Permit CITY OF TIGARD MECHANICAL PERMIT
g COMMUNITY DEVELOPMENT Permit #: MEC2010 00681
Ti GA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 1S126 DC00901
Jurisdiction: Tigard
Site address: 9640 SW GREENBURG RD
Project: GETHSEMANE LUTHERAN CHURCH Subdivision: Lot: 0
Project Description: Gas furnace replacement.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: GETHSEMANE EVANGELICAL
4474 SE MILWAUKIE LUTHERAN CHURCH
PORTLAND, OR 97202 9640 SW GREENBURG RD
PORTLAND, OR 97223
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/23/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/23/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/23/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 or 1.800.332.2344.
Issued By i ......00 411111111~ Permittee Signature:
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Call 50 .• Oby 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 Application 'City of Ti O rOr (11.11(1; l tiF: ()Ni.,
r �'' Perrait g
13125 SW Hal d Tigard. OR 97 c 0' �
Phone••303.639.4171 Fax 503:59&.1 ' " p - 441 11 „ OUsa Pun> 6 - , I
at Linea 503.639.4175 M � t au. ra S ee rage 2 ler
Internet: www.tiga d -4rgov a O� '` \�1 - edtN ad L/ SapPlonee at Intortnaaon i
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Mechanical permit fees" are based cm the value ad= work
(] 'New construction ,fAddition/altcratianlrcpi •, r, . . p r d. indicate the value (rounded to the nearest dollar) era
0 Demolitlod 0 Other: mechanical eiatetiats, equipment.•iabor. overhead. and profit.
1 rr + l d� t r 1�','Lr. tt ,eYu ; ...ten f; 7.nt-a' :7 ", q •Jr 7.M riP�y�d�a { , •,,�4 3 , 2 . .]t.'Y�}R'a l value :5 ,.,,.,.
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I Il "urn 1 . I IN S i 1� � ' 1 t. i' �L rr. i �Lm, L:r..r.s..�A Y:I...I rn i...R t 41e67^-777, • A..
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`2, y - and '2- fivniiy•dwelling 0 ComtttacinllinduSt ai 0 Accesgory.BuiWing F orap e ed at irtjorarrtiaai,Se 1
Multi fetnily ❑Master builder :0 Other Description j Qty. f Ea. I Total j
e�ml .1..... 1 wTLl>..�.Iptl - la ^liti 1154 T J;fT t �.c{'ii�FT ;'.AFL t x , /I t 1af'S y�r`� r ,�
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Z �},I i i l t, ,c 1 i " 1-4.1 . .ut.11 `Gp . } Yd',r`A Heatir4JC0oliAE'
{J � t Air conditioning 1
i Job Site address c( {0 0 • .L :r cir) a UL Grouts sire elan sheering plic®rnet 1 46.75
Fume= 100.000 BTU [duatslvetua) ( 44,75 G -
. CityrS4mclZ11!:t et .r Gti I - 3
Ftuuccc taouoo{ HTII rdl,orrvt'oa) 5491
Suiteibldg./apt..no.: • Project name: 6 c -44.., s t t /Yl .0.. . 1-feat pomp 61.06
Cross stneet/directicout.to jab site~ . Duet work 2332
•Hydmtiic hot water system 2332
Rel:idemiai bor`kr (radiator of
hvdroaic) 23.32 l
Veit renters (fuel -type, not dectria),
in -wall, in•deet, suspended. etc. 46.75 1 I
I .
Flue/vent for any of above 23.32 t 1
Subdivision: Lotrto.: Other: 3332
Tax no.: . Other Reel a • •. lances
M '' ', P I Ap 'ken l. • et 1, 7� 11 4
11t4yIIV?1 1 � `1' r r 1 11 , 1 i1 rt' L W
1 1 Werh eeler 2.332
Y : $ > - w � ! : er a � (33.39
1;185 rt .
IIIIIIIIIIIIIIIIIIIIIIIMMIIIIIIIIIOMIIIIIIII
Flux v for water heater or gas
e � is Gain poz`Q
fireplace
H.
'� �`.� to . li � no. ,`
woodrpcllot Stave _ 33.39
Wood . . acelinsen 1 23.32 1
• tom. � 1 �L ��7L� -� ,,,,,,, Ch . /11 1 r /flue/vent :3.32
r`,. "11 .r ,4tii11. }0'i�.i�:'r ro. !' � t ] Ll it} .+4 L'�I.� W:ay „, "�' t• 'rf 1 �.G: ;A H T. u i ? �.', •. 1� Ot1►GI. I 23.32
Name: 011 K r 6 s S i Environmental exhaust And ventilation •
Range'Itoad/other kitchen
equipment I 33.39
ratylSuneiZIP: Clothes dryer exhaust 1 33.39 9
o
�7 q p / adutx exhaust i (bathrooms, Phone (,$ 03) d T l ( F ) Singf toiler c.... . - . u ' • rooms) 23.32 1
9 .ur..�E , - •...0 �r.• - W l y yml 0 $ 17. - -OMrq, L.wl•' L �"; i Anic/craW 2332
1kill' � � �.i. r. r nef`� r �fi L''Y'i�
r! � 1 1• r �i: 1s I y� !SA ace fans 23
, f :sJU Cl.c � f.'.37{b$ " y •jil e, R.. r �.t. 1�. �.;. ,y'..t1 -1... � +... v "t.:
Other 2332
Bus'inc a tumte: Fuel piping
• Conteetmume: Sld..S tar .frost faurc $4.03 far each additional
F i
�►ddt ens Gas heat pump MIMI
CitylStarefzlP: Wall/suspended/unitheater
Phone: ( ) I Fex:: ( ) Water heater - I
Fire . la
E-mail: -mail: ce
Ran
3 Barbecue
?r �� ,:I y i i �r u ii 4 r.S7rill ,t y ; y Arlen EMI
nu,1 J�(4ii I c� •` G - etc= ., ;_ der;,.. i ;a�l�/tl •.
Busiai'ss name: Jacobs Heating ff: Air Coadisianlog . Clothes tart (tats)
Other:
Address: 44745E M"tlwaukie Ave 7 ' 1 t'W 1 ,7, 1 1 ti`,kr ° (`l "1�:?,
Minimum perms • fes (S9 .,'
City/Stater IP:.Ptirtlaod, OR 972 7S
Subtotal • .
Phone; (503),234 - 7331 . . car (503) 8O8 - 91011 t 0.00) 8d °
Plan review (25 °loofpeamil.fce)
CCI3 lie.: 1441 ,_--- State surcharge 02%.ofpe min fcc) /Q • td
TOTAL PERMIT FEE r• • Zij
Awit ' �� D � h ds t it►wb p aye or owned within
Print =tut: ,'� err i iii Dale: _ a z.. [ d ' Fee wethodolot:y set by Tn.Conoty Building Industry y 'Scr vine d I C�
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