Permit •
C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2003 -00070
-,0 i �, DEVELOPMENT SERVICES DATE ISSUED: 2/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S125DA -00200
SITE ADDRESS: 09070 SW 66TH AVE.
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
<= cfm: OTHER UNITS:
FURN > =100K BTU: GAS OUTLETS:
> 10000 cfm:
Remarks: F
Owner: FEES
WHALEN, VALERIE L Description Date Amount
9070 SW 66TH AVE [MECH] Permit Fee 2/21/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 2/21/03 $5.80
Phone: 503 245 - 7545 Total $78.30
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 - 234 - 7331 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: Permittee Signature: e?'") a t (
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Feb-14-03 01 : 20P P . 02
• a
Mechanical Permit Application
City of Tigard D a t "ccc i ve d i= 71-1-9 4 )
Pojeci/appl.no.; rojeedappl.no.; Expire datc:
. Address: 13125 SW Hall Illvd, Tigard. OR 97223 _
City offigard —
Phone: (503) 639-4171 Dart:issued:
Ilya"? I Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
[.and use approval: 1ft Building permit no.:
■ II" Ti" _______
_
TYPE OF PERMIT
.4 2 family dwelling or accessory 0 coif' iriA/industrial U Multi i3 Tenant improvement
New construction . ,.‘ial Adaiti • Walt •ration/replacement 0 Other:
. - a
JOB SITE I N FORM A.P.'50N COMMERCIAL VALUATION SCHEDULE
lob address: cratiamma :, , o I Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: : " nu no.: value of all mechanical materials. equipment, labor, overhead,
Tax map/tax lot/account. nu.; pmfit. Value $ _ . .
,..
Lot: - -- lock: I Subdivision: *See checklist tbr important application information and
Project name: C, -
4?... jurisdiction's fee schedule for residential permit fee.
Y
n
City/cou t -
_ 1 C ' CA 1ZIP: C.1 1 - Jz13
.. 14-2FAMILY DWELLING PERMIT FIX SCHEDULE -
Descri ion and locatidn of work on !itemises: AND CONIMERICA.L/IN DIUSTRI Al. EQui MIEN f SCHEDULE
..........„..- -- k "* " Fec(ea.)
04/6_1,
Fs'. dat of completion/inspection:
ii HVAC: Descri on Tata/
Qt . Res.onl Res.only
Tenant improvement or change of use:
Air handling unit CEA
11
Is existing space heated or conditioned? 0 Yes 0 No - .
Airconditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration ill existing 1LVAC. system •
MECHANICAL CONTRACTOR Hoiler/comptessors
State boiler permit no.:
Business name: CA C 0 teli:c1 }}PA .•-..ci HP Tons Ft TIJ/I I
_... ..
Address: 1 44.11 6 + . 5%, I p,-,.. 1 -- „..,_ 1 ‘7...- Fir-C/smoke da wet Shluet srnolce detectors; •
City: ' + 1 ' . Er ZIPC.:1 Z%,.D Heat pump (site plan required)
- ---- itaiiiri:placc furnace/burner BTU/11
Plione .1 IMEMg 41 ,;' E-initil:
Int.:hiding ductwork/Yent line :s 0 f■lc, 1
Cell 110.: ,
Install/ft:place/relocate heaters suspended, _ ......
City/metro lic. no.: ' _. , Wa II, or floor mounted
Name (please print): A CC. • r l'•••■, V... Vera for appliance other than furna
Refrigeration:
UONTAC.7 PERSON
Absorption units BTU/I4 _
Chillers HP
Name:
Compressors 14P
Address: . Environmental exhaust and ventilation:
City! State: ZIP: Appliance vent
Phone: Fax: 1i-until: Drycrcxhaust
OWNLII [lauds. Type I/ II/res. kill:lien/11;min a i
hood fin- stipmession system .. . _ . .....
N amc: --) A ■ At ° ,. Exhaust fan with single duct (bath fans)
. .
Mailing .2 ress: dIT • Allig k Exhaust system spari from heating Or AC
-
City: igasim =4 ra LIPilkriA Fuel piping and distribution (up to4outlets)
..._ ___ _ -.. _ Type: 1.1 _ 1•41 oi]
Phu : At Fax: E-mail: • '-
Fuel piping each addittonal over4out I ets ,
ENGINEER Process ppm (schema tic rcquircd)
Number of 01111M ...
_ N al ne : . °Wert:Ord appliance or equipment:
Addis.: Deem alive fireplace
_._
—.-
City: Stale: ZIP: Inset' • type /p'ellet --- -
- • ... ...— _
• WootisiOve stove
Phonc: Fax: E-mail: A •
Other:
Applicant's sig . a u : , . ,. . ig , 1:7211Z7:_ dli Oaten
.._ —
Name (print): ,,,,,,L, . A ..irmAl ___• .
Permit fee $ 1-2 .V)
'Nut all jurisdictions accept credit eardx, please t-. an jortoStcoolt r more infnanatine
Notice: 'ibis permit application . a, • ••
pa Minium ice
LI Visa U MasterCard
Credit rani numbers 1 / expires if a permit is not o Plan review (at 9h) $
ItApires within i th.) days alter it has been
State surcharge OM) .... $ =5
Neale of earditahlet as. shown on Ciedit card ... accepted as complete.
TOTAL $ --n._
s
.... ...
_
Cardholder signature Amount , 44I) 4417 (
S Ll