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7480 SW VARNS STREET ADDRESS: i:\records\microfIm\tsrgets\building.doc i MUM / CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 6394175 Business Phone: 6394171 /79 Date Requested: _ 5' �� ` A.M. _ M. MST: z f3 Location: _ 711,Z CJr V BUP: Tenant: A Suite:: / Bldg: NEC: Contractor: Phone: -?7 L PLM: Owner._ Phone: ELC:� r(iL e?= '/ Ci x.J _ SIT: BUILDING BLD.:(con't) PLUMBING MECHANICAL -ELECTRIC AL' SITE site Post/Beam PostAleam Post/Beam Cover/Service Sewer/Storm Footing Roof UndFUSlab Rough-In Ceiling Water Line Slab Framing Top Out Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain A/C UG Slab Shear/Sheath Fire Spklr/Alm CtawVFound Dr Heat rump I,o Approved Approved Approved Approved Approved Aj)pr/Sdwik Not Approved Not Approved Not Approved a roved Not Approved FINAL FINAL FINAL AL FINAL O Call for rein spec ' n 0 Reinspection fee of S______^_leguired before n 1 inspection 0 Unable to inspect Inspector: �_ — Dale: ? — __ Page of CITY OF TIGARD BtJ1I DING INSPECTION DIVISION 24-Hour Inspection Lina 619-4175 Business Phone 639-4171 Date Requested: ` ( l 0 - -- A.M. � MST: Tenant: _ _ Suite; 131 MIiC: `015V Contractor: �, � Phone: ' -- PLM: (timer: J Phone: ELC• C/ ELR. SIT: BUILDING BLDG(con'() _� EC NI SITE Site Post/Beam os ear Pos Cover/Service Sewer/Storm Footing Roof UndFI/Slnb Rough-In Ceiling Water Line Slab Framing Top Out Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer Ilood/Duct Reconnect Vault Bsmt Damp Drywall Storm � Temp Service MISC. Masonry Ceiling Rain Drain ;�_ UG Slab Shear/Sheatrh Fire Spklr/Alyn Crawl/Found Or I leal Pump Low Volt Approved pprovai �;��. � !' Approved .1ppr/Sdwlk Not Approved Not Approved ved Not Approved FINAL INAL INA FINAL O Call for reinspect' m 0 Reinspection fee of S _ required before next inspection CI Unable to inspect Ir•.pector:_ __ Date: —�=-6� Page —of (U CITY OF TIGARDD BUILDING IN 'E�CTION DIVISION 24-Hour Inspection Line: 639-4175 Business Phone: 639-4171 � / )ILC � � Date Requested: �./ �! I !(� A.M. P.M. MST: Location: _ ' '�l.d BUR Tenant: Suite: I Bldg: MEC: Contractor:_y,.E.t I-n—Lt Phone: (4 caQ PLM: _ Owner. Phone: ELR: L0)7 Ad� SIT: BUILDING BLDG(con't) PL BING MECHANICAL, ELECTRICAL SITE Site Post/Beam Post/Beam eam Cover/Service Sewer/Storm Footing Roof UndFI/Slab Ron -In Ceiling Water Line Slab Framing Top Out Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer Iiood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl[Found Ih Ilent Pump Low Volt Approved Approvedproved Approved Approved Appr/Sdwlk Not Approved Not Approved No pproved Not Approved Not Approved FINAL FINAL FINAL FINAL FINAL i —�� —P, � C1 Call for reinspecti M Reinspection fee of 5�--required before next inspection C7 Unable to inspect DOW.� 7 e;� _ Page_—_of CITY OF TIGARD ELECTRICAL_ PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98-0249 DATE ISSUED: 05/11/98 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PARCEL: S 1.01 DB-00706 SITE ADDRESS. . . :07480 SW VARNS ST SUBDIVISION. . . . :ROLL_I IVU HILLS ZON I N(3: R- 3. a BLOCK,. . . . . . . . . . LOT . . . . . . . . . . . . . :O -"F, JURISDICTION: TIG Project Description- Ndd first branch circuit to and eNisting single family dwelling. -RESIDENTIAL�IJNIT----- ------TEMP SRVC/FEEDERS---- -.-----MISCELLANEOUS-.----- 1000 SF OR LESS. . . . : Oi 200 Amp. . . . . . . : 0 PUMA='/IRRIGATION. . . . : 0 EACH ADD' I._ 5O0SF. . . : 0 r'O 1 - 4010 Amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL.. . . . . . . : 0 MANF. HM/ SVC/FDR. . ,., 0 S01.+amp7,-1000 volts. : 0 MINOR LAPEL ( 10) .. . . : 0 -----SERVICE/FEEDER- ---­- -------BRAN MH CIRCUITS----- -------ADD' L INSPECTIONS- --- 0 - 200 Amp. . . . . . : 0 W/SERVICE= OR FEEDER: 0 FIER INSPECTION. . . . . : 0 201 - 400 amp. . . . . . : 0 1 st W/0 SRVC OR FDR. : 1 F'E.R HOUR. . . . . . . . . . . : 0 401. - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 601 - 1000 amp. . . . . : 0 --------------------PLAN REVIEW SECTION-________.______..__ 1000+ amp/volt. . . . . : 0 > -4 RES UNITS. . . . . . . . : > 600 VOI-T NOMINAL. . : Reconnect only. . . . . : 0 SVC/FAR > 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner: _ _ FEES RTCNAPD SWAIVSON- •- __.__--___�~���_.______tYRe amoont by date r^ecpt '7480 SW VARNS STREET PRMT f 35. 00 GEO 05/ 11/9B 98--305657 T I CARD OR 97223 SPCT f 1 . 75 GEO 05/ 11/98 98-3O5F,57 Phone #: 639-4394 Contractor: --._____..--------___-------••----_._.....__ OWNER 36. 75 TOTAL -- -- - - RE DU I RED INSPECTIONS F_1 e c t' 1 Service Phone #: Elect' 1 Final Peg #. . : 0000010 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 188 days of issuance. or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon 1ltility Notification Center. Those rules are :et forth in OAR '52-001--0010 through OAR 952-001-1967 mai obtain a copy of these rules or direct questions to 011N byalling i5w246-1987. C er,mitt;ep :JignAtore "", ` ��Cl ISSI_red By : -- ------ --OWNER INSTALLATION ONLY- ------------------------------- The installation -------_--__.-------------.---- Theinstallation is, being made on property I own which is not intended for Sale, lease, or rent. OWNE R I S S I GNAT LJ RE'" OATE e INSTALLATION ONLY----------- - ----------- --____ CO I GNATURE OF SUPR. EL_EC' N: DATE a I_I CENSE NO: 4fi-++++++++++t++++++++++++++++_++ ++ ++++++4•+++++4.++++++4++1•++++++++++++++++•f++++ Call 639--4175 by 7:00 p. m. for An inspection needed the next h1_isiness day ++++++++++++++++++++++++++++++++++++++++++++++-+++++-++;++++++++++++++++++++++++ 14 CITY OF TIGARD Electrical Permit Application Plan Check tt _ 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd Phone (503)639-4171, x304 Date to P.E. Print or Type Date to DST Inspection (503) 639-4175 Permit yam, Fax (503) 684-1297 Incomplete or illegib;e will not be accepted Called-- 1. Job Address: v 4. Complete Fee Srhedule Below: Name of Development_ Number of Inspections per permit allowed Name(or name of business)Aza,s Sawk_s of; Service included: � Items Cost Sum Address 77 (�� y TTTTTT��aJs �j _ 4a. Residenfiai-per unit a 1000 sq.ft.or less $110.00 _ _ 4 City,'State/i ip- // ek / 7 Z Each additional 500 sq.ft.or Commercial ❑ ( Residential portion thereof $25.00 Limited Energy $25.00 Each Manuf'd Home or Modular 2a. Contractor installation o Dwelling Service or Feeder $88.00 !' - - ( ach copy of all r t Ifcen s) 4b.Services or Feeders l actor L .y Installation,alteration,or relocation Electri atret 644r f!J r--- 200 amps or less $ - Address - 201 amps to 400 amps $660.00 City�,� tate 1^�, Zip�/r7z 7 3 _ 401 amps to 600 amps $120.00 Phone No. - � 601 amps to 1000 an ps $18000 Job N0. Over 1000 amps or:.Its $340.00 Reconnect onlv $50.00 Elec. Co ice. No. Exp.Date_ - OR St CCB Reg. No., Exp.Date 4c.Temporary Services or Feeders CO usiness Tax or Metro No. --Exp.Dale_ Installation,alteration,c relocation 200 amps or less $50.00 Signature of Supr. Elec'n - 201 amps to 400 amps $75.00 - - 401 amps to 600 amps $10000 2 Over 600 amps to 1000 volts, License N __-__Exp.Date see"b"above. Phone N ----- "- � - 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with ) 4GY.t purchase of service or me S Print Owner's Na4/ ' C!2 feeder fee. Address O S /1 S S Each branch circuit $5.00 _ b)The fee for branch circuits City State _ Z.ipT z-7 3 without purchase of Phone No. /r- �f39 y service or feeder fee. `- First branch cllcuit $35.00 .�s!-o 2 The installation Is being made on property I own which is not Each additional branch circuit_ $5.00 2 intended for sale,lease or Dent. 4e.Miscellaneous (Service or feeder not Included) Owner's Sign3tur9 _ _ Each pump or irrigation circle $40.00 - Each sign or outline lighting $40.00 3. Plan Review section (if required):' Signal circult(s)or a limited energy- panel,alteration or extension $40.00 Please check appropriate item and enter fee in section 5B. Minor Labels(10) $100.00 _4 or more residential units in one structure 4f.Each additional Inspection ove, Service and feeder 225 amps or more the allowable in tiny of the above System over 600 volts nominal Per inspection $35.010 Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C.Chapter 5 In Plant $55.00 Submit 2 sets of plans with application where any of the above apply. 5. Fees: Not required for temporary construction services. So.'Enter total of above fees $ �- 5%Surcharge 105 X total fees) $ 1�r' NOTICE Subtotal $ Sb.Enter 25%of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Rpview if reouir (Sec 3) $ NOT COMMENCED WITHIN 180 DAYS,OP'F CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Al ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account p_ ^ Total balance Due t � I.IDSTSTI-C96 APP Rev lJ96 Fi #: G� `0 7 Address: Z Issued by: Data –� - 1a54 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed wit), the permit. rill in the appropriate blanks and initial boxes I and 2, and either box 3A or 31i: (� 1. 1 own, reside in, or will reside in the completed structure. �- 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. F13A. My general contractor is — (Name) Contractor regis. # t will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR F] 3B. 1 will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct mid that I have read and do understand the Information Notice to Prop, Owners about Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Intormation Notice to Property Owners About Construction Responsibilities EMPLOYEP RESPONSIBILITIES: --`till hist. t,.III h., ('III. ' Otvplvll,: %0IIIII-I1d-riv %k,11 k Cilll U.S.hati nal RcIlenut halik,for the tak pavrnL:; al 1-8(0-829-1040. WHER RI SPONS1811.111ES AND AHEAS Uh GUNUEHN: tkif 111:1N ht' I)t'ItlYlil ti, "kIIII litcyll;( It 1hiom.-Il ill"pot 114 ills. hablifi(.: -And propvrky damageinsur.mce, Cklll(ild plug '.11;d ofill Ill,, Time t4f �Jlpvr%kv Vill Jill oYeig-s: %tjix .Ilo. i, Fxpvrfi,,v- , vo zir oil,,n f!rnr ral contrittol',to co, lo wtON hililth w olf-11 i:lk;q 11w Ippl opl i-or lilnflt��,o 1111-v ('1 Ill pofform t fit-tf-eli I t'..1 i"Orl. I I'lle Boilld 1. :(I(I i�llrplpk-j Si N1 timte 3( 1),in Salem. CITY CIS TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PIERMII #. . . . . . . : PLI1198-01 I') DATE ISSUED: 04/12.9/98 PARCEL: 2SIOIDD-00706 SITE ADDRESS. . . : 07480 SW VARNS ST SUBDIVISION. . . . : ROLLING HILLS ZONING: R-3. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .026 JURISDICTION: TIG ------------------------------------------------------------------------------------- CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF (JSE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW P,REVNTRS. . : 0. OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0 FIXTURES—_---------_-- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES,. . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . 0 WATER CLOSETS. : 0 WATER LINE (ft ) . . . 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : Install a new gas water- heater for an existing single family dwelling. Owner: ----------------------------------------------------- - FEES RICHARD SWANSON type amol-int by date rer-pt 7480 SW VARNS STREET PRMT $ 25. 00 GEO 04/29/98 98--305364 TIGARD OR 97223 5PCT $ 1. 25 GE13 04/29/98 98-305364 Phone #.- 639-4394 Cont ract or---------------------- SPECIALTY HEATING X FABRICATIO 9528 SW TIGARD ST TIGARD OR 97223 ------------------ - ------------------ Phone #: 620-5643 26. 25 TOTAL Req 4. . : 000665 REOUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Mis --. Inspection Tigard Muniripal Code., State of Ore. Specialty Codes and all other Final Inspection applicable laws. All work will be done in accordance with approved plans. This permit soil] expire if work is not started within IN days of issuance, or if work is suspended for more than 180 days, ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in DAR 9524*01-9010 through DAR 952-000I-0080. You nay obtain copies of these rules er direct questions to 010. by calling (503)246-1967, Iss�ted By: Permittee Signati-ire : 4 +-+1 .....4.+++-!-++,f.........4 ...+++....4++++++++++++4-+4-4.+++4-+++++.++++++ .......... Call 639-4175 by 7:00 p. m. for an inspection needed the next b-.(s ines s day ..............V.............4.....................................j_++ rim CITY OF TIGARD Plumbing Permit Application Recd By 13125 SW-HALL BLVD. Commercial and Residential Date Recd TIGARD, OR 97223 Date to P.E. (503) 639-4171 Date to DSTPermitt Print or Type Related SWR t Incomplete or illegible applications will not be accepted Called Name of Development/Project �— On back Indicate Work Performed by fixture. .lob FIXTURES (Individual) QTY PRICE AMT Address Street Addrep Suite Sink 9.00 V SO (�t't�J� Lavatory — -- 9.00 Bldg 0 City/State Zip rub or Tub/Shower Carob. — 9,00 i l N �e I - y Show(r Only �� 9.00 1 , (%)_Y-0Water CloseF 9.00 Owner Mailing Address Suite Dishwasher - 9.00 �.41L_3 &&Y114, c- _ Garbage Disoosal 9.00 �Jjy/Stale Zip Phone _ Washing Machine 9.00 Na Floor Drain 2' 9.00 3• 9.00 Occupant Mailing Address Suite 4' - 9 00 - Water Hester nversion O like kind — 9.00 j City/State Zip Phone Laundry Room Tray 9.00 Name j Unnal - 9.00 ! 1 F' Other Fixtures(Specify) 9.00 Contractor ailing Add`retis Sults -- ` Jf IJ 1 Ir. r Still _ 9.00 Prior to permit CCIC�/State Zip Phone 9.00 issuance,a copy -�� - 9.00 1 of all licenses are Oregbn Const.Cont.Board Lic.• Exp.pate — 9,00- requiredif . r 7 r // ( e Sewer-1st 100" -- 30.00 expired in COT Plumbing Lic.t Exp.Das — ---• database �H , Sewer-each additional 100' 25.00 Name Water Service- ;at 100' 30.00 Architect Water Service-each a-lditionat 200' 2.5.00 Or Mailing Address Suite Storm&Rain Drain-1st 100' 30.00 Storm&Rain Drain-each additional 100' 25.00 Engineer [Cl. 1—Stale Zip Phone Mobile Horne Space -_ 25.00 Mommercial Back Flow Prevention Device or Anti- 25,00 Nscribe work New O Ad Ilion O Alteration Repair Cl Pollution Device to bf done: Residential Non-residential 0 Residential Backflow Prevention Device' 15.00 Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00 —� Catch Basin 9.00 Insp.of Existing f lurnbiny 40.00 per/hr _ Existirn.-so o1 SpeGally Requested Inspections 4000 building or te„ arty, 1.,.;j _ erlhr Rain Drain,single family dwelling 30.00 Proposed use of t Grease Traps 9.00 building or property. J — QUANTITY TOTt'�L I hereby acknowledge that I have re•at�this application,that the Information Isorrreinc r,nsr diagram i,required tf oLanny Total Is >9 given Is correct,that I am the owner or authorized agent of the owner,and SUBTOTAL that plans submitted are in compliance with Oregon Slate Laws. Signature of Owner/Agent Date -----J-"--- "- ;% SURCHARGE y - r 41 -1/1 {& 1 rr_4N REVIEW 25%,OF SUBTOTAL Contact Person Name Phone Requireu only 4 'lire qty total is>9 `_. at11I_e .ti ro.�b `i �C�4_ — TOTAL , .Minimum pemtit fee is$25-5%surcharge,except Residential B flow Prevention Device,which is$15+5%surcharge t.Wins'lpimam doe S PLEASE COMPLETE: Fixture Type Quantity by Work Performer! _ New Moved —Replaced Removed/Capped - Tub or Tub/Shower Combination —� Shower Only _ — Water Closet — Dishwasher__ — Oarbage Disposal -- — Nas_hing_Mach_ine — Floor Drain Z1 - Water Heater — — — —_ - Laundry Room Tray - Urinal -- Other Fixtures (Specify) COMMENTS REGARDING ABOVE: '151 Irtl::f'(I rtrrr'�i CITY O F TIGARD MECHANICAL DEVELOPMENT SERVICES PERMIT 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 PERMIT #. . . . . . . . MEC98-0150 DATE ISSUED: 04/29/98 PARCEL: 2S101DB-00706 SITE ADDRESS. . . : 07480 SEW YARNS ST SUBDIVISION. . . . : ROLLING HILLS ZONING. R-3. 5 BLOCK. . . . . . . . . . : LOT. . . . . . . . .. . . . . ..026 JURISDICTION: TIG -------------------------------------------------------------------- CLASS OF WORK. . :ALT FLOOR FURN. . . . ., 0 EVAP COOLERS: 0 TYPE OF' USE. . . . : UNIT HEATERS. . : 0 VENT FANS. . . . V, OCCUPANCY GRP. , :R3 VENTS W/O APDL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 F'UEL 0-3 HP. . . . : I DOMES. INCIN: 0 3-15 HP. . . . : 0 CnMML. INCIN: 0 MAX INPUT: 0 BTU 15-30 HP. . . . : 0 REPAIR UNIIS- 0 FIRE DAMPERS''. . : 30-50 Hlz,. . . . - V, WOODSTOVES. . : 0 GAS PRESSURE— . 50+ HP. . . . : 0 CLO DRYERS. . : 0 NO. OF FIR HANDLING UNITS OTHER UNITS. : I TURN ( 100K BTU: 1 10000 cfni: 0 GAS OUTLETS. : I FURN ) =100K BT(J: 0 > 10000 efin: 0 R(-mo t,14 s - Install a new gas water heater, gas furnace and A/C unit for an exrting single family dwelling. Air conditioning units cannot be place within the required setback areas. Owner: FEES RICHARD SWANSON type amol-Int by date recpt 7480 SW YARNS STREET PRMT $ 24. 50 GEO 04/29/98 98-3053,64 TIGARD OR 97223 5PCT $ 1. 43 GEO 04/29/99 913-3053iF,4 Phone #: 639-43'94 Contractor: SPECIALITY HEAlING & FABRICTN 9526 SW TIGARD $ 29. 93 TOTAL TIGARD OR 97223 Phone #: 620-5643 Reg 000665 REDUIRED INSPECTIONS This permit ji issued subject to the regulations contained in the B-45 1 i n e I n s p Tigard Municipal Code, State of Are. Specialty Codes and all other Mist,. In.--pection applicable laws. All work will be done in accordance with Final Inspection 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 fnllow rules adopted by the Oregon LItility Notification Center. Those rules are set forth in CAR 952A01-0016 through BAR 952-*1-0W. You may obtain copies of these rules or direct questions to OLINC by calling (503)246-9181. Issk(e B Per-mittee Signati.ir y P ++++4-++++i.++-+++++.++++ ................4........4-++++4-++++++++-+-+-+-+++-+-+++++++++-+► Call 639-4175 by 7:00 p. m. for inspections needed the next business day +4-+A........4.........4++f+++4......4-++4..............4-+-t..........u++4-++++4......... Plan Check# CITY OF TIGARD Mechanical Permit Application Recd By _ 13125 SW HALL BLVD. Commercial and Residential Date Rer'd TIGARD, OR 91223 Date to P E (503) 639-4171, x304 -- Date to DST r c— Print or Type yr Permit#_4i �' Y Called incomplete or illegible applications will not be accepted Name of DevelopmenuPro)ect �l Description Table to Mechanical Code DTY PRICE I AMT Job Street Address Suite# A) Permit Fee D_ 0 1000 Address 7 q r Bldg# Zip 1 ) Furnace to 100,000 BTU / 600 ( 7 117,4,)-1 Including duds&vents f Name for name of business) j 2) Furnace 100,000 BTU+ 7,50 Owner )I t ( rd—Sy-y' Oy} including duds&vents Ma,ling Address 3) Floor Furnace 6.00 l `) a O_� irinludin vent C _ rStafe Zip Phone 4) Suspended heater,wahe heater 6.00 ) 1 o'(I,r_t�QP ��-7„ —3 (� .1 Al .r or floor mounted heater Nama4or name of business) 5) Vent not Included in appliance Lermit 300 Occupant Mallin#Address 6) Boller or comp,heat pump,air Gond / 600 _to 3 HP;abso,b unit to 100K BUT" r Gty.Slate zip Phone i ) Boder or comp,heat pump,air conn. 11.00 _ _ 3-15 HP,absorb unit to 500K BTL"" Contractor Name 6) Boder or comp,heat;3ump,air con 1500 1!-30 HP;absorb untt.5-1 and BTL i Pnor to permit Mr�alllttp Address 9) Boder or comp,heat pump,air coed 2250 issuance,a copy 9 5U) I(( ay 1 . 30-50 HP;absorb unit 1-1.75mil BTU" of all licensesStafe ZIP Phone 10) Boiler or comp,heat pump,air:ond. 3750 are required d 1 n t- r1 70 4+._o-'54'q 3 >50 HP;absorb unit 1.75 mil BTU" expired in COT r `ontt.Cont.Board Lic 0 Exp.Dat„ 11 ) Air handling unit to 10,000;FM 450 database 14 115 Architect Name 13) Non-portable evaporate cooler 4 50 or Mailing Address 14.) Vent fan connected to a single dud 300 Engineer Cdytstate -�^ Ilp Phone- 15.) Ventiiation system not included in 4 50 _ appliance permit Describe work New O Addition O Alteration Repair O 16.) Hood served by mechanical exhaust 4.50 to be done Residential O Non-residential O _ Additional Description of work 17.) Domestic incinerators 7.50 18.) Commercial or industrial type 30.00 Incinerator Existing use of 19.) Repair units 4.50 building or property 40.) Wood stove 4.50 t Proposed use of 21.) Clothes drye,,etc. 450 buildirn or property_ kr' II 22.) Other units o;q r-t, i / 450 1 t_ hype of fuel-oil O natural gas at LPC O electric O 23) Gas piping one to four outlets 2.00 I hereby acknowledge that I have read this application,that the information 24.) More than 4-per outlets(each) 50 given is correct,that I am the owner or authorized agent of the owner,that plans submitted are in coripliance with Oregon Stele laws OTY.SUBTOTAL i Signature of Owner/Agent Data *SUBTOTAL _ 5°16SURCHARGE r ConL,ct Person Name Phone 7 PLAN REVIEW 25%OF SUBTOTAL / Required for all commercial permits only. TOTAL. "Minimum permit fee is$25+5%surcharge "Residential A/C requires site plan showing placement of unit I lmechprmt doc rev 4198 i 7� ri z 1 {