16815 SW 129TH AVENUE ADDRESS:
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MECHANICAL
PERMIT
CITYOF TIGARD D PERMIT MEC9 I
COMMUNITY DEVELZO'PMENT DEPARTMENT 011600N
13125 SW Hail Blvd. P.O.Box 23397,Tiged,Oregon 97 (503)639-4176 I EoPTE' ISSUED: 04/2".1/91
i E ADDRESS. 163 15 '3W 129TH PARCEL : 2`I1 6AD 202011M
AJIBDIVISION. . . . 1,4 / .' ZONING-
BLOCK. . . . . . . . . . "/lj L�T. . . . . . t. . . . . . . .
.'LASS OF WORK. . ALT FLOOR FUPl`!. . EVAP COOLERS:
YPE nF USE— . SF UNIT HEATERS— : VF---NT FANS. . . :
JL:LtjL ANDY GRP. . : R3 VENTS W/0 APPL: VENT SYSTEMS:
-:7012IES. B0ILERS/'.,'JMPRES90R9 HOODS. . . . . . . :
0-3 -4�,. . I DOMES. INCIN:
: /ELE/ 3-15 HFA. . . . : COMML. INCIN:
',?:AX INPUT-. BTU 15- 0 HP. . . . s REPAIR UNITS
RE DAMPERS?. . : 30-- nf?i HP. . . . . WOODSTOVES. . :
3AS PRESSURE. . . 504 HP. CLO DRYERS.
,10. OF UNITS----- - AIR HANDLING UN I TS OTHER UNITS.
,-'URN . 100K BTU: 1 10000 efic OnS OUTLETS.
:URN ) =100K BTU: > 10000 cfm:
?Pmar-ks: REPLACING C`LEC7RIC FURNACE/NEW HEtAT PUMP. $20. 00 FEE FOR NOISE
PEEADING.
AWTIPT'". ----------------- FEES
-:AY KEEFII—:*R type �Amoi.tnt by dote
4681b SW 12'9TH PIRMT $ 2E. 00 JLH 04/29/91
5PICT $ 1. 10 JLH 04/29/91
T J�JG
CITY T Y 0 R ') 7 4 111 Sc $ 20. 00 Jl_H 04/2`.)/91
'DPF-CIALTY HEATING/FABRICATION
)448 sw TIGARD ST
I IGARD OR 97223 -------------------------
. fi,.)ne #t 620-3643 $ 43, 10 TOTAL
66578
PEOUIRED INSPECTIONS
This oerRit is issued subJect to the rev, lat�jrs contained in the Final Tnsp- ctiaTi
Ticard Municipal Code. State of Orl. Specialty Codes and all other
�Pplicable laws. All wo,-k will be done in ;jccordance with
?Pvaved clans. This Ve?,git will exojre il work is not started
Within 181 days of issuance, or if work is susvended foi tore
Char 180 days.
`
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CAll fDT' insvection 639 41 '5
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CITY 0TIGARD RECEIPT` OF PAYMFNT RECEIPT mi. :X31—ip.125s 7,:
CHECK AMOUNT : 43. 1171
NAME SPECIAl— r Ica'4 CASIA 01101—INT N. 00
PAYMENT DATE 04/29/91
PURPOSE'. OF P A Y M I'--'N T AMOUNT PAID I)ORPOSE OF P(-)YMF.--NT AMOUNT PAID
CLME1;1 IAN I—0 0 0 2.2. 00 qT. BUILD PER t. 10
M 7 SC171—LANEVI.W.,
r.
Ch
16615 SW 129TH
TOTAL AMO(Nl* PAU) 43. 19',
CITY OF TIGARD MECHANICAL PERMIT Receipt# _
13125 SW HALL BLVD. Permit#
P. 0. BOX 23397 16 C) Description
nical Code
Table 3A MechaCITY PRICE AMT
TIGARD, OR 9722.3 ---
(503)639-4175 1) Permit Fee n- .0- 10.00
Na-a of Development 2) Supplemental Permit 3.00
Job Address
r� 5 L �y 11 Furnace to 100,000 BTU 6.00 av '
Address / V G--�— incl.ducts&vents
Tax Lot Map No 2) Furnace 100,000 BTU + 7.50
incl.ducts&vents
Lot Block Subdivision - -- ---'—
Name(or name of business) 3) Floor Furnace 6.00
_ incl.vent _12 6h� _
Mailing Address Phone _ 4) Suspended heater wall heater
6.00
Owner or floor mounted heater
City State Ztp 5) Vent not incl.in 3.00
_ , 1A,a appliance permit
Name(or name of busi ss 6) pair of heating,refr ig., - 6.00
Cooling,absorption unit
Boiler or comp to 3 HP
Occupant Mailing Address Phone 7) absorp.unit to 100,000 BTU 6.00 j
City/State -z;h f 8) Boiler or comp to 3 HP-'l 5 HP 11.00
absorp.unit to 51:0,000 BTU _
Name —^ 9) Boi,er or romp 15-30 HP 15.00
C// �/� 2D; (✓y j absorp,unit 142-1 million _
Phone 10) Boiler or comp to 30-50 HP
Mailing Address Phone22.50
1`11 � 7111 Boiler
unit 1-1.75 million — _
Contractor Y Zip 11) Boiler or comp to 50 HP
C;ty/8tate 31.50
�/G�� 0�,L ��-/l absorp unit 1,750,000 BTU _
State Registratlon No. City Bun.Tax No. 12) Air handling unit to 4.50
/ 10,000 CFM
66s ? � Air handling unit
I hereby acknowledge that I have read this application that the Information given Is 13) 10,000 CFM 4- 7.50
correct,that I am the owner or authorized agent 0 the owner,that plans submitled are In ---
compliance with State laws,that I am registered with we State Builders'Board,that the 14) Non portable 4.50
number given Is correct.(It exempt from State registration please give reason below). evaporate cooler
15) Vent fan connected 3.00
to a single duct
-- - - 16) Ventilation system not 4.50
_ included in appliance_ permit
Hood served by 4.50
17) mechanical exhaucl
rgnature(owner o agent) _ Date 19) Domestic type- i 7.50
Describe work ❑ add tion ❑ alteration [I repair El 18)
to be done residential rtl' noir-residential G 19) Commercial or industrial 30.00
Existin use of < type incinerator _
building or properly ✓ u 20) Othef i.e.,woodstove,water 4.50
heater,solar,clothes dryers,etc.
� Proposed use of —
building or property --- 21) Gas piping one to four outlets 2.00
Type of fuel- oil O natural gas ❑ LPG ❑ electric '
> — 2.2) More than 4-per outlet
j N-QTfCE SUB-TOTAL
r THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON ---
�,
c� STRUGTION AUTHORIZED IS NOT COMMENCED WITHIN 180 5% SURCHARGE
Wi DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME,AFTER -- - -- �- -
WORK IS COMMENCED. TOTAL
Special Conditions
Date issued by