Permit R F • C ITY OF TIGARD MECHANICAL PERMIT
F' �, COMMUNITY DEVELOPMENT Permit #: MEC2010 -00257
TLGARAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2010
. §; Parcel: 2S103DB10500
Jurisdiction:
Site address: 13215 SW GENESIS LP
Subdivision: GENESIS NO. 3 Lot: 70
Project: Riles
Project Description: Replace gas furnace.
Owner: FEES
RILES, JOHN R & SUZANNE B Description Date Amount
13215 SW GENESIS LP Furnaces < 100K BTU 06/09/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 06/09/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/09/2010 $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: VB
Occupancy Grp: R -3
Stories:
Fuel
Fuel Types: Natural Gas
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: tilithV Permittee Signature: S EL A p .1- .A TS tint
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.
06/03/2010 1:3b 5038139257 JACOBS HEATING PAGE 02/02
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Me ,",not,7" ; '7 ,':", 1, ' i■, , 2 . ,V`il'' ' ?1, 5 A ' •i ‘ W ,t`'
chanical Permit Application ,-,,:-,.,,,,.::,L,:ei '(,;‘,1-'1,;
juN 0 4 2010 ,.,,
City of Tigard Perrnit No.-
'-, ,.. -e• .." Datenty:
Ili --- - 13125 SW Hall Blvd„ Tigard, OR 97223
V - " g ;;;4, Phone: 543,639.4171 Fax: S03.595.1960 CITY OF TIGARn PI" ReViCW
. .... Duefity: Onser Penuii.
. - ••-, -,- , - I.' Inspection Line: 503.639.4175 BUILDING DIVISIOP Dit*?latYrBr pins RI see Pagel for
.
, IN.;■144 -,,.! .44 nuernet: www_ligardna.gov Notlfied/Meiliod: Supphimentol Informerien
:., . • -i'h . :. ::':,.?' . 1 - ,' . .5 4 77 , - + - ..f 4 : - . . , ,,T ;" ',..:,,yr:f "' - ''.-.?...,:.:, sail** usAckaius-r
Mechanical permit fees' are lased on the value of the work
0 New construction 41a"Additlion/alterntior performed, Indicate the value (rounded to the nearest dollar) of all
El Demolition 0 Other: mechanical materials e. ui • labor overhead, isnd • rofu
- ' ' "totion 17 . : ', ..Y., , --, • value: S
" it ; • - 1 itgiatii 0,1 i I ' '1 , 11 SYSIIMS TEES
Xl...1- and 2-farnily dwelling 0 Commercial/industrial 13 Accessory building For special inform:Anon tete checklist
0 Multi-family 0 Mutts builder In Other: Description • • Ea, Total
MESIMNNHEMTML7illarais,Argi5a5,17774:25iatlijak Heating/cooling
Air conditioning
Job site address: I '' -,..) .0---ne.5: _oczp _ .lan Mewl • becalm 46.75 111111
City/Stale/Z1P: '71 p ci o f._ (vi -1.-,s• Furnace 1000000 BTU duets/vents III 4635 Iiiii
Furnace 100 ow+ BTU duets/vents 54,91
Suite/bldg./apt. no.: Project name; .
Heat • m . Mil 6L,06 Mal
.
Cross street/directions to job site: put work ill 23.32 Mil
Hydronic hot water system 23.32
Residential boiler (tadiator or
hydronic) r 23.32 111
-- --
Unit heaters (fuc -type, tot eleoUic),
itpwrdl, in-due suspended, ete. 46.75
Fluelvent for an of above 111111 23.3
Subdivision: Lot no.: Other: 23.32
Tax mitp/parcel no.: . Other Nei a • • Bermes
- - - - - -.- . • . - :• - -. , 7., , , - -,--• • '' ; .1 ..- .s • , ,,' ;-Z
• • . - '. '—.... : 4..;g1444,g4,4 , l.t. ...; i . - , 3 . .1.■:! : , , . ' al 2332 MIIMI
33.39 MIN
_ __ IEEN111
_
CC---t.... (":;-^- rof ck. • Lc._ li_liter _, IM 23 32 MIEMIIIII
Wood/pellet stove 11.11 33.3 111111111
Wood fi • lace/insert NM 23.32
- Chimney/litterfilueNent _ 2332
- 1-71 ai Other: 23 32
Nitinre e41lMIIIIIIMIIIIIIIIIIIIIIII Environmental exhaust and ventilation
Range hood/other kitchen
e • te • ment 33.39
Clothes d exhaust 33.39 Mill
Single-duet exhaust (bathrooms, min
Pherle:-e (49 ''' (.61.44(Gi Fax ( ) toilet Rom , amass utili rooms
IffiltaingiaMS3011. MS '7 toWs..""p:INN Attie/craw .� fans =MI
Other. 23.3 1111111
Business name: Fuel piping
Contact name: 514.15 for first four; 54.03 for each additional
- Furnace etc,
Address: Gas hoalpump
City/State/ZIP: WalVsusoendednutit heater a
Phone: ( ) Fox: 1 ( ) Water heater
Fi - lace 1.1.1..
&mail: REM . C I= 11.1.11..111
linlincriV.Isra•H'MlirliSPEMINVIAMMIES enthecue - ME
Clothes dryer (gas)
Business name: 3neobs Renting & Ale Conditioning
_ Other:
Addrrns: 4474 SE Mitwookie Ave RIMISATZ4
City/State/ZIP: !Portland, OR 97202 Subtotal NM.
Minimum • errnit Ice (S90.00) '' 0 .0 1
Phone: (503)234-7331 Fax: (93) 003-9108 IIMEM1111221=1:nal3=1:3.11111111
CCB lie.: 1441 glee surcharge (12% ofeennit fee) I 0 - . lb
TOTAL PERVIIT FEE 100 - 26) I
Authorized signature rYkae/L^„A.,..". Mc- o r.- y- Thin permit application entire. if a pertak b not obtained within tfin
days after It bat been liccepted AI compiete.
Print name: 4.4 A.,1: e (\L- -k- Date 1, 0 i • Fen methodology seri by Tit-County Buittlina totinttry Service Board
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