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Permit
CITY OF TIGARD MECHANICAL PERMIT - COMMUNITY DEVELOPMENT Permit #: MEC2009-00498 Date Issued: 09/22/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 1S135DB08800 Jurisdiction: Tigard Site address: 11160 SW 93RD AVE Subdivision: ASHBROOK FARM Lot: 23 Project: Roake Project Description: Replace gas furnace. Owner: FEES ROAKE, JEFF Description Date Amount 11160 SW 93RD AVE Furnaces < 100K BTU 09/22/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 09/22/2009 $8.70 PHONE: 503 - 620 - 6932 Minimum Fee Adjustment - Mechanical 09/22/2009 $58.50 Contractor: JACOBS HEATING & AIR CONDITIONING 4474 SE MILWAUKIE PORTLAND, OR 97202 PHONE: 503 - 234 -7331 FAX: 503 - 808 -9108 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: Total $81.20 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: e � t /' ,9 Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. ,9/21/2009 12:02 5038139257 JACOBS HEATING PAGE RECENED Mechanical Permit Application FOR, Qrf1FIC E USE ()NIX • S EP 2009 u� �rtri / • IIII City -f�fTigard q0 d9 /' 'Pc;cnit"`t` , yre,zo 7 _ 0�_ �C✓ - a 131 SW Ha Hlvd„ Tigar OR 97223 y ■ n ' Phone: 5U_,_ 839.41 Fax: 503.3.98,14 V' . I • ?' Plna K w Oilier ! _ al)lielt34'cvic Oi Permit i Inspection Line: 503.639.4175 pLk ,1 ",i -l .\- -- r. Ser.thiga - nor . T1Cfilti] ('�, a tl /E9y tWrly , lfll tnel: N'; W.11(;atd•or = oV i lnaiSedfmoth,d: , "µ _. N._... / /.. :Su pplmrenrnl tnr`e tin Etmr ^."'.' � . , � TarTilt, o� C,t3rw'1`,vlE12LX;rt<Pw � 5 t srn�'n>;J'1 � ftisl;e ►rrr..kl.j,•r y.. Mcchttnic:tl ertnii revs' arc based on the valtae oC SIC week 1 © \c • construction ldditinn t�lterutionrrcpl:rcement performed, Indicate the value (rounded to mc;ncurest antl:lr) of' ,rll ❑ Demolition . 0 Other: iue_chnnicn4 nneriats, egrlitlrnent, i:tbrar, rvet3it•:id, and'pat1,. - , - ,....1 _ and 2- fcrrnily dwelling ❑ Commerc,ial /inclu .. �'. 0 �' �: R1CS1p�" riN7'[: 1. Tu�:,[ s�II,11�INiE1`1]�c /;�1'R�i�1t•4 � "�"�,5* / ssvfy building - ' , .,. :.........,.........�,,.�" 0 v1ulri- family 0 Mulct builder ❑ Other: c r r rlhn c cant r ar ,rte 'd d tgcor r ,rr .[.C4 1. ,,t3 n 1lv+tb Lc7Crti7lVt�t „ 6tiiri,natrn,t _ rua C' 1t'I. Ea. � fatal rs address 1 I cO 3 . ,... .74,U1._ itiircandhinnin nnc�rtt ibsi -..,_ _ freQ.tt6:nitc Flan 06.1;64 ploocrnrnl,_ ,„„,_,___1_14.°° _, �_I.1 bQ I 1 Cit +' tirtt `LI� ` ] r� d rtrlrwcc 11.10.000.671'11 {duel r�crn+) f ia.(IU Suite/bldg./apt. fat nn.; n � �� , urrncc i001,000-• ill U fd;crar,'rnivl _ I i.9(1. " µ 1'rajecl nWnc: mm f 1:(10 flan heal urn 1 • DLI I • ('rot,5 sttrcc(/dirGC�inllc to job site; _ � 10.(N1 � I_ - ° ° - -- - I Ivd rnlc h waiver system I 1 • µ w _, _.,w - M (tcSiderrtint boiler (rtldiau)r or 1 — i , ?d _ 14.0 "'- 10 It hc;rterS. (f xrc l -t ypo , riort•cl - 1 t ,n- w 'nff. itr' eruct, suspended, etc. ll I.:. t1U: L � �� .�.. ._,.......... t „o t are. �itfue / . ... for Trry of above S'ul +dig is ion: w.- ... 5 K (1 . �._........,, ,.,,.,,...._.....,......_.... -- .....,..........M,.,,......_. .............._...._._., _ , (,191tCY'1 11Y.0(1 Tex roar /parcel no,: _ - • . ' ..Dt1SCR1'.PTLON,.01 wooex, - } r , Water appliances If!..(J0 - ...._.. "- ,...�._m ,- .�...M,......... fu l'i're 'lace .�....,......., .,. .._ :„. G�• _S `-. G.L 1' 1CL. t} �!'inr Vcltt CUi W1wr I1z:tttt;'r.rrr pi. ._ . ...... .. . •,t1r.oplacc 141.110 ' '-- _ Loet :410.1: i' LIPsD �- 10.00 ti ., ?nd;!pcHCt stove 1 0110 Wood l'arctitnc&inscrt .1.0' r( • M ItIP .11n :li I`1i`:OWNE ...W. (:hinirlevflincdfluplvent 10.00: (Alter ..,. e -1-.7 T �' "v�S Envirann ventilation - ._. _...... rentirl C%lla U9t AI r Address= Ron1t+'Jutrtcliadtcr kitchen 1 cgriy l rl.iy t C'itvlSttv,YfP: r - f;ltpll4,r dorrr. cxlt.tuSt ' r1((t,� _w 1 ._ ,,,.w --� - Sixgl��dtus c cl7arl..t {patft'roclnls, ; P hnnc: 7 leav ( I (:t131 , 1�„ � � ink'. 2:aiTllrir ;mrntc t 1 xrlr .... . I tfl — -- • AI? it" r m--; ' Allic/crtizti'Iti a ce cans � ..... ' GtT]YTv'aT:It'Sl' a \, >, � (lUU t It r ti$) Business name: (Alio; �. 10.011 f___ Contact reamer • -_ -_ ,$1:.00 for coda ;i•rlilitiona'l SSa401'on first "fnury Address: fur dtlL'. L1C _ — j City/State/ZIP: t1: i SUS Irndecninii heater F910a1c: ( ) 1 Fa * ( ) WRI heater .rte Fire. 177ue 1111 l:- rrrar(: . c . .. ... epee 1 bli ; ,'i' 1Sar'Er C1';ohcs defer U ' _. 1, name; Jacobs heating roc Air Cnnclitirinint! (L �,. - ._ ....- _ - - ..._ li7rlrtr; - .Address; 4474 SE �lilwaulcir -- -- i er: ..... ' "'[ __-._- --- C[i(titili A['lifttNnT "gDES'� (`itviStatc Portland. OR 97202 __ _ °- Sulrrcar: i i 1 C _ " min imam permit Ice. $72.54'1 i` / . 1 ' Phone: (503) 234.7331 Fax: : (503) 803.91118 �• -,. _ t 1 - - - - - 1 _ ............. -__ Nun r4 "viext' (254:, of' p ztti't feu) ' C('1lIrc.:I441 - .... 4 "..,.-.._.._.,. _ __ - - --' ! MI rclin,¢ie (1. 2% °f ilen,* fc%) Try -, i �i, l Y a; ttr�lrr x r:l: :�5 f..;O) mthptned Signatn ‘, 'r." � T I,e Aix Fmlr "tip(illcnttGn tapirck If ILPCnnfAN eel tlbaained nilhin IRO ��. �� _ d'aYr +her is: liar been acaepriil era rrrrnplece. Print name: i1 1 t .-\ .. j ' + Date: G'7 1 " free n y ter Uv Tri•C:outtc 0,,ledii, Industr, C; , • T lkote,,iotrn, :•12,1Ttei nrik dot. tl:lr txlf^ 4.1rl..I C 0. r...