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Permit MECHANICAL PERMIT CITY OF TIGARD ®: COMMUNITY DEVELOPMENT Permit #: MEC2009 -00618 Date Issued: 11/19/2009 T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104BA03300 Jurisdiction: Tigard Site address: 12087 SW WESTBURY TER Subdivision: Lot: 0 Project: Bartholomew Project Description: Replace gas furnace. Owner: FEES BARTHOLOMEW, KEVIN L & PATRICIA Description Date Amount 12087 SW WESTBURY TERR TIGARD, OR 97223 Furnaces < 100K BTU 11/19/2009 $46.75 12% State Surcharge - Mechanical 11/19/2009 $10.80 PHONE: 503 - 747 -6670 Minimum Fee Adjustment - Mechanical 11/19/2009 $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: 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, rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility tification 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 dir ct questions to NC b ailing 503.246.6699 or 1.800.332.2344. Issue By: /Z� Permittee Signature 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. f �` _ liq -. fetal)IL tIliiI( Ili_ '"w b1'� s ,. Mechanical Permit Applicati I C �� _', - , , V, M1rasx. lie wc,.,s 1 .I, . t ° . Reeaivwd O Pamu No.: `t L r �.i' ' . s 13125 SW Hall Blvd., T OR 97223 P ., Review Other Permit: ilt,...... `_ , Phone: 503.639.4171 Fox: 503. 598.1960 pads . . ,:I w, n Line: 503.639.4175 N V 1 0 L U U 7 Oa1e R dy+By: �ru` la See Page I rue i«t ti yi= I t Ini nice: N etified+Mmhod: / / Supplemental inrormatIon CITY OF TIGARD �� Intetttm: www.tigard- or,8m' a 5v ._ TYPE OF vvetALDING DIVISION i commiatam. FEE* sc1ITEn13IZ - USE CHECKLIST Mechanical permit fees° arc bawd on the value of the wort ❑ New construction ddition/alleration/rcplacement performed. Indicate the value (rounded to the ncarar dollar) of ell 0 Demolition ❑ Outer: __. mechanical materials. equipment. labor, overhead. and prvfit- Value: $ CATSGORYQR CONSTRUCTION RESIDENTLU. BQUIPMEiVT /SYSTEMS * • and 2- 111mily dwelling 0 Commercial/industrial 0 Accessory building Far apical, information uaa checklist. ❑ Multi- family © Master builder ❑ Other: ' Description I Qty i Ea- 1 Total • 'JOB SITE INFORMATION AND LOCATION _ NeatinglcooUn_ � e(1 Air conditioning 46.75 Job sin arras: & a C �! 6L 1rcquitcs aue pion thowinspucntKttt) / Furnace 100.00 ct 0 BTU (dnslvents) 46.75 City/Slate/ZIP: -71 a" �'� ��!!- Furnace 100,000+ B7U tauathcwsl 54.91 Suitc/bldgJappt. no.: PEOJ me: Q ecl norm ("44'l0i Q WI 4! LA) HOPI ■ . 61.06 Cross strcct/directions tojob site: Duet work � NI � . H . • nie hot wafer stern Residential holier (radiator or h $onicl 23.32 Unit haws (uoHype. not electric). in -wall. in -duct, suspended. etc. 46.75 Flue/vent for any of above' 3 Subdivision: 1 Lot no` Other: 2132 Tax map/parcel no.: _ Other fuel appliances .i'DEISCRIMON OF WORK • Water heater 23.32 - Oat flrelacc 33 -39 A' r • etc • Flue vent for water beater or gat fireplace - 23.32 Log lighter (cast. _ 23.32 _ Wood/pellet stove 33.39 — - - Wood fueplace/inscri 23.E Chimney/liner/Rue/van 23.32 OI'JdiCf'9f OWNER I _ 0 TENANT Other: 23.32 _ Nam: e_ t ` Z� U i a y4 at ,, Environmental exhaust and ventilation V1 Rangy: hood/other kitchen Address: equipment 33.39 City /StoteJ21P: Clothes d r exhaust 33.39 Stngte.duct exhaust(bathroorns. III IIIII Phone: (16"3 7417 0 (76 Fax: ( ) toilet cam • , - L. unlit rooms) • 0 APPLICANT' C] CONTACT PERSON Attidem ,ace fans MIME Other: 23,32 Business name: - Fuetping Contact name: 514.15 for first lour: 54.03 for each additional — Furnae s ate. Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Phone:( ) Fax: : ( ) Water heater Fireplace Eon& ltaa • R BBarbecue ! _ Business name: Jacobs Heating d( Mr Conditioning Clothes dryer (Bast - Other. - Address: 4474 SE Milwankie Ave MECHANICAL PERMIT BEES' . Cityl5tatclZlP: Portland, OR 97292 - Subtotal (. S Minimum permit fee (590.00) " 0 ' 0 Phone: (503)2347331 ( Pax: (503) 808 -910$ Pier review (25%orpermit (c) I CCB lie.: 1441 ... 5miesurehoz c(t2%ofpermtt ibc) / • SO `' ^--- TOTAL PERMIT FEE WO • ■ a / 77th wont application moots if a permit is not otua4cd within 180 Authorized siBnature i r pk . �� r days otter it hap bawl accepted as com L ' " -�TJ T EI tL'N Date: ( ! .7 - 0 ' • fee nethadotocr see by T .Coco y Buitdiae tarteirry Service So t:19uatigWenniunlEC iAP peoe 1(1091109 HQ+1617T (1c101rcOM WEB) C702-0 r .7 Z0 /Z0 39dd 9NI1d3H SSOD r L5ZBET8E05 95 :bT 6002/8T/TT