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Permit � CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2010 -00647 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010 Parcel: 2S114BB16600 Jurisdiction: Tigard Site address: 16292 SW 103RD AVE Project: WHISLER Subdivision: RIVERVIEW ESTATES Lot: 12 Project Description: Gas furnace replacement. Contractor: JACOBS HEATING & AIR CONDITIONING Owner: WHISLER, SUZANNE F 4474 SE MILWAUKIE 16292 SW 103RD AVE PORTLAND, OR 97202 TIGARD, OR 97224 PHONE: 503 - 234 -7331 PHONE: FAX: 503 - 808 -9108 FEES • Specifics: Description Date Amount Furnaces < 100K BTU 12/14/2010 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 12/14/2010 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/14/2010 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 . . 2.2344. r Issued By: ✓= Permittee Signature: _ ', /G - ��t 3.. 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. 12/13/2010 08:39 5038139257 JACOBS HEATING PAGE 02/02 Mechanical Perm It A:ppli ' O r (3l3 of 1. i(:;1. 1 ! r)�I,1 City of Tigard icy 1 r 13125 SW H ' R D., ✓ (p /II Perm No.; . Y Phone: 50 3.639.41 . 71 Fax :503.598.1460 P}aaRttifew �� _D 1 i r, ,at Inspection Line: 503.639.4 173 DEC 1 2010 Dotter Other Pe:mitt D. drtttrntt www:tigani -orgov ate Rc tiblliy; Notified/Method; 1>7 See rime 2 toe 7 • r TI(` i I SappiernenMt•infpe'matf 4. r: t u i ;. t T � • ,l.a��IIa . .. , �'Y R v . [ r - ) s -ter Y n In Ncw construction MILL' o eh>x8don/rC moment : . ww .,,Lra }' ° F Mechanical e I I T n v value -'a q � dtgoN °. ' © demolition ❑ Other: - performed, Indicate the vaiu (rounded to the near st d Of all F't l" `ii �r'`.i st "s.: `i�'4 '� „ r tf� 7 . �a y_ ` -rT,: s rt'^.”- mechanical materials. -a' . ern, labor, overhead .end cord, � and �+ �� : s a.,:nr ..�� ,. .ti��i r � f u 1 .�„ {iS�rsn:. 1 yt)wcIFlrt �J __ 7 '; I- fanril g ❑ Commercial/industrial al ❑ Accessory boil din : D'e �r.S , '..'t -L :V. 1 '�' � ' • r, ; : , , �. :n'Iwlti- family r err ; rle�, ��p ❑ Master builder ❑ For,aperiatmo moon far rhea . ^'s ift'iGi 7 ta ,, s Nf v . r ' _ r- — Description .._..,�.. ta. , p,...- -.. r . m ' "+.4 r i • , "' Y, QtY TTotal : r.....,.. �., `.. !Indio:. Jobsitc.addt�55: s ❑ r • SCO O 3' r- Air conditioning I rIY75tat. : . � } ,L;: aim sug . Im Flown, •„z --eon 46,75 t Dl I Furna WO O H711 *toasters) 46.75: • .7 Suite/bldg./apt. no.: Fulmer 100 age* ETU duo:Vo is Hes Gros stM'ctldircctiorts to fob sift: amp 61 MEM _ _— Duet wtFr IHRIMMI ._ _ R • ronic hot water em IMINEFIIIIIIM Residential boiler (radiateror h •ronit • LJnk haters :('tucl »typew. not cicptrao). MI i . in -wall ut-dar -ended. etc. 46.75 Subdivision: i Lai no,; . Truk rnnp/poreci n Other s w ' i �' '.° � c t o.: t+ ' w:ti - r: it Other fuel AppIlnndes ..�.,. Z3.3 .. ,,1 1 ,11 daw' 3 u ^fs. J. #. LW .w 4 7 .! t .4 s i / + 7 { . ° +Y .q fry 7? �1. IIIIIIIIIEffil r'� ...C tiwh• k, s t �, ra WattT lltattr , ae.�t imiti Flue vent for venter heater or:gas a IIM . • a.S tiv -nac f rlaee wood/pact owe 33:35 : nor� - W yy�'..,'�' Cb irtt a Ft . we/insert � Ynnar;,. r�..k� _n.;c �:.. y r ec� N`. a M '^'TZ ; m om. �, r4 ar rliner/fluetvent rstut>r: otrr � r S Erlviromr alit cabalist !and ventilation Address: Range hood/other'kitchen City /State/ZIP: ... 33:39 . Clothes drvcr.exh'aust 33:39 Phenc:' p ) r '1 ( ) Single -duet cathaust:(bautrooms, a� `�'t��Y.w1' �� '.r� �. 5"- ��' d a•E. ' "�` y� tot .�tncs,ts. mil 'n _. »m, .' �.. ._...._:•14{'r,.....&... ,,. . � '"iG'•�,: -��,: t it._ '� - �. .�� ; Fla inesa name: Cnh Ct Conti�tt name_ 4 Furl plpi ,73.3x Adtlress: $24.15' far .tritIbu S4.03fbre thadditional Fumaic,.ei . Citytl$t1p: Gras beat. , W. Phone ( ) 'alllcuapended/unit:heatcr Fax : ( ) Water heater E-Inailr Fi •race sllidi (&i.MM s!;1r . ± ;: ._,,.x qr 'q „} ^1t ,tlSittC53':ntnne Jacobs ^�>..l:a.., • ^s--�S�.. "a ,at ° ' Pleating & . Air {Conditioning Clothes d r ; IIIIIIII Addmss: 4474 5E 11411w itattic Ave Other ,.. City/hue/ZIP: Portiund. OR 97202 �+ n� " " " r.........xz_� +;.. ,. x Phone (503)234-7331 Fax: .(S03) $88 =p310ff Minimurii;pen tit fee ( J0.00) � Plan review :( %nf permit ''fee) CCI3 lie.: 1'441 State north...: (129 of , it fee) ": 1 w "815 methodology Authorized signature: f will; � � TOTAL PERMIT FEE / , 6 Print name: �+� - t e Thie perxnif N t erkha , barn : tin e d 0 or oh o l itt, yttrfn i eU , Dale: 1 nip aft 3er r'tt.has boea y 9 i !d n s dusty etc. �:L�� ! ` Pet methodology y act 6y.Trf County oi ldinR Industry Service Bove 1 " 1 SYifdiryttMl ¢uttrhtEC.PtsnsstA 7GP1RH