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City of Tigard Building Department ll �
13115 BW Hall Blvd. Tigard, Oregon 977.13` '
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
laspeGt ton:
Footing Plbg. Underslan Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALe
Post/Beam Struct. San. Sewer Framing .-Bldg
Post/Beam Mach. Rain Drain Insul-v_Aon -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. �ech.✓)
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Date Requesteds f 3 _T _fin~t' AM �y�jPN
Addreess_`1�25 (w� Permit f: 1'N--c `1-3-drop
Builder:_- - ( (""z(2
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
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Cir," OF T11GARD Y.
COMMUNITY DEVELOPMENT DEPARTMENT
13125 5W Hall Blvd.Tlgad,Oregon 97223.8199 (503)639-4171
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City of Tigard MECHANICAL PERMIT Planck/Rec. # _
13125 SW
Hall Blvd. APPLICATION Permit # _
Tigard, OR 97223 r 1 - Clt-J /
(503) 639-4171 /" _ / (L
esaipuon
Table 3A Mochanics•I Code OTY PRICE AMT
Job , 1) Permit Fee -0- -0- 10.00
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Address
' C -7 - ? 2) Supplemental Permit _ 3.00
NU— Furnace to JOO,000 BTU
1) incl. ducts&vents 6.00
Furnace 100,000 BTU +
'� _; �.�' / rt F> l'r ' 2) incl.ducts&vents ..50
Owner >�
qqFloor Furnance
t't \ J ,'�' 3) incl. vent 6.00
q .. -soen a eator,wall nater
4) or floor mounted tieater 6.00 Is
.o «. ect not mc.in
Occupant I 5) appliance permit 3.00
y' apRepair of floating,re,ng.
6) cooling,absorption unit 6.00
.. 3ailer or compto A
r `C. ' T ( �) ,, 7) absorp.unit to 100,000 BTU 6.00
ffoiler or comp to 3 HP- 15 HP
8) absorp.unit to 500,000 BTU 11.00
Contractor , •n Boiler or comp toy,- .
9) absorp.unit.5- 1 million ETU 15.00
q. "....a..q . ., iter or comp to 30- 50 HP
r 7 10) absorp.unit 1 - 1.75 million BTU 22.50
hereby acknowrm ge that I have read t,ts app kation that the Boiler or comp to
50 HP
information given is correct,that I am the owner or authorized agent 11) absorp.unit 1,750,000 BTU 31.50
of the owner,that plans submitted are in compliance with State Air handling unit to
laws,that I am registered .vith the State Builders' Board,that the 12) 10,000 CFM 4.50
number given is correct. (If exempt fiom State registration,please Tir handling unit
give reason below.) 13) 10,000 CTM+ 7.50
on portable
14) evaporate cooler 4.50
ent an connected
15) to a single duct 3.00
"-
Ventilation system not
16) included in appliance permit 4.50
Hood serV y
17) mochai-."c.Ai exhaust x.50
Des vbe work new U a itron alteration repair omestic type
to be!One residential o, non-residential Q 18) incinerator 7.50
Existing use of ommercia or in ustna
building or property_ 19) type incinerator 30.00 -
Other re.,woodstove,water
Proposed use of 20) heater, solar, dothos dryers,etc. 4.50
building or property
21) Gas piping one to tour outlets 2.00
Type of fuel-oil Q natural gas Q LPG() electric Q
22) Moro ttan 4-per outlet
OTIC
Minimum Fee$2590_ SUBTOTAL t`
PERMITS BECOME NULL P`10 VOID 17 WORI'OR
CONSTRUCTION AUTHORIZED IS NOT COMMENCED 5%SURrHARGE
WITHIN 180 DAYS,OR IF CONSTRUCTION OP WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 PLAN REVIEW 25%OF SUBTOTAL
DAYS AT ANY TIME AFTER WORK IS COMMENCED.
TOTAL
Speda'Conditions
Datc issued by
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STATE OF OREGON
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Registered as: 0-No.
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. r T'4 CONSTRUCTION CONTRACTORS BOARD
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CONTR/ALL „TkUCTUHF"; Bond [ a,UUO
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[ NUN—EXEMPT 1. Insurance [ FEDEAATED MUTUAL
[ COkPORATION ' ( 02,-h5 '; INS
Expires
[ ( r 5/l.I Employer Accounts:
[ .1 ACCURATE OIL Co
o UI [ JN FILE
( 67L2 NE 47rH Rev
C PORTLAND Orta WC
7219-uorr IRS
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CITY OF T I CAF D - RECEIPT OF f'(4YMENT RECEIPT NO. t9,3-243065
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1 CHECK AMOUN1 34. 12 C �
AME z A-ACCURATE OIL Co CASH AMOUNT x 0. 00
PDDRESS a 6732 NE 47TH PAYMENT DATE z os/to/s3 �
SUBDIVISION e
PORTLAND, OR 97218--
PURPOSE OF PAYMENT AMOUNT PAID PURPOPE OF PAYMENT AMOUNT PAID
MECHANICAL PE 25. 00 ST. BUILD PFR
MISCELLANEOUS RC:.FUND 7. 97
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)825 SW KIMBERLY DR
�x*RFFLJND DUE v $7. 87**
11-OTAI_ AMOUNT PAID
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