Permit CITY OF TIGARD MECHANICAL PERMIT
1111 t , COMMUNITY DEVELOPMENT Permit #: MEC2010 -00680
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 2S102BB00410
Jurisdiction: Tigard
Site address: 12050 SW KAROL CT
Project: BEDNAREK Subdivision: KAROL COURT Lot: 9
Project Description: Gas furnace replacement.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: BEDNAREK, CHRISTOPHER
4474 SE MILWAUKIE 12050 SW KAROL CT
PORTLAND, OR 97202 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.
Issued By� .`i = Permittee Signature: ,
[[ Call 50 �' 75 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 Applica C -
r It
. City of Tigard n ' Daud9Y ) Pamit No.:
13125 S W Had Blvd„ Tigard, OR 97223 2010 Mau Review
�/
' Phone; 503.639.4171 fsoc 503-598.1960 p CC 2 1 1 'Dam/By; Omer Pamir.
a i i ;;t I: a� Inspection Line ; S03.639.4175 (� 93a1e>tt Y Lois 'f,' SeeFoga for
Intoraet wvJw dgard-0r gov ^1�/ of � " �N Maofi�R.feuaasd: Supplemental lo(arnarion
coy 1 � Y .
I 1 I -, 7 tU , .. m �. , ..,) c. wr I t d t xh12 r 'j t t �h n, • � Ih • -. c " tr `
„IL'i1i i;' ; 1 rJ {t; '�.li {. a t, Ill .,A !1^ r ji.l. ? ..a :wr_v`M J �.d -'ti ,�,. J .1 F,F, , Fs .ra 7 � R.•o', , a _ _,xd . :
0,.New construction AdditionialteratigNteptace pent Nloctnttti Cal permit fees' arc based an the value of the work
( pm Indicate the value (rounded to lbe nearest dollar) of ati
❑ Demolition ❑ Other. mechanical materiels. equipment labor, overhead. and profit
r ti rill, �G r 1a-p a a, : a warm g ik', II i a�iIT Value: 5
j I , , i w:f�'. J x { , � . ; ; : , t nd.a: ` `ft ,"^
'mom, r .I�.,ay.'m r .t .r wu, x :rrs:J wu � x,a.r a., 170. � ....,.., .
d1 r, t 1::1 - g-. .,,1 ity
l a:r
.
i. and 2- family dwelling [.Commercial /industrial 0 Accessory building :, =' - •- ' " I ' ' _ , " ; .
For special information acre cbccklat,
❑' multi -family ❑ Master buttdcr ❑ Other:
g m „„„,, Y� oL', 1 F..+w�W,z,74 7,Iti.p T c.i.4 fit t ,^ 1* .. i
. Description 1 ' . 'I �J. Total [
1`IN;iE:li ll elot� outiiii , ` ; 7 ,a... � % _.'cc.:_,.: 1 I '. " ?� m e - 1,,..a zinc .a, "toting/cooling
S Air conditioning
Job. site address: t V r a . C.� lreauires sitetttaea showing plsmmal 46.75
Cityl5tatar/ZfP ( ! (Li puma), 100:000 BTU fdueulvemsl / 46.15 i 7'a
1 Furnace 190.000+ BTU (duashsntat S4.91
Suite/ W. 00Lnc.: tj 1-Project name: Z 4 0 we ' L K Heat pump 61.06
Cross streetlduecxions to job site: Duct work 23.33 .
Hvdranic hoz warm system ?3.32 i
Residential boiler (radiator or
hydranic) 23.32
Unit houlers.(fuel+ type, not electric),
in -wall., in-duet, suspended. etc. ! 46.75
Subdivision:
no.: for any of above 23.32
- Other 2332
Tax ouplparcol no.: Other fuel appliances
1 .ikraai; ■ 'n're +„i 'p, Ace's, ': le 7 4,1. x { �, � � 1 ;:; :4Nhia�' {�fiti?711q Water beater I I 23,12 I
�... I Oas flmptaee 33.39
•
Flue vent for water hearer or gas
} fire lace 23.32
. 4., ef Wood/. am stove 33.39
Wood fftsplaee/inser 23.33
����QIf�'I�'I, �a 1IU "'- ^ -a7!L� u . t .� a � , ra1✓<<:- �'G' �"'� w " . c' --� Pklt I� ' QlltntuwRlner/flue / vent 1 23.32
f + I k�wvin� ;!71 r . f�� {"'.nt�rlll.A.`�ati
, f :5;"Y�1: 1 5vi.� - I�,p, Qther• 1 2332 !
Naino: C. r t S L tArlaT+2.e Environmental =bang and ventilation
Address: Range hoed/other laiehen
Ili ■ spent 33 _39
City/State/ZIP: alit'
Cloth drvcr exhaust 33.39
_ S - due& =11=1 4t (bavomtu,
Phntse: ( } ; �(p 0 ,S' to ils coanparuncnts. utility . reruns) 21.32 .
1" "1 IIp7.as af4 ntlnii a ra.fJ +sn +'��,1ik. . t�Mlj) '- �?:"is4�if1`.WiS AQUCrCP'aR'ISpECCENLS I 23-52
Business t>arne: _ _ 23,32 . 1
Fuel plAlealt
. Contact name: 514.15 for first four, $4.03 (or each additional
Address: Furnace. etc. _ I
Gas heat puma
City/State/ZIP: Wall/suspended/unit hearer
Phone: ( ) . ' Plot; : ( ) _ Water healer
Pirepta
Email: x I Ranee
I^, r'1 a • 'l r 1 Yen,':i� � l nt ,ntT Yv77.741'N 1.i Ittfe� �qi"' iUaTq� 411 wR1a'
,/��{e�7 'duei �?.':• std e�� .cwv. � ;.��;br I .: :idu.... �2� :. � , i� }., , i . � tt. In t� ...� ";I 'f, ailrllee7rC _
II
Business mew: Jacotra Bestial 4 ells Conditioning Clothes dryer (uasl Other. i •
Adair: 4474 SE Milwaukie Ave
Ng iF11
-. t Z p: Portland, OR 97:02 Sabtot01 '�
Phone: (S03),234 -7331 Fax: (503)508 -9108 Minimum permit fee (59000) - p •
Plan review (25% of permit fee) .
CCB lie.: 1 1 Stine surcharge (l2% of permit sec) a •
TOTAL PERMIT FEE �..$0
AtdliOrized Sigtattae: wr." 1 r1 This permit.spplteadan expires ifs permit la am ohnlocd attain 110
d days Altar it Au been accepted as complete.
Print name: •41"f - t \/', !1 e , I Date: 1.2 1.2. 1(] 1 • Fee methodology see by Tn•Counly Building le'uuay Scnicc O ` rd
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