Permit CITY OF TIGARD MECHANICAL PERMIT
Ill COMMUNITY DEVELOPMENT Permit #: MEC2010 -00270
Date Issued: 06/16/2010
- ficAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103CD01600
Jurisdiction: Tigard
Site address: 13755 SW FAIRVIEW CT
Subdivision: HOLLYTREE Lot: 16
Project: Holt
Project Description: Install A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
HOLT, ROY Description Date Amount
13755 SW FAIRVIEW CT Air Conditioning 06/16/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 06/16/2010 $10.80
PHONE: 503 - 603 -9896 Minimum Fee Adjustment - Mechanical 06/16/2010 $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: Permittee Signature: 69 ,v ,p / C7 o,✓
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 Ap lice n ; J ' i r . ^ .i °+ > ; ,r ` , 't ti
P i i `)1 11i 1�,-m),I ��+
tl u „, ^!' ! -. Z . 1 .d ✓4 k �� P�J x�#L : ke'- �ed:N,d: fie& - .1 ,, ,;:n :. ,,:, NNda
h + � fi+ •4v��s',},�
' City of Tigard Received . r Pv mil Nu/rige of O/O -? (?? 7 ,I
® 13125 SW Holl Blvd., Tigard. OR 97223 U N 1 5 2010 0 � Q awe tea ,„ '���
M d , Phone: 503.639A 171 Fax; 503.596.196 Other Permu
31 i •- r i')t 111Fectimn Lino: 503.639AI75 / �� ` y q der: �� / /o yrQ . Coy
s. :'40. ,1 sxi^ Internet: www.tigard-or.gov GI S 7 .- ' _� •p r�•+ii`� W iii fib'' Iwu V
BUILDING DIVISION
NenfiedlMathod;
TYPE OF WORK COMMERCIAL FEE° SCHEDULE – USE CHECKLIST
❑ New construction ddition/altcratiort epincemcnt Mechanical ptumit fees" ale blued on the value oak work
❑ Other performed. indicate the value (rounded to the nearest dollar) eau
❑ Demolition mechanical materials. equipment, labor. overhead. and profit.
CATEGORY OF CONSTRUCTION Value: 5
�I and 2-family dwelling Accessory RESIDENTIAL EQUIPMENT/SYSTEMS /SYSTEMS FEES*
y g ❑ Commercial /industrial A ccesso building
El Matti -Earn! Fora teak ++as checklist ❑ Media r buil [� Other: Description i Qty. [ Ea_ 1 Total
JOB $TTE INFORMATION AND LOCATION Henna coa
Job site address: / .33 S Air planing
u` ••i r` (�.(� �--(; ire cite tan rhowia mono 46.7S 71 • ��
Ci(y/StateolZJP: ' t ,r{,.1 e• t "R r � ''7 �23 Furnace 100.000 BTU (duasnean) 46.75
Suitc/bIdgJapl. no.: s. 1 Project name: ' + . E . . 1 fi- Heal Furnace
pup 61.06
Cross street/directions to jab site: Duet work 23.32
Hydroaie hat water system 23.32
Residential bailer (radiator w
bydronici 2132
- Una heaters (fuel-type.. not electric),
in -wall. in - duct. suspended. etc. 4675
Subdivision: I Lot no.: Fluc/vem_for any of above 23.32
Other , 23.32
ui
Tax ap/pattxl no.: Other fuel dppi iaacts
DESCRIPTION OF WORK Water heater 23.32
Gas tireplow _ 33.39
Flue vent tar water heater or gas
- Y) 5-k-a- 11 1..) e_ GJ A; r CondLiA•i a�
fireplace — 23.32
lighter (gals) 23.32
Woo4J►/ ellcl stove 33.39
Wood fireidezelinscrt _ 23.32
ROPERTY OWNER I D TENANP ChimaeYitincHllurlvenl 33.32
Other 23.32
{�
Name. �O n l Environmental exhaust add ventilation
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
/ _ Q ` Ao Ct ! r Single-dt+ct exhaust (bathrooms.
Phone: (rap3) (, ! Q l iP I Fa ( ) toilet compartments. utility rooms) 23.32
0 APPLICANT 13 ❑ CONTACT+ PERSON Attidremwispace fans T 2332
Busirwas name. Other 1 23.32
Fuel Moine
Contact name: 514.15 for firm four: SIA3 for each additional
Address: Furnace_ etc. —
Gas hod pump
City/State/21P:
— Wel Anse tded#unir heater
Ply: ( I J Fax:: ( ) Water hearer
■
E -mail: -- Fireplace
—
Range
CONTRACTOR Barbecue -
Business name: Jacobs Heating & Alr Conditioning Clothes dryer iglu]
Address: 4474 SE Milwaukie Ave O ar.
MECHANICAL PERMIT FEES°
City/State/ZIP: Portland, OR 97202 Subtotal 5! .. 7
: 003)234-7331 I Paz: (503) 6108.0108 Minimum permit fec (590.00) To as _
Plan review (2S% of permit fcc)
CCB lie.: 1441 V — Stato surcharge (12% otpermit fee) fO • $Q
^ TOTAL PE RMIT FEE ) CZI V)
Authorized signal r , Th moan n permit application moire, itmoan is oat attained Milne 180 /
days afar it has hies mused w teepees VVV /
Print name: � 7 m .•; lea Y r r rV Dale: ,att000 sa TriL
le (♦ • Fan methodology by qty Building ladusuy Semite Bawd Bawd
i 'tduildniWarsinlsrEGP+brmaAppdm MOM 4404 6171111 •. OaYWGnI 2 .3 7
E0 /Z0 39bd 9NIld3H S800d[' LSZ5ET8EOS OS:TT OTOZ /ZT /90
E0 /E0 39Vd
IS
14G
SITE PLAN
1
HOUSE
FROM'
JNI203H SHODVI
srRC>vr . J ,4";oh y /
Job Name R-D3 f�,dl•T
Address
7/6411-Z 5'922
Model # C /AQlr g z,s' ,
Make
JACOBS HEATING & AC
4474 SE Milwaukie Ave.
Portland, OR 97202
(503} 234 -7331
(503) 813 -9257 fax
G s'
DIRECTION
L9ZbET8E09 09:TT 0T0Z /ZI /90