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11655 SW GALLO AVE _
CITYOF TIGARD _ MECHANICAL PERMIT
DIEVELQPMENT SERVICES PERMIT#: MEC2002-00583
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/17/02
317E ADDRESS: 11655 SW GALLO AVE PARCEL: 1S134DC 07000
SUBDIVISION: GALLOS VINEYARD ZONING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG
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:
LPC; 3 - 15 HP: COMMIL INCIN:
MAX INPUT: BTU 1.5 - 30 HP:
FIRE DAMPERS?: 30 -50 HP: REPA0 Ft UNITS:
GAS PRESSURE: 50 + HP: WOO'.)STOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CL,;
2 10: 11A FPOM:HILLSBORO OFFICE 5036e10793 70:50359e1960 P:2/2
Mechanical Permit Application
"Da t e trece e I ve,d!
City of Tigard Project/appl.no.: Expiredatc:
Cityof Tigard Address: 13125 SW Hall Blvd 4,1911t 414 DitcissurA. By:_ Rocciptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Payment type:
tulding perinit no,:
Land use approval:
ng or accessory Cl Tenant improvement"
&2 family dwelli U Multi-family
U New
action 4Ad(lition/alteratioii/rei)iaceirient L3 10ther.
IF COMMOCIAll, N1A11UATI6X
.IQB S11-F INFORMATION i
Job address: 11t1,1 (A) Indicate quipment quantities in boxes below.Indicate thc'611ar,
Bldg.nn.: value of all niccharticil materials,equipment,labor,overhead;,
Tax map/tax lot/account Ho.: ,profit.Value$
Lot:
Block: Subdivision: • t for important applicationinformation inform and
11s,iject name: 0 teo schedule for residential pei,nit fee.,,
ZIP:
1114144 low
N14146111A
D % ripflonandlo 1'7
location of work on premises:�_"�np"J"
Desicrilpflon Qty. Res.oidy Rev 0""
7'1i'�4�611'
1.date of—co I inspection:
repiecky L
Tcn TH-11-11proventent or change of use: Air handling unit
I.Sexisting space heated orconditioned oYes DNo
Air conditioning(site plan required)—
---
Is existing space insulated?qYcs O AtFetationorexistiligliVA(:.systcm
A-A-11ANIt-All, CON'111ACTOR
oiler compressors
State boiler permit no.:
Business name: qD-,K14-t.r AMrHP Tons—I1TUfH
Address: S.C�7 f?j W IIQ c d a r n-p,--r Mir c i smoke d vt
Fire/stir -
State: Z111: site plan ret 111red
rep ace tae i IT—
city:�g T4--'_Pu�nP '
Lone: Fax:: E-mail: InstalWe tiTi7 c urrier T7'
Including ductwork/mit liner U Yes 0 No
1713 no,: -Tn7Fa1l/-i JpTacc7r_cloja`iC_heaters-suspendcri,
o..
Cityimetro lic.no.:/U 57k wall,or floor I motinted
Vp
Nairic(please print): or-ln;¢Wl- ant ora_p IaWceuthC. an furnace
R-effigeralinti-
Absorption units BTU/H
Chillers_ HP
Name:
Com E 0,ssors____. HP
_;idiirrss; miles,,.- RCA-9 1ir rimental exhaust and vent ton:
A pliancccvent�__
ps, 1-7
y
F-unail_: fox aust to
crx
oods
hood Litefit e,suppression system
Exhaust fan with single duct(bath fam)
Nnnle:' I-e
944
-rx-Flaust systema art from helting or A
Mailing address- 116�55 0 FuelpIpIng riddistributlon upto4ouuui.,
City; r Statc:6R�ZIP: 41 LPG NG Oil
-r Type:
C i"�Yn, /,
�P.,OF 11 C
Phone: 3 Fax: E-mail: -a-V77 11 cs-
9"', I�_, ..I - —
$2 PIPIng(Schenuttic i;_qn1rT)
Nurnher of outlets
Name: or equipmeni'... -
Address. Decorativefirtfilace
Cate: Insert-tyl!�
City: Wootiqtovc/pc.llet stove
Phone: L
ApplicaL,11's signature: -0 pate: 01 or:
01-
Narne (pfin!tL);
pennit fee.....................
11..11 jddkd. ;M--til-;j;.Plena car]jud&diciltin Im more ln(wma Notice:This permit application Mini
fee............... $
U Visa Cl MasterCard expirer if a pennit is not obtained 1,len review(at %) $
Cmdit card number -__----. - ---L.-1
DIrri - within 1 ao tl;lys aper it has bvcn State surcharge(8%)....$
$ accepted as complete. TOTAI. .......................$
'
Oht
-Amount 440-4617(60Y_