10495 SW JOHNSON STREET-1 �
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10495 SW JOHNSON COURT
-ITY OF TIGW�',,D PECEIPT OF F'i ','IIIEtI*T RECEIPT NO.
(-'HEr,tl'* AIIGUNT v
NAME HEWTTT . DEBORAH CASH AMOU1,11, c
AD 0 F:.",E.."f» s f364�-.) ';(%I trieTH FAYMENT DATE % t
SUPI)l lyl 15 1014 t
FAEAVEP-! ,'ON. OP 7 0 V)49S SW JOHNSON G I
r,,,I..JF,,,F,n-ISF oF PA, NEN'r AMOUNT F'O ID PURPOSE fir.
FAMENfT AMOUr-JT FAT 0
M
F I RF Pt,ACE I NSPE,'.:-f J ON I-EE
TOTAL AMOL114T PAID Q0
CITY OF TIGARD MECHANIC;! PERMIT Receipt #
13125 SW HALL BLVD. Permit
P. O. BOX 23397 —
�I' Description
T GARD, OR 97223 n{y� i,I Table 3A Mechanical Code A — — CITY PRICE _AMT
(503)639-4175 / �f , �'� 1) Permit Fee -0 10.00
i Name of Davebprtrarp / --
2) Supplements!Permit_ 3.00
W _�1Sr1Y)
,fob Address' �; 11 Furnace to 100,000 BTU
I Address / /�(�,( incl-ducts&vents 6.00
Tax Map No. Furnace 100,000 BTU +
Bial* d�Axftilrlon _2) incl.ducts&vents_-- 7.50
Name(or of huskon) Floor Furnace
�� ,(-� A-1113) incl vent--_--`__ 6.00
M-OV Adarw p d Suspended heater,wz!I heater
Owner Iti ) or floor mounted heater- - 6.00
CNyrState ap 5) Vent not incl.in77 3
/����r ,/1 ` �?'1�,3 _appliance permit- —
Name(or name of businessl)L_ (- - - Repair of heatkg,refr ig.,
6) cooling,absorption unit 5
Mailing Address - Ph" Boiler or comp to 3 HP
Octtrpant )
absorp._uni• o 10_0,000 B I a 6.00
CHy"Slato_— --- __._ ap ---- Boiler or comp to 3 HP-15 HP
8) absorp.unit to 500,000 BTU 11.00
Name ) Boiler or comp 15 30 HP
9 absorp.unit 16-1 million 15.00
Maiiiny A�n.es- Phone --Boiler or comp to 30-50 HP
10) absorp.unit 1 -1.75 million 22.50
Contractor cityiSiato - Zip - Boiler or comp to 50 HP -
11) absorp.unit 1,750,000 BTU 31.50
State Registration No - v City Bus TaxxNo- 12) Air handling unit to -- x.50
10,000 CFM
I hereby acknowk" that I have read this Air handling unit
application that the information given is 13) 10,000CFM 1 7.50
coned,thn',am the owner or authodri id agent of the owner,that plans submitted are in —--- ------- --_--_------ _
t:. eq aence wdh Slate laws•that I am n�gisterod with the State nuilders'&lard,that the 14) t!Jn po4able
nur-tmr given is mmect (11 exempt from State registration please give reason tx low) evapo;ate cooler 4'�
15) Vent fan connected
to a single duct
- -- 3.00
- -- Ventilation system not
I6) included in appliance permit 4
Hood served by
17) mechanical exhaust 4
me
Signature(owner a agent► -- - --- uwie — Domestic type
Describe wort: 11 addition I I alteration I I�repair I I 18) incinerator 7.50
to be done --.--residential-[ I_ non-residential I 1 Commercial or industrial
Existing use o1 - - -- t 9) type incinerator_. - _ -_ 30.0)
builuing or property -. _-- _-_--- -- - - - --- 20) Other i.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers,etc. _
building er property 21) Gas piping one to four outlets 2,00
Type of fuel- oil natural gas ( 1 LPG I I electric I I -
22) More than 4-per outlet
NOTICE — ---
SUM-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- ----- ---- -
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 160 5%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDEn OR PLAN REVIEW 2596 OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER - ------- -
WORK IS COMMENCED TOTAL
Special Conditions
- - .._ --- ----- _�- Date issued by
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