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CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT t: MEC2001-00219
DATE ISSUED:
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S 11 2S11 B5C-
C-16300
SITE ADDRESS: 12345 SW KING RICHARD DR
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTIOI`I: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF L T HEATERS: VENT FANS: 1
OCCUPANCY GRP: R3 VENTS W!O APPL: 1 VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES 0 3 HP: DOMES. INCIN:
GAS 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP' WOODSTOVES:
GAS PRESSURE: 50 +- HP: CLO DRYERS:
FURN < 100K BTU: 1 —AIR HANDLING_ UNITS_ _ OTHER UNITS:
FURN >=100K BTU: 0 — 10000 cfm:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: Replace oil furnar•n with gas furnace; watwi heater vent and gas outlet.
Owner: _ I FEES
-HURSH, NEWTON + NELLIE H TRS Type Ey Date Amount Receipt
12345 SW KING RICHARD DR I PRMT BB07/06/20( _ $72 50 KING CITY
KING CITY, OR 97224 5PCT BB 07'06/20( $5.80 KING CITY
Total $78.30
Phone: -- -
Contractor:
C & S HEAT AND AIR
2214 NE 99 ST
VANCOUVER, WA 96665 REQUIRED INSPECTIONS
Mechanical Insp
Phone:360-573-1638 Heating Unt Insp
Reg#: Final Inspection
This permit is issued subiect to the regulations contained in the Tigard Municipal Code. State of Ore. Specialty Codes
and all other applicable law All -..,ork will be done in accordance with approved plans. Th's 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 OAF; 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9189.
Issue By: . f (If Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for Inspections needed the next business day
07/06/2001 09:58 9036393771 CITY OF KING CITY PAGE 02
Mechanical Permit Application
Date tscelved Permit no.:
Cit Df � and ,�" "� (�' Rojecl/apal ro.: 13xpltedale
A.ddresa: 13125 S�W Hall Blvd,Tigard,OR 97223 nate icsner
�By- � Receipt no.:
C'iryofTignrd Phone: (503) 639-4171 -
Casefile na Payment type.
Fax: (50 ) 595.1960 -- '-
—
Buildingpermit no,:
Land use. approval: _�--,-__--------
U MuIH family L Tenant improvement
TUNrW
2 family dwelling or accessory 'J Add ition//nUe at on/replacement `l Other: _ -eonsuuelian
--I MM , �' Indicate equipment quantities In boxes below.Indicate the dollar
Job address: 5 _��) / ��n value of alulpment,labur,overhead,
Bldg.no.: r Surte l mechanical materials,eq
no.. - — -- r r V 4,
Tax ma /tax lot/account no.. __
1U Block: , Subdivision: *Seechecklist for important application infolYrtatlon an
jurisdldinn'n fee schedule for residential permit fee.
Praject name_: / Luigi 0
�----
rll /county: ZIP: r "i a 111111011 ON
p,�,�ription and location of work on premises- �__2L�
/-fin A/�1r t"' wt 1 ly F/� 4_. Nli 1� rer(ea) Total
110i
De�riptluu Qty. Recon] Rvs,unlyj
Est.date of coin )etioNinepectian: � - O / Q- �� v�--
Tenant improvement or change of use. Air handling unit Clan o° _
Is existing space heated or conditioned?LI Yes O No -git,:unditinning(eii�e��a.�n_rruedj
Is existrig spa-insulated?O Yes U Na AI[eratlun n etciyting HVAt'syatr.m �__
nitwnompressote w
State boiler pcanit no,:
Business name: (" /� f fj_l n -_ —____ HP Tons BTUM
Addm.;s: lr ` rre/smo a em a uetamo a electors
- --- -- _
CI /Cp✓vr:R ... - I`�Inr, W_jZ1P �� S ea�ue p ;ttT-ro are ) ---
-- 1 Inata �eae�irn,^.c ume g! H /
Phone:a.Q -/67 Faa i F mrul Includin duotwortc/ventllner Yea o
CCB no.: f3�0 .L _ - -- --- ne[al rap ac ro ocatrheaters-suspended.
City/metro lie.na.: wall,or floor mounled
L E S' - ant fora iianp�cc o lett an furnace
Nnrnr(pleasr.pt•int): l-- r geon-
Absorption units ___ BTU/H _
Chillers-- — HP —
Name: L S_d_�i 1rL Com ressore _ NP
Address: a'/ /►/ q _ —� roma 1 ex ttetl an rerrl lel on:
City_ JL !/ /L State:
Pbone, - .1 Fax: Email erex sue►
Hoods�Rlre• tc en axtnat
hood fire suppreeaioo systerr.
Exhaust fan with single duct(bath fans)
_..w--- Rxhauat sy st,m a art from hcat in it or AC
Mailing address: Ron(up to 4 outlets)
City Suite: ZIP: _ Ty1,Pc Na oil -
Phone: f tut. E rnnil! � Fuc I ing each additional oval oullrts
rocas piping(ac
Number of outlets
Naln•.: —_ Aer�rtiYl rip lance oreqnl-paterih
)iddmsi prrorative f r lace^ _ -.
ZIP — insert-rye -, —
City: - --- ocsrovrI etatov
Phone: Fax: mail: — ---
tbTiec
App 11 ant's signature: Date: O / ter: -- —__
Permit fee......................$
Nru dl ju,ie,14 Kc.p"Vii cards,pleat.rail)udut'icuon hx rose rnMrtnsllwt. Notire:This permit application Minimum fee................
U Visa a MA,lorr'ard eipires if a permit is not obtained plan review(at _.,. %) $
credo cad nun,hn _ —_r- -- ---- - -- within 180 days after It has been
eplre+ State L .....ge(R9E) ....$ -
` Ilam+�r�uAhnlM•q�hmvn nn rtcdir ruA S accepted a3 complete. -
TOTAL .......................S �
_----- —
Cudhrldu rl`nuure AmountM0.017 1~0W
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