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AKMHOIH Z)ISIOVd MS 0096T
-- MECHANICAL vim.
FF_RMl'T
ciTYOFTIFARD CCiYOFTWAR6 #. . MEC=3 J. rid £IC
C0►1.4MUNCTY DEVELOPMENT Q� ATeM3DENT 01029001 V. ER 111 T+
175
19125 SW 1 Wi MA. P.O.BOX
23997.T{pvd.OM- 23
SITE pUDRE,:5
G . . . : 14600 SW PACIFIC HWY ZONING: R-12
SUBDIVISION. . . . . LOT. . . . . . . . . . . . . .
BLOCK. . . . . . . . . . .
COOLERS:
-FLOOR F1JRN. . . .
CLASS OF WORK. . :ADD VENT FANS. . . :
�•- UNIT HEATERS. . . VENT SYSTEMS:
TYPE OF USE. . . . :SF VENTS W/O ADPL:
C)CCUPANCY GRP. . :R3 BOILERS/COMPPESSORS HOODS. . . . . . . .
DOMES. INCIN:
STORIES. . . . . . . . . 0_3 HFA. . . . :
F-UEL TYPES---.--.-----____ CINCIN:
: /WOU/ / / 1 -30 HP. . . . . REPAIR UNITS;
MAX INF-'11T: BTU WOODSTOVES. . : 1
3LA-50 HP. . . .
FIRE DAMPE.FS''. . : 50+ HF'. . . . : CLO DRYERS. .
i3AS PRESSURE. . . : OTHER UNIT:;. :
NO. OF UI\r I TS•-.------ -- AIR HANDLING UNIT GAS r1UTLETS. :
(- ].11r�0Q1 c.fm
FURN < 100K BTU: 1x.1000
FURN > =iQrr71K BTU:
Remarks-. EXISTING WOODSTO11E FEES
-__
-----...._
Owner: --- -- ----__""_-__._____.__ _ _-.-- type arno:.lnt by (hate rec•pt
CATHERINE ANNAi:J pRMT $ -5. 00 JLH 09/25/91 -
14600 SW PACIFIC HWY F'CT $ 1. r-S JLH 09/25/91 -
T IGARD OR 97224
Phone #: 639-4755
C:ontrar_tor:
CONTRACTOR NOT ON FILE
-•-----$ rS. 25 TOTAL
Phone #:
R e r� e t REoU I RED I NSPE CT I ONS -
Filial n a l Inspection -___-_.-----•----.-.__..
this permit is issued subject to the regulatinns contained in the
Tigard Municipal Code, State of Ore. Specialty Cod!!; and all other
acplicable lav , All work will be done in acco'dance with
approved plans. This permit will expire if vo,,k is not started
within 1(10 days of i,,suance, or if Mork is suspended for more
than 190 days,
ermittee
fCall for inap,-ction - 639--4175
City of Tigard MECHANICAL_ PERMIT Pianck/Rec. #
31.25 SW Hall Blvd. �qC APPLICATION Permit # _
PO Sox 23397
Tigard, OR 97223
(503) 639-4171
•N �A �, .1 Table 3A Mechanica:Code OTY PRICE AMT
Job 1) Permit Fee -0- -0- 1000
Address •�•
2) Supplemental Permit 3.00
•^•a^�^• �• �� — Fumare to 1 OYJ BTU
1) inti.ducts&vents _ 6.00
MakV ONFurnace 100,000 +
Owner 4�9 -f/ 2) incl ducts F�vents 7.50
umance
3) incl. vent 6.00
�•^• d^r"' Suspern w iter, wali heater
4) or Floor mounted heater 6.00
•u �• u»� Vent not mc.in
M
Occupant 5) appliance permit 3.00
CAYS0Repair of heating, re ng.
6) cooling,absorption unit 6.00
•" Boiler or comp, Rpat purnp,air con3--
7) to 3 HP absorp unit to 100K BTU 6.0r;
•o •'• �"^� ---
Boiler orcomp,hieat pump,air conk.
8) 3-15 HP absorp unit to 500K BTU 11.00
Contractor , — Boiler or comp, heat pump,air con
9) 1530 HP absorp unit.5-1 mil BTU i5.00
"'• "°^
N. a.T..N—. goiler or comp,heat pump,air con -
10) 30-50 HP absorp unit 1.1.75 mil BTU 22.50
ere y acknowledge that I have read Is ap hcatron,i t eh er oror comp,heat pump,air cond.
information given is correct,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 3150
of the owner,that plans submitted are in compliance with State Air handling unit to
laws,that t am registered with the Cor-truction Contractors Board, 12) 10,000 CFM 50
that the number given is ,orrect. (If exe,,,pt from State registration, Air handling unit —
please give,oason below.) 13; 10,000 CTM
Non portable
14) evaporate cooler t.5c
'lent fan connected
15) to a single duct 3.00
Ventilation system not
16) included in appliance pemhit 4.50
grn.•ow.w.,n..�--" .., sprvpd by
17) mechanical exhaum A 5o
ascribe wo'or c—new addition a teratian repair r nerRa or hn sL.4a
to be done residential O non-residentir;O 18) type r�cinerator 30.00
Existing use o u r-i,e�wo stove,water
building or property �— 19) heater,solar,clothes d-vers,etc. 4 Du
Proposed use of 20) Gas piping ore to four outlets 200
building or property - -
Type r!I,hel .oil natural as LPG 21) More than 4 per outlet —
YP O 9• O l7 electric O
NOTICE
Mininrm,Fee$25 G') SUBTOTAL
Pt RMITS BECOME VOID IF WORK OR CONSTRUCTION — --'
At THORIZED IS NOT COMVENCED WITHIN 180 DAYS,Oil 5%SURCHARGE
IF CONSTR!IrTION OR 1'.,:jRK IS SUSPENDED OR -
AE 4NDONED FOR A PERIOD O' 1f10 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AF'ER WORK IS COMMENCED. ---- —
TQl'AL
Special Conditions_
Date issued — by
k"ECHPMT
.aet.Mew
JI
CITY OF TIGARD - RECEIPT OF PAYMENT RECEIPT NO. :91-217840
NAME ANNAND, CAT14CRINE CHECK AMOUNT v 26-25
ADDRESS 14600 SW PACIFIC HWY CASH AMOUNT : 0.00
PAYMENT DATE
TIGARD, OR 97P24- SUBDIVISION
PURPOSe OF' PAYMFNT (MOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
MECHANICAL. PE 25).00 ST. BUILD PER 1.25)
WOODSTOVE PERMIT
TOTAL AMOUNT PAID 26.25
a rd
}^ h y
1 �✓
M-SCE" "iON TIME . POOMIT NO. : Z6J�_g_
DATE ' J— DATE ISSUED :_.z
OWNERS NAME :—;7— — —T
ADDRESS: /'�l � .--
CONTRACTOR
TEST : Air ❑, Water❑ , Visual ❑ , Laboratory
RESULT: Approved O , Disapproved Cl , Pending ❑
SKETCH:
I \
i
INSP: CTOR DATE
EJ1'L: Attach supplemental test data beretal
a
City of Tigard Mechanical Permit Permit1—
Fee—.._
New Installation ❑ Replace 0 Relocation n Addition ❑ Alteration f_1 3%State
TQTAL--- ----- --
CONTRACTOR _ _ — -- --- — -- OWNER
ADDRESS.------- WORK. ADDRESS—_ —
PHONE ----�—__ — . _Y—.—.— APPLICANT_.__—_----- -
Heat Input Rating (BTU Per Hour) _ Iv,fnt Size Flue Size --^—__
FUEL OIL. FI GAS F..❑ ELECT [J OTHER
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit3.00__ --Air Condition Comprdssor 15 to 30 HP 10.00
New Under 100,000 BTU � 4.00 �Air Handling 10,_000 CFM _3.00
Now- 100,000 BTU &over — 5 5.00
.00 Air Handling C ver 10,000 CFM — _
Floor Furnace 4.00 Evaporative Cooler —� 3.00
Wall - Floor-Suspended 4.00 Range Vent Fan __2.00
Install Vents Only 2.00 — Vent Sys*-m — 3.01
Repair _Heat&Cooling —� 4.00 Hood Commercial _ 3.00
Air Condition Com _pressor Under 3 HP 4.00 ` Commercial Duct System —__—_ 10.00-
Air Condition Compressoi 3 to 16 HP _— 7.50
INSPECTOR'S COMMENTS ----
CITY BI-ISINESS LICENSE REQUIRED r OR ALL CONTRACTORS OR SUB-CONTRACTORS
APPROVED BY DATE ISSUED BY — DATE
RECEIPT N0.
774 Signature of Applicant
City of Tigard Mechanical Permit N? Permit���S��_ ,
Fee_
New Installati
o,p L Rep'ace (� Relocation (� P.cidition i� Alteration �J �� State_
,,l TOTAL
CONTRACTOR _AW1A)__
(NU OWNER 1C. AL
_4LU WORK ADDRESS� �Q
_ APFLICANT _
Heat Input Rating (BTU Per Hour) V Vent Size Flue Size v
FUEL OIL ❑ GAS ELECT C] OTHER
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit _ _ _ / _ 3.00 Air Condition Compressor 15 to 3U HP 10.00_
New- Under 100,000 BTU — _ 4.00 Air Handling 10,000 CFM 3.00
T New• 100,000 BTU&over r 5.00 Air Handling Over 10,000 CFM 5.00
Floor Furnace 4.00 Evaporative Cooler 3,00
• �_ _.'Jail - Floor •Suspended 4.00 Range Vent Fan 2.00
Install Vents Only 2.00 Vent System 3.00
x� Repair - Hnat&Cooling _ _ J _4.00 _Hood Commercial 3.00
Air Condition Compressor Under 3 HP 4.00 Commercial Duct System 10.00
` Air Condition Compressor 3 to 15 HP 7.50
Y0! INSPECTOR'S COMMENTS
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�ACITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS
APPROVED BY DATE _ ISSUED BY _ _ DATES,
r;y RECEIPT NO. C�•
"' S ature of Applicant
Permit No.
Address— -'1y(,gQQ
ij Permit charge
Owner Connection fee
V Paid by
Type of Building_ Date connected J.
Service Rate-— Inspection fee---.----
Contractor- Paid by____ Date
Size of connection Assessment—— Paid
PERMIT TO CONNECT
Tigard Sanitary District
ria
PERMIT N9 1313
PERMIT IS GIVEN TO
or
TO CONNECT A
TO THE STATEN OF TIGARD SANITARY DISTRICT
"�?'
THIS PERMIT MUST BE POSTED ON THE DCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF C-t(NECTION HAS SEEN COM-
PLETED,
PERMIT FEE PAID .........T11',ARD SANITARY DISTRICT
fill
- ---- - ----- - - -
CONNECTIoN INSPECTED AND APPROVED
Supedntendent