D .
Int Sheath/Shear
_ C
Framing
Insulation
Drywall
----_" -"--
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof - - -
Misc:_ - --- --- ----- ----
Final
PASS PART FAIL ----_--
PLUMBING
Post&Beam - —--- .._.---— -- - -- — -- --
' Under Slab
Top Out -- - - -- ---- - -- -- -----
Water Service
Sanitary Sewer ---- - -
Rain Drains
Final _---- -
PASS PART FAIL
CHANICA -
Post 6 BeamRQu ,.�.
gni In -- ----
as�Line;`
Smoke Dampers -
`SSS . PART FAIL
RICAL —
Service
Rough In - --
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL - _
SITE —
Backfill/Grading
Sanitary Sewer
Storm Drain ( j Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE ( ]Unable to inspect-no access
ADA
Approach/Sidewalk
hepate Inspector Ext
Final
PASS PART— FAIL DO NOT REMOVE this inspection record from the job site.