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CITY OF TIGA RD
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COMMUNITY DEVELOPMENT DEPARTMENT 00MON
13125S.W Hell Blvd.,P.0 ilox 23397.Tigard,0-qnn97223,(503)639-4175 I. 01 '11.55LIED : 10/1.7/8E.3
-JOU4 AlJUAh::SS : (3020 SW MAI-1111...E.I...EAF ST
'TAX MAP/1-01, SUB: 1.'T 6'K
11-61,40 USE:.' :
1-01 Slzv :
NO: NO .
WL)r4K CLASS : AL'TEWATION F:TJ1:4NA(`,E <100K I A'.1 P' HAND1.44 <.'.0
USEK. VYPE� - F(W11Y FUMACE 1001(+ AIR HANDI-P 10K
(:.ONST TYFIU.: PUANOC'E: EVAP.EX)OLEP
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VIENT VEN'T . SY511.:M
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NO FiTOPIES : kiLp/cOMP INCINERA'T'OR WOM
-301-11 '1 NE PATOP 11 WM
DWELI... .UNITS : U-141/(:1OMP 15 IN(,
F 110- 'TYPE: GAS 30-50HP PEVIA1141 UNITS
MAX '.I:Nl:)tJ'T* ULAMOMP 30-HIP 0 THl'-:'.l4
1'- :I IMPR51? GA-5 PIPING UIXILETS I.
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PHONE: (."503) P-15 -5931. 5'1'A*T*E TAX 9
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O PHUNE ( 503)
R PEGIS37441111.11:11IN NO . 4141 10TAL : *19.90
This permit is Issued subject to the regulation-,contained in Title 14 RECEIPT NO.
of the TMC. State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances. and It is hereby PFFIQUIPF-:0 INSPECTIONS
agreed that the work will be done in accordance with the plans and GAS LINE
specifications and in compliance with all applicable codes and
ordinances The issuance of thiP.permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void if work is not started within 1130 days,or if work Is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
RII required inspections are requested and approved
Permittee Signature
Issued By
(',At I.. F('.)P INC. 639--ell-1,03
SEPI'SATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TIGARD MECHANICAL PERMIT Receipt#
Permit#
Description
Table 3A Mechanical Code CITY PRICE AMT
City of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee o o- 10.00
P.O. Box 2,1397
Tigard, OR 97223 2) Supplemental PermitY - 3.00
639-41751) Furnace to 100,000 BTU 6
incl.ducts&vents_ _ -Cr0
2) Furnace 100,000 BTU 1 _ 750
incl.ducts&vents _
Name of Development 3) Floor Furnace 6.00
incl.vent
Job Address �- 4 Suspended heater,wa!I heater 6.00
Address (� (J S,UJ ` r )_or floor mounted heater
' z ��� --
Tax Lot Map o 5) Vent not incl.in 3.00
Lot Block Subdivision appliance permit _ _
Name(or name of business) 6) Repair of heating,refrig., 6.00
cooling,absorption unit
Mailing Address Phone7) Boiier or comp to 3 HP 600
Owner /(�/// y/0 L21/S-5!i3 absorp.unit to 100,000 BTU
City/State Zip 8) Boiler or comp to 3 HP-15 HP 11,00
absorp.unit to 500,000 BTU
Nam 9) Boiler or comp 15-30 HP 15.00
absorp unit 1/21 million
Mailing Address Phone t 0) Boiler or comp to 30-50 HP — 22,50
y absorp.unit 1 -11.75 million _
Contractor City/State t 7 1a zip,5zL� 1 1)�Boiler or comp to 50 HP 31.50
u�`C cp2 ---��C9 - absorp.unit 1,750,000 BTU
State Registration No. City Bus,Tax No. 12) Air handling unit to 4.50
Z/,/, 10,000 CFM
i hereby acknowledge that I have reed this application that the information given Is 13 1) Air it handling unit 7.50
corre t,that I am the owner or authorized agent of the owner,that plans submitted are in - -- ----
compliance with State laws,that I am registered with the State Builders'Board,that the 14) Non portable 4.50
number given Is correct(If exempt from State regisiralicn please give reason below). evaporate cooler
--- 15) Vent fan connected 3.00
!o a single duct —
_------_ -__ ---_-_-- 16 Ventilation system not 4.50
i-icluded in appliance permit
17) Hood served by 4.50
I mechcnical exhaust
Signature er or agent) Date 18) Domestic type 7.50
Describe work 171 addition F1 alteration Li' repair (_1 incinerator _
to be done residential U _ non-residential U 19) Commercial or industrial 30.00
Existing use of ^ _ type incinerator
building or properly 20) Other i.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers,etc. -_
building or property Z��'S
21) Gas piping one to four outlets 2.00 Zr a,)
Type of fuel-- oil ❑ natural gas (1 LPG ( 1 electric Cl
22) More than 4-per outlet
NOTICE SUB-TOTAL Moo
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -�-- - --
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 fo SURCHARGE j-C,
DAYS, OR IF CONSTRUCTION Oft 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------- ---- _-