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CITY OF TIGARD MECHANICAL PERMIT
Permit#
Description
Table 7A Mechanical Coda —_—._ OTV PRICE. AMT
City of Tigard _0- -0_ 10.00
13125 S.W. Hall Blvd. 1) Permit Fee _ _
P.O Box 23397
Tigard, OR 97223 2) Supplemental Permit — 3.00
639-4175 1) Furnace to 100,000 BTU i 6.00
incl.ducts&vents
2) Furnace 100,000 BTU 1 7.50
_incl.ducts&vents_
Name of Development 3) Floor Furnace 6.00
incl.vent
Suspended he6ter,wall heater 6.00
Address
Job Address r•Ir 4) or floor mounted heater _—
� � ��� �—.— --- —__..
Tax Lot 00"--' Map No. ;L ' 5) Vent not incl.in 3.00
appliance permit
Lot 4 Z Mock `�ubdiws•�n(<r�r t/�r., f -
No (or name of business) 6) Repair of hearing,refr ig., 6.00
-7 cooling,absorption unit
--
MaWngAoress Phone 7) Boiler or comp to 3 HP 6.00
Owner absorp.unit to 100,000 BTU— T __
ciiyist�ta — -- Zip 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit tc 500,000 BTU
Name g) Boiler or comp 15-30 HP 15.00
absorp.unit 112-1 million
Mailing Address Ph" _ 1�) Boiler or comp to 30-50 HP '22 50
absorp.unit 11.75 million
Contractorcny�state -'-Z;p - 1,) Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU —-- _
Slate Registraticxt hip City Bus.Tax No 12) Air.handling unit to 4.50
10,000 CFM
_
I hereby acknowledge that 1 have read this application that the Intcxmatkx g,ven is 13) Air handling unit 7.50 10,000 CFM +
oprrad,thal I am the owner or authorized agent of the owner,that plant.subenifMd are in -- — _—__.__ _-- —• -------
cranphance with State taws,that I am registered with the Slate Builders'Board,that the 14) Non portable 4.50
number given is cared (If exempt from State registration please give•nnson below) a Iaporate cooler-- _ _
15) Vent fan connected f 3.00
to asingle duct
----
_ Ventilation system not
16) 4.50
inr.luded in appliance permit _ — —
._ Hood served by ~- — 4.50
17)
mechanical exhaust
Sigal:xe a
army Date Domestic type 7.50
___ __ _ 18) incinerator
Describe work F] addition C l alteration 0 repair D -- ------------ -- -- --
to be done — residential — non-residential ❑_V 19) Commercial or industrial 30.00
Existing use of — type incinerator
building or properly TV _.___—- 20) O►her i.e.,woodstove,water 4.50
heater,solar,clothes dryers,
Proposed use of ,[? -'�`�`
building of properly _ ---------- 21) Gas piping one to four outlets 2.00 )e L
Type of fuel oil I I natural gas jq LPG 1 electric I I
22) More than 4-per outlet
NQTICE SUB-TOTAL.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR COV
Mie SURCHARGE
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 50____-..____._—..__—__
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 100 DAYS AT ANY TIME AFTER -
TOTAL
WORK IS COMMENCED _
Special Conditions
Date issued _ _ by
BUILDING P1=,ter ' l ;'•PPLICATION DATE _=' ,,9_ _? ISIR25
THE UNDERSIGNED HE_P.EE Y APPLIES FOR A PERMIT FOR THF WORK HCREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN'rHE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LO.'NO
OWNER .Tray e.iz l.le r JOB ADDRESS 4175 SW Mill Strest
— ARCHITECT
ENGINEER
BUILDER Jay Miller $1 r Inc ADDRESS _1113 Wx 232991, Tipt d _ DESIGNER
STRUCTURE Ll NEW ❑ q'P.^bEL LJ ADDITION ❑ REPAIR D RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
1-1 RESIDENCE ❑ COMM Ll EDOCA.'101,• AL ❑ GOVT ❑ RELIGIOUS Ll PATIO ❑ CARPORT GA iAGF n STORAGE ❑ SLAB FENCE
OCCUPANCY R-.3� _LAND USE ZL NE � BLDG.TYPE "3 FIRE ZONE--PLAN CHECK b Y Lj -HEAT_-Qa L.. —
Construct single family dwelling with attached •gavagao all per apy roved plans,
Sub-
SEWER PERMIT# 34051 (Idu) 3 baths* 11) traps garage area 535
OCC.LOAD FLOOR LOAD 40 HEIGHT 70+ NO.STORIES 2 AREA 237.0 NO.BEDROOMS 4 VALUE 10303PI.
--BUILDING DEPARTMENT SEI BACKS FRONT Z? REAR 60+ LEFT SIDE P RIGHT SIDE 16 _
Permit 443•x_ THIS PERMIT IS ISSUED SUB,IECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE.ZONING
797.95 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE
Plan Chick _ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal _ --^_ RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
27115 L* E..SEPARATE PERMITS REIUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 's
Total 753-10 SDC-600•
TT 1 r.,
a� � mrI sl.r al. � ssl car w
1 2
t
..l L;.::i.:•.r'Si:iySi�1K1 1l17tu.�_, ..tF
DATE INSPP, TYPE INSPECTION REMARKS PLUMBING �y DATE
Contractor .h
-- Corr -"1 7
Permit No.
Fixture
Final
HEATING — —
�� Contractor
LI2c — Permit No.
ur lr Gas or Oil
�� — ` +�•==------ -- Rough-in --Final
SEWER
_ Ficial
— ------..—�-------- -- DRIVEWAY .—
Final
Storm Drainage
(Rein Drain)Final
Sidewalk
Curb a Street Final
Approach
BLDG. DEPT. FINAL T- P—RANY CER'riric TF OCCUPANCY
CERTIFICA :OCCUPANCY Final
L.endscnping
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