Permit " a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00152
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/06/2010
Parcel: 2S110BA06500
Jurisdiction: Tigard
Site address: 12160 SW WILDWOOD ST
Subdivision: SHADOW HILLS NO. 2 Lot: 48
Project: Provancha
Project Description: Replace gas furnace.
Owner: FEES
PROVANCHA, TOM & CINDY Description Date Amount
12160 SW WILDWOOD ST
TIGARD, OR 97224 Furnaces < 100K BTU 04/06/2010 $46.75
12% State Surcharge - Mechanical 04/06/2010 $10.80
PHONE: 503 - 522 -9601 Minimum Fee Adjustment - Mechanical 04/06/2010 $43.25
Contractor:
JACOBS HEATING & AIR CONDITIONING
4474 SE MILWAUKIE
PORTLAND, OR 97202
PHONE: 503 - 234 -7331
FAX: 503 -808 -9108
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: n I n ( Permittee Signature:
` 4� V `V Q /,�iln ) Q Q P
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-,
Mechanical Permit Annlication • ., - , • 1•01z 01..1.1( 1.. rtil.:
City of Tigard Received
Dated3y: V.0 Permit No.: rykie2on
N..,_. 1312$ SW Hall Blvd, Tigard, OR 97223 APR 0 2 2 0 10 Pim Review
Other Permit Plume: 503.639.4171 Fax: 503.598.1960 Dasidar.
- Inspection Linz: 503 it
-639.4175 sa
Dun rablity: c 21 See Page 1 for
Internet: itnvw.tignrekr4ov Notified/Method. C l Supplemental leforinenaa
11111111.MISZtrnliggniin A**. - 4 0 /ati**.4. 1 .10 61 0:" igirC*C
Mechanical permit Res' am based on the value of the work
0 New constructiOn faAddition/alteratiOnlreplecethent performed, Indic= ihe value (rounded to the nearest dollre) of all
0 Demolition 12 Other: mechanical materials. equipment labor. overhcadotnd profit.
' ''.' • '.: ' r:- '''' ...:4014 Value: S
W•Mr lb!... '.'.Ligi7 .• : ,.'....'
:•-• .. RER0lintMLICOMPP/IMOISVGEOIS VW*
lq-1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For vectat Warnsat• on raff Chile-MLA
0 Multi-flintily 0 Master builder 0 ' -.
Other: Description 1 Qty. i Ea 1 Total
.- . i .-: . • ' ..::::-.. '. :. / V.: 441 _ : .... ;t C .......11 D' ). Heating/cooling
Air conditioning
Job site aridness: 1 .,.. 1 k ..0 0 , •,,,,-.) (....0k i CP 10•■•\C _ . 10 di__n ta.
r.an 46.75
City/StatalP: % i ee, o rz_... cl-iD---/-1 Furnace 100,000 BTU oructriveou) _ k 46.75 "110.1
Fumacc 100,000+ BTU (duChiserrh) 54.91
Suite/bids/apt. no.: [Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 2132
liy_drooic hot water system 23.32
Residential boiler (radiator or
hYdrmic)
23.32
Unit him= (fuel-type, not electric), .
in-wall. in-duct, suspended. etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
- Other. 2332
_. -
Tax mnp/pareel no.: Other fuel appliances
WaIer)rater ..._
-'.... ..; ' : • .. • •-: ... VOW '::.•: .....:„ •-•--..'...; : -:,-.:. . -
.-. - 23.32
Gas fireplace 3339
Flue vent 63r water heater or gm
, re- y .., ..-, -6-A.," fla_ LQ, fireplace
Log lighter (gas) 23.32
.
Wood/pellet stove 33.39
_
Wood fir5lacainsert 23.32
- .; •. Chn ne
*116PgRitaX1V.127 -1;.;' , ii...,: s 'liliat 7 ,. . • -.- ,... ,,, , •- 21Z2
23.32
Nli mc;
T. .•r cg C.--i f' 41; 41° 1•4\) Gvn-thl a Eavironmental Carina and ventilation
9 Range hood/ether kitchen
Address:
- equipment 33.39
City/Suite/ZIP: Clothes dryer oakum 3339 ,
Singio-duct exhaust (bahrooms.
Phone: 60"5.,....-n-- - 4 11,09 k Fax: ( ) calla cam aus up rooms) 23.32
.:• '' --',' ' i.'07 . ;• 4 ,.., Pr ;,', .:;e 1•,.:j 7: : .. , Atriacrawispeze fans _ 2332
Other 23.32
Business name:
F
Contact mune; 514.15 for first tour s additional
Address: Furnace. etc. .
Gas halt munp
City/Statc/2IP: _ WIllimepeodcd/unit healer
Phone: ( ) I Fax: : ( ) _Water haw _ •
Fireplace
E-mail: .
_Rale
• __ .. .
• - r . ..... • . :::'..,,, ...,,,,! ...iftl; ., . p .. ..{: , ...' - 7... , ''f' !c - - .' ... w .,. - :‘ , ''' B bccue —
Business name: Jacobs Heating & Air Conditioning Clothes dryer (tou)
- Other:
Address: 4474 SE MIlwaukir Ave
!:.: "_'. ''''..: :' ' ' •
,._ .. . ..
ay/State/ZIP, Portland, OR 97202 Subtotal
Phone: (303) 234-7331 Fax: (S03)10-9108 Minimum fee (S90.00)
Phut review a5Vs of penult fee) 1
CCB lic.: 1441 - . su s urc h arsc ( r 2% of pasnit fee) ' IC) r i
_,
TOTAL PERMIT FEE 10:'r
Authorized signature: rYkr/J26. vv--- rr-k- ivi.„,,,-4,„ . - -it...permit opplicedim eipii Ir a permit is an& sassailead within 180
days slur !than Wee eccepied is onopiere.
-
Print nanw( Y\ .42_..k c.. r.,:, rv Date: 0 41,1 • Fee mellsolology us by Tri•Cauray Bui1die8 laskary S hood
I UkarsegriPemsecIEC-Feresisees dee )(KIM 4404bIrC pltilniCONVWEM
NI/Z0 AEd 9NI1V3H ssoDvr LgZEET8E3g ZI :VI J1/?B/t3