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7424 SW FIR STREET i N .P U` 'Tl H U, H �7 C�] C�1 �3 I --- 7424 SW FIR STREET CITY O F� TIGARD _ MECHANICAL PERMIT DEVELOPMENT SERVICES #: 4/602000 00115 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATEE ISSUED: PARCEL: 2S 2SIOl 101 DC-0350! SITE ADDRESS: 01424 SW FIR ST SUBDIVISION: ZONING: R-3 5 BLOCK: LOT: JURISDICTION: 11G CLASS OF WORK: A[.1 FLOOR FURN: EVAP COOLERS: TYPE OF USE: `I- UNIT HEATERS: VENT FANS OCCUPANCY GRP: R3 VENT:., W/0 APDL: VENT SYSTEMS: STORIES: BOILLPS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: Lf'G 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 FP: WOODSTOVES: GAS PRESSURE: 50 + 1-1P: CLO DRYERS: FURN < 100K BTU. AIR HANDLING UNITS _ OTHER UNITS: FURN >=100K BTU: <= 10000 (fm: GAS OUTL ETS: ' > 10000 4,611: Remarks: Gas piping for stove, water heater, and dry , Owner: ___ FEES _ __-- WALKER, JAMES CAL\/!N Type By Date — Amount Recelpt 7424 SW FIR ST PRMT KJP 4/6/00 $50.00 0001230 TIGARD, OR 97223 5PCT KJP 4/6/00 $4.00 0001230 Total $54.00 _ Phone: Contractor: JOHN DRAGOMIR 7472 SW FIR ST TIGARD, OR 97223 _ REQUIRED INSPECTIONS_ Gas Line Insp Phone:503620-7600 XIli' En Final Inspection Reg#:LIC 89531 ORIGINAL This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all oiher applicable laws. All work will be done in accordance with :Ipproved 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. AT? ENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 052-001-0080. You may ob 'n copies of these rules or direct questions to OUNC b calling (503)246-9189. Issue By: Permittee Signature: Call (503) 639-4175 by 7:00 P.M.for Inspections i,e-"(ed the next usiness day CITY OF TIGARD Mechanical Permit Application Ree'd By Plan Check# 4 13125 SW HALL BLVD. Commercial and Residential Date Rec'd1- /I - 2rXy TIGARD, OR 97223 Date to P.E. (503) 639-4171, x304 Date to DST Print Or Type Permit 0 _ Incomplete or illegible a licatiotis will not be acce ted Called Name of Develupn.ent/Pru/ei.1 Desrription ` Table 1A Mechanical Code Qt Price Amt Joh Street Addreifs Suite# A) Permit Fee l P'c 16.00 / ,^ !. p� ✓� �d- 1) Furnace to 100,000 BTU Address �.�4 �'�.c/ r /� _ including ducts 8 vents _ see footnote 1,2 M 9.6 ^ Bldg# '"y/State Zip 2) Furnace 100,000 BTU+ )tip Q 7 including ducts&vents see footnote 1,2 12.00 Name(or name of business) r 3) Frucr Furnace Owner ')/lI f-S ( '. `-tL l!q�-jL L``� including vent see footnote 1,2 _ 9.65 Mailing Address �! 4) Suspended heater,wall heater or floor mounted heater see footnote 1,2 9.65 5) Vent not Included in a liance permit 4.75 city/slate zip Phone Check all that apply: 'Boiler Heat Air For Items 6.10,see or Pump Cond City Price Amt Name(Jr name of buslness) footnotes 1,2 Com 6)<3HP;absorb unit to 100K BTU 9.55 Occupant Moping Address 7)33-15 HP;absorb unit 100k to 500k BTU _ 17.65 City/Slate Zip Phone 8)15-30 HP;absorb unit.5-1 mil BTU 24.15 Nerve !9)30-50 HP;absorb Contractor _ unit 1-1.75 mil BTU 36.00 I I fvOvt 10)>50HP;absorb unit -- Prior to pemilt Maning Address_� SU/ �7 r >1.75 mN BTU _ __l_—_ 60 15 _ issuance,a copy J f< 11 Air handling unit to 10,000 CFM of all licenses cny/Steie a n p Zi P q e 7.00 are required If I �,�- 01` i 7 2! 3 � 16a 12)Air',iandling unit 10 000 CFM+ expired In COT Oregon Cupid.Cont.Board Lk.# hxp.bale __ 11.8 database 13)Non-portable evaporate cooler Architect Name __,gl7.017' _ 14}Vent fan connected to a slre duct _-_ 475 Or Melling Address —'- 15)Ventilation system not Included in appliancepermit 7.00 Engineer cnyrstate zip Phone 16)Hood served by mechanical exhaust _ 7.00 Describe work to be done: 17)Domestic Incinerators _ 12.00 New Repair O Replace with I&e kind. Yes O No O 18)Commercial or industrial type incinerator .25 Res dentia)pk Commercial O 4840 19)Repair units Additional Information or description of work. - 8.40 20)Wood stove/gas FP/other units/clothe dryer/etc. _ 7.00 NOTE: For Commercial projects only;Units over 400 lbs require 21)Gas piping one to four outlets:���,'r-,� structural gas talcs _ See footnote 1 �� __ r'% ,•,c 3.75 Type of fuel. oil O natural gas LPG 0 electric O ::2 More it on 4- er outlet(eat 75 ` Minimum Permit Fue$60.00 SUBTOTAL — I hereby acknowledge that I have read this application,that the information F'ro SURCHARGE_ given is correct,that I am the owner or authorized agent of PLAN REVIEW 2�%OF£l)BTOTAL N the owner,that plans submitted are in compliahce with Oregon State laws __. _fie ulred for ALL commercial errnita onl TOTAL signal re of Owner/Agent Date —•------- ,S Other Irsspectionp and Fees: L Ms^ections out0de of normal business hours(mininum charge-two ontact Person me Phone hours) $50.00 per hour 2. Inspectlor s fcr which no fee is specifically indicated (minimum T4r''�C) chario-halt`ic ur) $50.00 per hour Foonotes for commercial projects only: 3. Additlonm 1 1 In review required by changes,additions or revisions to 1. Provide full schematic c`e>ishng and proposed gas line and pressure plans(rrdnl:m n charge one-half hour)$50.00 per hour 2 Provide drawings to scalp showing existing and proposed mechanical 'State Contractor Boiler Certification required units. �/ ••Re!idenPll AIC requires site plan showing placement of unit !\mechpermdoc rev 7/19/99 EXPIRED ,-...ENNsAk —CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 [Footing ruin Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mach. Shear/Sheath Framing -Mech. Plbg.Und/Flr/Slab Pibg.T-)p Out Insulation i lec Post/Beam Struct. Mach, Rough-in Gyp. Bd. d9 San. Sewer Gas Line Appr/Sdwlk Reins. Other: _ -- ---- Date. A.M P.M. Entry: Address: L�-----• — Tenant: _ - -.— Ste:—.__ MST: _._�----_- BUP: Con/OwMEC:— PLM: ELC:��73 THE FOLLOWING CORRECTIONS ARE REQUIRED: FLR: -- . .,,, Date- ,/APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO MFHANICAL ITY OF TIGARD CPERM T T ' F DEVELOPMENT SERVICES F-,F.RMIT #. . . . . . . : MEC97-00 .4171 0(,,-T E._ ISSUED: d 1 9.4/97 13125 SW Hall Blvd., Tigard,OR 97223 (503)639 SUED' 0:� ppRCEL" Es ioir.)c-03502 ADDRESS., . . : 0-74-24 SW F--IR ST -zo�mNg. R `3- 5 i-OT. . . . . . . . . . .... BLOCi4. . . . . . . roo-[-ERS: ih ()�.-,!7 OF W091',- - __(3oF� vFNT FANS. . - 0 C,'L UNIT HEATERS. .- 0 )F-Nl gYSTEMS'- 0 USE. SF w/o 0 - 0 TY". OF HOODS. . . . . . SOILERFl/CoMPRFESSORS -1 IPANCY GRP STORIES. . . . . . 03--3 00 COMML . INr''IN- 0 F r - TYP:,c,-,-- -.. ..... -1HP. . . . R[j:1AIP UNITS. V! /GAX/ 15- 0 WooDSTOYES- . : 17) MAX TjqV-'UT' 0 BIV 30-50 VIP- - 0 cl-o DRYERS. . : 0 Fjf,tF DAMPERS?, - 50 1 Hr'. . . 0 (JTHFR UNITS. " 01 Gpq'; r*'RLs(-jURE- - - AIR HANDLING UNIT9 NO.. OF UNITS--- 01-ITI 0 FUPN l 1 Oo v, B T t..) cfm - 0 F,UpN ) =1000 BTU- 0 (WALJq--.R 790130) FEES by flat rerpt 1.4!97 0414 typ" 1710 -FnT Ot..' j(jjylr -fAT 1.497 97 -"3 0+14 AAL-KE1 PRMT 74;-'tiqW FIR ST Fq-cj-� - 02/14/97 ?7-2904114 TIG,ARD OR 97PP7, EXPIRED -!jr-CT 1 . 25 TAT fflo jnr,OL _ )T, HEATING A/(7 H OLC-,ATE BL-W) f:,ORTj..AND nR 97202 ToTni. P)CIII(I #* �-4,03--P714- 73,31 REDUIRED INSPFUTTONS 9eU #. - : 0@00 1.4 Line TT*1sP to the co"tairod in the am II)SP 5,jbject p.,Ost/Be This persit is issued specialty Ccdes and all other Mechanic-al Incip - stat. of are. P with Tigard Municipal Code, in accordance aspect i 011 applicable laws, All work will be donet started T . e if worh is no 111spection approved Plans. This per!it ill empir suspended for ooreFinal '�;thin 18@ days Of issuance, ot, if WOr4 han 180 days. pet-mittee 639 -4175 Issued BY " ' ion all far' City of Tigard MECHANICAL PERMIT Planck/Ruc. �t 13125 SW Hall Blvd. APPLICATION Permit PO Box 23397 Tigard, OR 97223 (503) 639-4171 escri� peon L-,jKa t•- Table 3A Mechanical Code CGTY PRICE AMT JobZ j ('L_ f 1) Permit Fee 0- o. 10.00 Address w 2) Supplempran.Permit 300 Furnace to 100,000 - .- 1) incl.ducts 8 vents F.o0 Furnace 100,000 BTU - Ownor 1 .1 '�r t1 2) incl.ducts S vents 750 Floor Fumance 3) incl. vent 6,00 Suspended seater,wall neater 4) or floor mounted heater 6.00 Occupant - Vent not incl.in Ate_ 5) appliance permit — 3.00 Repair of heating,re ng. 6) cooling,nbsorrition unit 6.00 Boiler or comp,heat pump,air con . r r R -V 1) to 3 HP absorp unit to 100K BTU 6.00 I�+,� I S IFD Boiler or comp, eat pump,air—cond. Contractor T-t p lav{ `1) 3.15 HP absorp unit to !X)OK CTU 11 00 w C ° Boiler or comp,heat pump,ear c,n . -' a) 15.30 HP absorp unit,5.1 mil BTU 1500 4k.Ta.w­ Boiler or cornp; heat pump,air cond. _ 10) 30.50 HP absorp unit 1-1,75 mil BTU 2250 1 hereby ac ow pry IFr t I have-ria us app— icatatton, t-at t 1© Boiler or comp, eat pump,air cond. -- Information given is corroci,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50 of the owner, that plans submitted are in compliance with State Air handling unit to laws,that I am registered with the ConsUuction Contractors Board, 12) 10,000 CFM 4.50 that the number given is correct. (If exempt from State registration, Air handling unit - -- ploase g ve reason below,) 13) 10,000 CTM + 7.50 Non portable — — 14) evaporate cooler 4.50 FIR ' Vent on connects _ 15) to a single duct 3.00 entiaUon system not r ~ 1 G) included in appliance permit 4.50 Hood sere y 1'7) mechanical exhaust 4.50 Describe work now a itron a toraUon repair ommercia ur to r71a5 - to be done residertial Q non-resi6mlial Q 1 B) type incinerator 30,00 Txisung uuse oTT -—� Other i.e.,wo stovo,avatar building or property 19) heater,solar,dothes dryers,etc 4.50 Proposed use of 20) Gas piping one to four outlets 200 building or property_ 21) More than 4-per outlet _ type Of fuel -oil Q natural yns ((� LPG Q electric C7 —� TIC -- 4-1 Minimum Fee$25.00 SU0TOTAL `� c PERMITS 13ECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCPAI;GC IF CONSTRUCTION OR WORK IS SUSPENDED OR - ABANOONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL ' AFTER WORK I5 COMMENCED. TOTAL Special Conditions Date issued --by WMFp/M./T •aArmWv CITY OF TIGARD DENEILOPMENT SERVICES P ERM PERMIT #:I_ PERMIT 13,125 SIN Hall Blvd,, Tigard,OR 97223 (503)6394171 DA'rE ISSUED: 02/13,/97 PARCEL- 2S1O1 Df--13502 I TE ADDRESU. . - +71742 4 SW F I R ST SUBDIVI ION. . . . ; 7..(JN T.iVC;:R Bl....00K. . . . . . I . . . : I_CST, Project Description: INS71- 1 BRANCH CIRCUIT _..__.RC:SI1?E:N'fIAL LJNIT-- --- _.-_...TEMP SRVC/FEEDERS.-•-----. --- MISCELLANEOUS-_......._ 1.1 00 SF UP LESS. .1 - 1 0 0 000 amp. . . . . . , : 0 PUMP'/TRRTOATTON, . , . ° F"ACI-I ADD' l_ 500SA. . . : 0 01 400 amp. . , . . . . : 0 S T GN/OUT I._INE LTG. . - it n TMITED ENEROY. . , . . : 17' 401. 600 amp. . . . . . . : 171 ~TONAL./PONFL . . . . . , : 0 wnNF. HM/ SVC/FDR. . : 0 601+amps--1000 volts. : 0 MINOR L_ASEL ( 10) . . . : 0 -SERV I CE/FEFD!:-_R ._- ----BRANCH CIRCUITS - - --•- ADD' I_ T NSPECT T ONS---- - 200 amp. . . . . . : 0 W/SERVICE SJR FEEDER: 0 PER INSPECTION. . . . . ; 0 1. 4001 amp. „ „ . : 171 1st: W/n SRVr OR FDR., : 1 PER 1.1O1IR. .. . . . . . . . . . . 0 1 - 600 amp., . . . , . : 0 EA ADD' L PRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : CP 1 11700 amp . . . . : 0 ____.... . __... _._...__.._ PLAN REVIEW r ECTTnN - . '00+ ) -4 :amp/volt. . . . . : 0 ) -4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : f7 onr)nct o n I y. cVC/FDR ) = E;7'5 AMPS. . : Cl nrq PRF_A/SPEC 017,('. _ ..................................._ FEES_FE, _.-__.._...._._._._- .. . TAME" WALKER type- a+mourrt- by date rrC:pt; 7424 SW '=I R ST GRMT $ 35. 00 TAT 02/1.3/97 PCT $ 1 ,, 75 TnT 17..11 ,.11. /97 97 91,' r' (X)RD RD O IZ '-?-'�'E'3 one 4: -------------- 'InENI x FI_FCTRIr CO $ (-,. 75 TnTAI ";7'7'' '.:.)W TF'CH CFNT17 R DR. REQUIRED I trISP'f"L ''T ONS _ ' OARD OR 9722.3 lir i 1. i n g Cover Underground Coy,- ,one #: 5013 -684-3,6001 Wall Cover Iniect' 1 Servi!.� g #. . i.-!647 permit is issued subject to the regulations contained in the _�- - , __---- - ;ard Municipal Code, State of Ore, Specialty Codes and all other Pk,r-M ,pplicable laws. All work i4ill be done in accordance with /1, / app-oved plans. This permit will expire if work is not started within 18N days of issuan.e, or if worn is suspended For sore TS _ � --•�� -- than 188 days, I SsUed -?.y _ . . OWNER I NSTPL I.AT T ON ONI..Y "a installation is being madv on property I own which is not itended far, ,1.e, lease, or rent. ANFR' S SIGNATURE: DATE: CONTRnCTOR TIMSTAI_L..ATION ONLY - i GNATURE OF' SUPR. EL..FC' N: __ DATF : i rENSE:. NO: Call for inspection 639- 4175 Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. _ c Tigard, OR 97223 Permit # 7-6d'-0 c Phone (503) 639-4171 Clete Issued CITY OF YICARJ FAX (503) 684-7297 TOD No. (503) 584-2772 Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Addrests'%q �' _�._�r - - Service included Items Cost(ea) Sum City/State/Zip—, ci mj;__ 4a. Residential -per unit 1000 sq ft or less $11000 4 Name (or name of usines Each additional 500 sit ft.or -- — portion thereof __ $2500 Commercial Residentia Limited Energy _ $2500 1 Each Menurd Home or Modular — Owelling Service or Feeder $6800 2 2a. Contractor installation only: 4b. Services or Feeders Electrical Contractor Installation,alteration,or relocation Electrical � � � 200 Amps or less $6000 2 AddIB$s l 201 amps to 400 amps $8000 2 City c State Zip 401 amps to 600 amps $12000 2 Phone N 601 amps to 1000 amps $18000 — 2 ,n/ Over amps or volts $34000 _ 2 Job NO. 1 r Reconnect only $50 00 2 contractor's license NO. _ -- 4c. Temporary Services or Feeders Contractor's Board Reg. No._ Installation,alteration,or relocation Signature of Supr. Elec'n 200 amps or less 2 License No. lone o 201 amps to 400 amps -A $SU no 2 401 amps Io 500 amps $7500 over 600 amps to 1000 wills $10000 - 2b. For owner installations: see"b"above Print Owner's Name _______ ;td. Branch Circuits -- Flaw,enerstlon or extension per pane Address a)The fee for branch circuits with City State_-_ Zip purchase of service or header fee. 2 Phone No. Each branch circuit $500 o)The fee for branch circuits w/fhouf --- The installation is being made on property I own which is purchase of service or header fee. 2 not Intended for sale, lease or rent. First branch circuit $35 DO 2 Each additional branch circuit $500 Owner's Signature _ 4e. Miscellaneous (Service or feeder not Included) 2 3. Plan Review section (if required): Each pump or Irrigation circle 34000 2 Each sign or oulllne,lighting $4000 Signal circuN(s)or a limited energy 2 Please check appropriate Item and enter fee In section 5B. panel,&Notation or extension 34000 4 or more residential units in one structure Minor Labels(10) $too 00 -— Service and feeder 225 amps or more _ System over 600 volts nominal 4f. Each additional inspection over Classified area or structure containing special occupancy the ailowable In any of the above as described In N E C Chapter 5 per Inspection -` $35 00 Per hour $5500 _---� Submit 2 sets of plans with application where any of the above In Plant $5500 apply. Not required for temporary constru:tion services. 5. Fees: NOTICE 5s. Enter total of above fees y 0 5% Surcharge (05 X total fees) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal 5 AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for CONSTRUCTION JR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ A PERIOD OF 180 DA% :'•'ANY TIME AFTER WORK IS Subtotal $ COMMENCED. .w Trust Account 11 1". PP g - Balance Due $ CITY OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 'TE* ADDREFM. [ADTIUTSION. . .. 'PE OF IJC)E. r-,F UNIT HFY)T'FRr% 0 VFW FA!,,Ic% CUPANCY (311P. P` ,,E,114 1'C W/,0 (-)P 1--,L 0 I'lF..'11T ''17 T F 17. 0 .r Tk(1TLFRF3/rnw,rF!3MR5 tinnns. . . . . . . . 0 IP I E0. . . . . HP. Nr 151 Hr'1 T. 0 r'[IMMI . 7 T N: 0 'X T 1,,1 17;1 I'T 0 I17'1.! I 30I I Ir', 0 QFP()T 1-7 I r 1':1; 0 30-50 1-1 P. . . . r r LA r-—oi r r =0 ,-! - . . . I It D R y F,r 0 IAN T T5 H r -.1 T)1. T N G I,IN Fr" (7171-IF'R t1t,1T7'F3. 1 r AT r -i� Q N < 1001{. P T I.1 1 10.110 0 c, in : III r,tjr, ri cri r—rr- A RN 0,.11 71 T 1 Cf 10000 r-fin : 0 int.-it Installation of gas NO ane. replace existing oil f.Irnace "/new gas lace, 11 P r IN .,rjt4M T P In, rsW DENNIM' I�P r 171M 1 q 4'o r) 'Wr:.'r\T0N CIR if: P 0. Pr7011 11 f?r-'r) T (''T I I , This pfi-xit is issued Subject t the regulat,ons contained in the 7T-1-P `-..ird Municipal Coder State of Ore. Specialty Codes and all other r I. t. i rl L", ! Int Tlij) icab)F laws, All work will be done in accordance with Final 7n!-,PrrJinn -oved plans. This pereit will expire if work is not started ........ An 18? days of js;vancs, or if work I! suspprded for ocry 180 days, ATTENTION- Oi,pgof, lam rpqUir@s you to follow rules pted by the Oregon Mility Notification Center. These rides are forth in OAR 952-11101-WIP through OAR W-011080. You may .,in copies of thise rules or direct questions to ON by calling 7 124-9187, '5 IA V, fir 711 rly-1-it 11 &W/— + 1 1 4 f- 4 1 1 1 1 j 4. 4. -1 1 4 i_.{-4 4 +-1-r I +1- 1' 1 4 4 + I I f, I + I A .1, .4..+ t + ++ I r 1 1 4 1 in t)i I- c,r)s; ri e e(I vi`rJ I,b h IL CITY OF TIGARD Mechanical Permit Application Plan Check#_ - PP Recd By 13126 SW HALL BLVD. Commercial and Residential Date Recd _ TIGARD, OR 57223 Date to P.E (503) 639-4171, x304 Date to DST Print or Type Permit#,4,4—ff __ _Incomplete or illegible applications will not be accepted Called _ Name of r.avelopmendProleci Description Table 1A Mechanical Code q Price Amt Job StreetAlddreaa gvh�t �e mit Fee 10.00 Address 7l} / ,5(�t T 7-�� 1) Furnace to 100,000 BTU / -- including ducts&vents 6.00 atdgf rltyrstafe Zip 2) Furnace 100,000 Bl U+ g7az,3 including ducts&vents 7.50 Name(or name of business) 3) Floor Furnace Owner 0WAf1�P(,Q&E-A)1q ACA50YIP— includin vent__ — 6.00 Mailing Address 4) Suspended heater,wall heater Or floor mounted heater 6.00 7;-) JET/?P ST _ 5) Vent not included in appliance permit --- CRY/State Zip Phone 3.00 CHECK ALL 'Boiler Heat Air Name(or name of buelness) THAT APPLY: or Pump Cand Qty Price Amt Com •• Occupant Mailing AAdress 6)< 3 BTU HP;absorb unit to - _ _ 600 7)3-15 HP,absorb unit CMy/slate ^` Zip Phone 100k to 500k BTU 11.00 `^� 8) 15-30 HP;absorb — — unit.5-1 mil BTU 15.00 Contractor Name 9)30-50 HP,absorb ______— unit 1-1.75 mil BTU 22.50 Prior to permit Melling Address 10)>50HP,absorb unit issuance,a Copy >1.75 mil BTU 37.50 of all licenses CRyfState Zip Phone 11)Air handling unit to 10,000 CFM are required if - 450 _ expired in COT Oregon Const Cont Poard Lk M Exp Date 12)Air handling unit 10,000 CFM+ database __. ____ 7.50 _ Architect Nan1e 13)Non-portable evaporate cooler 4.50 or Mailing Address — 141 Vent fan connected to a single duct 3 00 Engineer ciryrStnte zip Phone 15)Ventilation system not included in g _ appliance permit _ 4.50 16)Hood served by mechanical exhaust -� Describe work to be done 4.50_ 17)Domestic Incinerators New Jf� Repair O Replace with like kind Yes O No O _ 7.50 Residential Commercial O 18)Commercial or industrial type Incinerator 30.00 Additional infcrnatlon or d@scription of work — 19)Repair units 4.50 :� r;i c_ /`r va•ss-��L--�_ ___ __ �7 20)Wood stove - � „ 4.50 •- 21)Clothes dryer,etc 4.50_ Type of fuel: oil O natural gasy LPG O clectric O 22)Other units 4.50 I hereby"nowledge that I have read this application,that the information 23)Gas piping one to four outlets given Is(correct,that I am the owner or authorized agent of 2.00 the owner,that plans submitted are in compliance with Oregon State laws. 24)More than 4-per outlet(each) _ 50 SlAnature of Owner/Agent — Date - -— 1Minimum Permit Fee$25.00 SUBTOTAL g f� B 9 -- -- 5%SURCHARGE Contact Person Ndme Phone _ PLAN REVIEW 25%OF SUBTOTAL Required for ALL commercial ermits only r,o"le ��1�l - j'� cj - TOTAL 'State Contractor Boller Certification required "Residential AJC requires site plan showing placement of unit i ', I Omeehperm doc rev 07/20/98