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A CITY OF T I G A R D _ MECH� NICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC1999-00501
13125 SNI Hall Blvd., Tig:rd, OR 97223 (503) 639-4171 DATE ISSUED: 11/19/1999
SITE ADDRESS: 10855 SW ERRO! STPARCEL: 2S 103AA-01401
SUBDIV!SiON: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 003 JURISDICTION: URB
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:
_ FUCI-TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX !NPUT: BTU 15-30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP: REPAIR NITS:
GAS PRESSURE: 50 + HP: ALO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OI.+ER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Replace electric heat with new gas furnace and add gas piping, for an existing single family dwelling.
Owner: _ FEES
BUBLITZ, RUDOLF F Type By Date Amount Receipt
BRUNFIILDE E � � PRM4 DST 11/19/19E $50.00 99-319895
PO 80!( 230506 5PC2 DST 11/19/19 $4.00 99-319895
1 iGARD, OR 97281
Phone: % � / ,_ Total $54.00
Contractor:
OWNER
REQUIRED INSPECTIONS
I;as Line Insp
Phone: Heating Unt Insp
Reg#: Final Inspection
h
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All 1,-)rk 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. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR c,52-001-0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)248-9189.
Issue By:
Permittee Signature
Call (503) 639-4175 y 7:00 P.M.for inspections needed the next business day
CIT`i OF TIGARD Mechanical Permit Application Plan
Beck#Rec'd _
13125 SW HALL BLVD. Commercial and Residential Date Recd _
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 r /`►�/�7 Date to DST
Print or Type Permit#fie
Incomplete or illegible applications will not be accepted Called
Name of DevelopmenvProject Description I
//o u J ra 14 r Table 1A Mechanical Code Qty Price Amt
Jub Street Address Suite# A) Permit Fee 16.00
Address /0 e r5 �, W. L 1,7" ✓lP"I 1) Furna(,e to 100,000 BTU
Bldg# 'ti/State zip Including ducts&vents 9.65
J 2) Furnace 100,000 BTU+
including ducts&vents 12.00
Name(or name of business) 3) Floor Furnace
J Owner / ✓do, U 0/ J L including vent 9.65
/ Mailing Address // 4) Suspended heater,wall heater
/ Tio 1 d /M f'S 5 5•W L y l a yil ee T or floor mounted heater 9.65
5 Vent net included 0 appliance ermit _4.75
CRY/State �1 pzip Phone Check all that apply: 'Boiler Heat Air
l l oil i V•1 / 1.1 a 3 6 -7y) For Items 6-10,see or Pump Cond Qty Price Amt
Nam or name of business) footnotes 1,2 Com ••
6)Repair unitQ
Occupant Mailing Addross 6.40
7)<3HP;a',sorb unit to
100K BTJ 9.65
City/State zip Phone 8)3-V HP;absorb unit
100k to 500k BTU 17.65
Contractor Name ^ 9)15-30 HP;absorb
ra,/4 loe— unit.0-1 mil BTU 24.15
Prior to permit Mailing Address 10)30-50 HP,absorb
Issuance,a copy unit 1-1 75 mil BTU 36.00
11)>50HP;absorb unit>1.75 mil BTII
of FII licenses CIIY/Stale Zip Phone 60.15 _
are required If 12)Air handling unit to 10,000 CFM
expired In COT Oregon const Cont Board tic N Exp.Dato
_ 7.00
database _ 13)Air handling unit 10,000 CFM+
Architect Name CAPIRPrN11.85
4,11.1 Li 14)Non-portable evaporate cooler
Or Malllnp Address 7.00
15)Vent fan connected to a single duct
Engineer Cnv/Stale zip Phone 16)Ventilation system not included In 4.75
_
appliance permit 7.00
l3escribe wurk to be done: 1 1)Hood served by mechanical exhaust
_ 7.00
New O Repair-0 Replace with like kind Yes O No O 18)Domestic incinerators
ResidentWI Commercial O Modification O 12.00
_ 19)Commercial or industrial type Incinerator
Additional information or description of work. 4825
IF,Fc` f fkiAi"�NSPj/�cc ��7�'S 20) Other units,Including wood stoves
tc'eex A,4 7.00
NOTE: For Commercial projects only;Units over 400 lbs.,located on the 21)Gas piping one to four outlets
roof,require structural calcs.prepared 4y licensed engineer. 3.75
Type of fuel: oll O natural gnIV& LPG O electric O 2.2)More than 4-per outlet(each) .75
I I hereby acknowledge that I have read this application,that the information Minimum Permit Fee$50.00 SUBTOTAL
given Is co sect,that I am the owner or aulhorizer'agent of 8%SURCHARGE 't
PLAN REVIEW 25%OF SUBTOTAL
the owner,that plans submlN-id are in compliance with Oregon State laws. Required for ALL commercial permits only
Signature of Ovvtier/Agen►t/���i1 Date r� TOTAL , -
u Other Inspections and Fees
Contact Person Name — Phone
2 / t Inspections outside of normal business hours(minimum charge-two hours) $50 00 per hour
u r It~ J B(J h/I 2 Inspections for which no fee Is specifically Indicated (minimum Marge-half hour)
Foonotes for commercial projokIlls only: $50 00perhour
3 Additional plan review required by changes,additions or revisions to plans(minimum
1. Provide full schematic of existing and proposed gas line and pressure, charge-one•haH hour)150 00 per hour
2. Provide drawings to stale showing existing and proposed mechanical *State Contractor Boller Certification required
units, "Residential A/C requires site plan showing placement of unit
1:lmechpenn.doc rev 11/1/99