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CITY O F TIG/ARD MECHANICAL
ilk DEVELOPMENTSERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . . MEC960354
DATE ISSUED: 1.0/14/96
PARCEL: 25114AB-033600
SITE ADDRESS. . . : 1.6515 SW 93RD AVI
SURD TVISION. . . . : KNEELAND ESTATES ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . .23
CLASS OF WORK„ . :Al_T FLOOR FURN. . . . 0 EVAP COOLERS: 0
TYPE 7if- USE. . . . :SF UNIT HEATERS..: 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL 0-37 HP. . . - : 0 DOMES. INL"IN: 0
: /GAS/ 3-15 HID— . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15--30 HP. . . . 0 REPAIR UNITS: 0
FIRE DAMPERS'?. 0-50 14J. . . . 0 WOODSTOVES. . : 0
GAS Pr"ESSURE. . . 50+ HP. 0 CLO DRYERS. 0
1\10. OF UNITS—----- AIR HANDLING UNITS OTHER UNITS. : I
TURN ( 100K PTU: 0 1,0000 c f m : 0 GAS OUTLETS. : I
FURN ) =100K BTU: 0 > 10000 cfm : 0
Remarks : Gas fireplace insert and gas piping installation
Owner-: FEES
GAIL DOWLER type amol.trit by date v-ecpt
1G5t5 SW 93RD PRMT $ 5. 00 I JDA 10/14/-�'6 96-285139
5PCT $ 1. 25 JDA 10/ 14/96 `36—='83139
TIGARD OR 972124
Phone #: 639-4897
COST PLUS) HEATING
9464 N ST LOUIS ST.
PORTLAND OR 97203 ---------------------------------
PI-ionp. #: 781 -9090 $ 2G. 25 TOTAL
Reg # . . : 47978 RE 7QU IRED INSPECTIONS
This perrit is issued subject to the regulations contained in the Gas Line I n s p
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mectianic:al Insp
applicable laws. All work will be done in accordance with Final. Inspe-:ticin
approved plans. This pereit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
than IN days.
m i i: F. e
Call for inspection 639-4175
Plan Check
CITY OF TIGARD Mechanical Permit Application Rec'dBy
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E.
(503) 639-4171, x304 Date to DST i
Print or Type Permit#
Incomplete or illegible applications will not be accepted Called
Name of DevelonmenVPro(ect Description
II Table 1A Mechanical Codrt OTY PRICE AMI'
Job Street Addres sone# A) Permit Fee -0- -0- 10.00
Address ;� ��" '�
Bidga Cayistate Zip 8) Supplemental Permit 3.00
Name for name of business) 1.) Furnace to 100,000 BTU 6.00
Owner I i bw(Q-� Pcl.ducts&vents
Mailing Address ,�_ 2.) Furnace 100.000 BTU+ 7.50
l�' , ` : incl.ducts&vents
CdyiFtate zip Phone 3.) Floor Furnace 6.00
(5 s'' `/d i incl.vent
Name(or name of bus nese) 4.) Suspended heater,wall heater 600
or floor mounted heater
Occupant Mailing Address f.4 5.) Vent not incl. in 3,00
appliance permit
Cnylstate Zip Phone 6) Boiler or comp,heat pump,air Gond. Soo
_ to 3 HP.ab.qorp unit to 100K BTU _
Name 7.) Boiler or comp,heat pump,air cond. 11.00
(1-U,/ /,/-j /// '7 3-15 HP,absorp unit to 500K BTU
Contractor Mailing Address 8.) Boder or comp,heat pump,air Gond. 15.00
q c/&q,, f/ ��'`r) _ 15-30 HP:absorp unit 5-1 mil BTU _
Attach copy of City/State 11116
'' Zip Phone 9.) Boder or comp,heat pump,air cond. 22.50
Current Licenses /'U t Kt9'71 ',P( i 30-50 HP:absorp unit 1-1.75 mil BTU
Oregon Const.Cont.Board Lic# Exp Gate 10) Boder or comp,heat pump,air Gond 37.50
/71l 7,1, >50 HP:absorp unit 1.75 mil BTU_ _
COT Business Tax or Metro a Exp.Date 11.) Air handling unit to 4.50
_ s 10.000 CFM
Architect Name 12) Air handling unit 750
10000 CTM+
or Mailing Address 13) Non poflable 4.50
evaporate cooler
Engineer c tyrstate zip Pt one 14) Vent fan connected 3.00
to a single duct _
Describe work New O Addition O Alteration is Repair O 15) Ventilation system not 4.50
to be done Residential O Non-residential O included in appliance perm-t
Additional Description of work 16) Hood served by mechanical exhaust 4.50
17) Domestic inctnerators 750
Existing use of 181 Commercial er industrialtype 30 OC
budding or propeiTy _ _ ___.—_ ___.___ incinerator _
19 1Repair units 450 _
Propo';ed use of 2(' Woodstove 4.50
budding of property
211 Clothes dryer etc. 450
Type of fuel-oil O natural gas, LPG O electric O 22) Other units + '.50
I hereby acknowledge that I have read this application,that the 23) Gas piping one to four outlets 2130
-.1 information given is correct,that I am the owner or authorized agent of VU
Zs.owns% at plans gtjbmMed am in compliance wdh Oregon State 24) More than 4-per outlet (each) '0
L. awe. ly U G
Signature of Owner/Agent Doi QTY.SUBTOTAL
"SUBTOTAL
Contact Person Name Phone 5%SURCHARGE
PLAN REVIEW 25%OF SUBTOTAL
TOTAL
dsl\mechpmt doc (rev 7196) 'Minimum permit fee is S25+5%surcharge