Permit °' n CITY OF TIGARD MECHANICAL PERMIT
•1 s COMMUNITY DEVELOPMENT Permit #: MEC2010 -00579
.IIGA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
RD
Parcel: 2S114BB17900
Jurisdiction: Tigard
Site address: 16303 SW 103RD AVE
Project: Misslin Subdivision: RIVERVIEW ESTATES Lot: 25
Project Description: Replace gas fumace and air conditioner. Unit must meet 3' minimum rear and side yard setbacks.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: MISSLIN, GREG
4474 SE MILWAUKIE 16303 SW 103RD AVE
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 639 -8595
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Air Conditioning 11/12/2010 $46.75
Type of Use: SF Furnaces < 100K BTU 11/12/2010 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/12/2010 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104.72
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
y Ze7,)(7476.2 e g Qit /970/06_,;(v---7-70/
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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 ApplicatiOnRECEM
City of Tigard Received
1 n zOlZ Dalerfly: // /2//O o'fig Pcrw Nu tiCee 2 s0/0 -- b / 05 - 79 -1
N...._. 13125 SW Hall Blvd.. Tigard, OR 91323 NO \/ 3 - " Plea Reviess
Phone: 503.639.4171 Far 503.59S:1960 . ,tkee./By: • Oster Pesmit
e
inspction Line: 503.639.4175 nat. El Sge rue
Int Pass 2
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ern www.tig
et ard•orgov ... Infonstansa I
al*ING 111
-'!,..': •::. : . • .;;•' . : , 1 1 !!.. ...:. ; •:..;;;„• . Z 1 ,;,;....:21V: : "." .: ..::• 1 . :■.Vity.W".0E;;..WORS;,%!:::: . :: • : . ',7.''...;::;. : . :, :'k : ::':.. : : : ' . ...:•g . ..," ' ''::: : .....::,';': '.:4=0 .:SPRIEDW 'r 1 4 1 : 4 :71g 2 C44 35 ff 1
Mectmnical permit tees° are had on thu value of the - work ,
1: New conalmetion AEAdditiordaheraliOnireplunamml performed. Indicate the value (rounded to Um nearest del lait of all
13 Demolition CI Other: mechanical materials. eguipmcm, labor. encrhead. and profit '
:.•
Value
,. 'i ..*. :••• '. ' : !!: • • "'!:!:8:-:..•':•;.:.'aiTEOEliti4:AtifitittAtria*Fildiyl.!:;•.- ..;.: •:.;;•::':".• ':•",:':: . -.... , . ... •
..7. .... • ••WEE0.01 . 4 7 nli.:491 11 PAntir4. 4 TEE ''' •
and 7. 0 Commercial/inclustind 0 Accessory builditv,
For veva1 mfunrunion ade checklist
•
0 mum-famil .0 Master builder 0 Other: •Deseiiption QtY Ea. i Total •
.. ' ....... • ''.. - . "040$0.1.: ..?;li;:p.:;:'IP.n..:!,,,....,,:.,,;. :.:..
'::''..:; 4
14 Sitruddrss: i• (S 303 . S . lik.) 10 .5 AV e.., Air conditioning
•e• rot I 46 75 t fte ' .7•S'
re lam du shewine ......reasq_____
City/Slate/ZIP: 9 - 7 ..a( --- , r. unlit= 100.000 BTU (ourtsipeou) 1 46.75
Furnace 100.U00* BTU Mucuieents) 54,91
I SehrJblds/apt..no.: s 1 Project name: Tr i sS tiy) Heat pump 61.06
Cross strecUthrections to job site: Duct work 3,3,32
Hydro:tie hot Walfa SyS1CM 23.32
• Rtuidential dodo (radiator or .
hvdmnic) 23.32
Unit hcaices (fuel-type. not electric),
in-wall, in-duct, suspended. eV. 46.75
• Fluervem for onv of above 23:32
. Subdivision: tot nu.:
1 1 23.32
Tovinapipareel no.: , Other fud appliances
, • '.: ....:::•...: .: ....';.,.::• ."i':?• " W"•hulicr 23.32
Cm lingdace 35.39
•
Rue vent for water heater or gas
(r-place 23.32
g, ;pi aC,..e (.9 cCA-I* - Lo li • tin ( .. I 23.32
. .
"4,-( C4y\o{.4 4- ■orin 4 -r woodLEaL 39
Wood fireplace/insert 1 23.32
,: i 1 2332
'• ..... m 44_ . : . .•, , , i ,• .;,i,,:::::; , , , , ,.. ,;.:‘, Chinineviliner/flurfocat
' • • ....—.:.--" -:........-.... Other 1 '3 3'
" Nartic • '(6 rn WI '‘ .n .(*) . Environmental relining and ventilation
--,---,,..—._
liangehooditither kitchen
Address: equipment 33.39
City/StaterLIK Mates drytir Wm
.
Singk-duct.exhaust (bathroom.
Phone: (SO ) e - 19t• _ 3.vs- hut: ( ) magi comparuncius. utilin. 'mum) 23.32 •
.•'::!''..':. , . ' •f ,7 •Tg. 1 / 11 . ii40-*4-ti*POON.'■'.;,;'..",';:t■ ', Atlikt3wIsPlg firs 23
Other: 23,32 i
Business nine:
Foci piplint
Content name: Sl4.15 for Brat four: S4.03 f or each additional
Address:. ...Furnace, etc. 1 _
. Gas heat pump
City/State/LW: • •
Wall/suspended/unit heater
•
•hone' ( ) I Far yl ) Water beaus
_Fin:pita;
i fentail: • •
• Itcyin a
;, T.Ai.:'..;',,..•4i1::;',',: :!'!,:!•••'., . Barbccuc
*-----
. .,
Business name: Jacobs Resting s1 Air*Condkioning Clothes drvtr (
• I Other:
• Addees5: 4474 SE Alihvaukie Ave ....... .... . . ... . ,. . .. . •
; .,.• .' • 'E...
City/Suttalf!: Portbmd, OR 97202 Subtotal
Phone: (a03) 234 • fax: (503)103 . Minimum permit Re (S90,00) I
Plan review (25% of permit feu) 1
A ten lit.: 1441
1 1 State surcharge (12".1i of permit fee) 1 U ..:22_ iv --
TOTAL PERMIT FEE i . 7
-VII —
Authorized signature : 7,,...„, MA. _Argyffar,/i2,111111 This pennitapplisetiou e res xpi ire pecan is net enab u led Ain 1.911
d.,y4 ober ix lass been neeepren a., eueeptite.
Print Dante: A Pi RIMPTittl— e I I r I Ild 111111 III Dalc: • t i -. 0 • Fecieemooidegy set by Tri•CaunlY Budding Industry Streier Elva& .,_.
1 kiluildinOirnablio41:04.rriaipt. 4... 1111/1/00 441-it.ITT (I I /02ICONVWEI) ( 70:52.69s6 -"(
•
60/Z0 3Ed ONIIV3H SEMOVC LSZ66T8609 0:6T OTOZ/60/TT
eo
Job Name
Address
Model it
Matte
£0/£0 3BCd
SITE PLAN
HOUSE
FRONT
STR. E t • / 3
6/Z6 /*nors e
/d70 3 Slid 40 4 f
2 y.OGGd '6 dU3
JACOBS HEATING & AC
4474 SE Mitwaul:ir Ave.
Portland. OR 97202
(503) 234 -7331
(5031 613 -?257 fax
DIRECTION
ON
9NIlti3H SHOOtif' L5Z6£Z8£05 ZO :6Z OIBZ /60 /It