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C'IYOFTIFARD =A0111111 F-Ili-NIMIT NO. ME11390703.
CO"AUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223,(503)639-4175 E)ATEK J,S In L) 15/01)
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This permit is Issued Subject to the regulations contained in Title 14 PF:(.A:.* iT1T* NO /03 S/ 7
of the TMC, State of Oregon Specialty Codes.zoning regulations .............
and all other applicable codes and ordinances, and it Is hereby
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agreed that the work will be done in accordance with the plans and I;1Y) I I r4l..
specifications and in compliance With all applicable codes and
ordinances The issuance of this permit does not waive restrictivf, I"'OS I & 1:41::r'lm
covenants Contractor and subcontractors shall have current city I!1 11 11A 1 1,1`4
business tax permits This permit will expire and become null and i 0f.1
void if work is not started within 180 days,or it work Is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections Are requested and approved
t ee�—,cy 9 e®
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Issued By
SEPARATE PERMITS REQUIRED FOR WORK OTHER THA14 DUSCRIBED ABOVE
# -_—_— -
CITY OF TICARD MECHANICAL PERMIT ReceiptPermit # _—_--_.--_-.--
Description CITY PRICE AMT
Table 3A Mechanical Code —
City of Tigard 1) Permit Fee -0- -0- 10.00
13125 S.W. Hall Blvd. —
P.O. Box 23397 2) Supplemental Permit 3.00
Tigard, OR 97223 --------------------
6391-4175 1 Furnace to 100,000 BTU 6.00
incl,ducts&vents _
2) Furnace 100,000 BTU + 7r6.00
50
incl.ducts&vents —
Name of Development 3) Floor Furnace ntincl.vent
Suspended heater,wall heater
Job Address 4) or floor mounted heater _
Address -. — Vent not incl.in
Tax Lot Map No, 5) 3.00
appliance permit
Lot Block Subdivision Repair of heating,refr ig., 6.00
Name(or name of business) i 6) cooling,absorption unit
L L Boiler or comp to 3 HP 6.00
Phone, 7
Melling Address )IF absorp.unit to 100,000 BTU
I
OwnerCUc1c__ 'y Boiler or comp to 3 HP-15 HP 11.00
city State Zip 8) absorp,unit to 500,000 BTU
_LL' L/ Boiler or comp 15-30 HP 15.00
Nemo 9) absorp.unit 1/2-1 million
Maiun <.ddress �Phone 10) Boiler or comp to 30-50 HP 22.50
g absorp.unit 1 -1.75 million
y S Boiler or comp tc 50 HP 31.50
Contractor city state / Zip 11) absorp.unit 1,750,000 BTU
City Bus.Tax No 12) Air handling unit to 4.50
State Registration No. 10,000 CFM _
13) Air handl!ng unit 7.50
1 hereby acknowledge that I have read this application that the Information given Is 10,000 CFM 4-
correct,that I am the owner or authorized agent of the owner,that plans submitted are In Non portable compliance with State laws,that I am rogatered with the Slate Builders'Board,that the 14) P 4.50
number given Is correct.(II exempt from Flate regirltatlon please give reason below). evaporate cooler_
15) Vent fan connected 3.00
—---- --- to a sin le duct
t 6) Ventilation sysf em not 4.50
included In apuliance p jrmlt
------ — 17) Hood served b r 4.50
mechanical exhQurt
9lgnature towner or ag�n1► Date 18) Domestic type 7.50
Incinerator -
Describe work [I addition 7 alteration I I repair LJ Commercial or Industrial
to be done residential [V non-residential I 1 19) 30.00
type incinerator
Existing use of Other i.e.,woodstove,water 4.50
building or properly —`- - - 20) heater,solar,clothes dryers,etc.
Proposed use of 2.00
build Ig or property ___ _- 21) Gas piping one to four outlets _ Olt)
Type of fuel- oil O natural gas W LPG I I electric f_1
22) More than 4-per outlet
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON C gURCHAROE �J
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 _ ---
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 225%OF SUB-TOTAL
ABANDONED FDR A PERIOD OF 180 DAYS AT ANY TIME AFTER TOTAL
WORK IS COMMENCED,
Special Conditions
Date Issued by