Permit CITY OF TIGARD MECHANICAL PERMIT
°� COMMUNITY DEVELOPMENT Permit #: MEC2010 -00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/17/2011
Parcel: 2S102CB00302
Jurisdiction: Tigard
Site address: 13185 SW PACIFIC HWY
Project: Salvador Bakery Subdivision: Lot: 0
Project Description: 3 ton RTU
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: CJ GLOBAL LLC
4474 SE MILWAUKIE PO BOX 5668
PORTLAND, OR 97202 ALOHA, OR 97006
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/29/2010 $161.16
Class of Work: ALT Type of Const: VB Plan Review 12/29/2010 $40.29
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 12/29/2010 $19.34
Stories: 1
Project Valuation: $3,500.00
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $220.79
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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
issua or if wor ' suspended for more the 180 days. ATTENTION: Oregon law requires you o follow the rules adopted by the Oregon
Util Notification Center. Tho : ules are set forth in OAR 952 - 001 -0010 through • e r = 1 -0090. You may obtain a copy of the rules
or •irect questions to OUNC b ailing 5t .232.1987 or 1.800.332.2344.
I ued By: Permittee • ff•i/
Call 503.639.4175 by 7:00 a.m. for the next available i • - tion 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 ` FOR OFFICE USE ONLY 4
City of Tigard Received
� � i
Dateve 1.4 . U ��� Permit No.: ` d )
° 13125 SW Hall Blvd., Tigard, OR 97223 .�
' Plan Re'vie •' g
Phone: 503.639.4171 Fax: 503.598.196 � Date/B . �
TIGARD � I Q Other Permit:
-
Inspection Line: 503 � ��L
A l. 0 Date - • Juris: H See Page 2for
Internet: www.tigard- or.gov 1 t3 r F Notified/Method ri p Supplemental Information
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❑ New construction g•Addition/alteration/t VAt �/ 11 0 �u Mechanical permit fees* are based on the value of the work
�� V' 4 - 1 _ _ - I performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
}� mechanical materials, equipment, labor, overhead, and profit.
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- '1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building .Qs °` 2" - °
❑ Multi - family ❑ Master builder Other: For special information use checklist.
❑ r s e in o us
,xdrG33 =:, .,, < Description Qty. I Ea. I Total
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I Job site address: \ 3r 3L,D C tfA 1� El�U Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: % al '� �� Furnace 100,000 BTU (ducts /vents) 46.75
Fumace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg./apt. no.: Project name: � I Heat p um p 1 ` - R f O
l/ �/1(- o kr , ci V` wi�f 61.06
Cross street/directions to job site: I Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
i =;3� ",33.'53 =��SS:" .`x` .���y„x -«`r a�Yz'�:. rgtif' e� l :�xrF ^.' >'.;
. � . _„,„, I' T i U.N U =a ' 4 2 x-.. Water heater
Nom,,..' , _ „„ „ , . )�VF±URI{� : :��. M ,�,:. ': � ° :..,.�,� 23.32
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1 � Q � v Gas fireplace 33.39
l c4c, [� , Flue vent for water heater or gas
fireplace 23.32
~
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
, :: _ : �,_ ,max, ,x- :. r , k .s, ;,3„; ., ....,<; , _ ,,, Chimney/liner/flue/vent
.Y' a , ,Y;, "..a�},,�. 1�y w t ,,.- a y 23.32
.,, ;4a'k'1 „,,, ^w'?; ^- ,+ „17,i,W, .�i < R f r ". ;' 3 .L' 114,71, :- l q, : ,lar:D 9,p
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/� ; „�' Other:
Name: ^ \ v a V (J Gt k _�/ 23.32
Range hood/other kitchen
Address: j 3I <6 J� CA - Environmental exhaust and ventilation
g
equipment 33.39
City /State /Z1I 3 e 1d l 0 ( . e ei 1 .-:::.,5 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (S ) j! 3 / F ( ) toilet compartments, utility rooms) 23.32
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�. -k�>"m r9 ��:'� r "' ````$ � -a +l��i %Y;� ✓iixi s , - .N� °.. . r;� , g�mam,.- ` +.�;,
h a'i ;<x E#:* *FjZ., <a # '=xa�°��:4. "� 3 °'` Attic/crawlspace _F.� ^s'�..�t.. ,z , -�, -�- , ,,���r�.N.. R. A.. `w +.��,�: -:;`" '•��`�.,��fl, GT,1'tEIiS.. ':.. >.,.;�;: p fans 23.32
Business name: Other: 23.32
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) - Water heater
1 E -mail: Fireplace
"s+ '`' „ -�;,,,' "ia; �:;,r.r� <:-,w-- ;..:�. ..,,; Range
�::. <- '`4,r��,, �ais "� .:.�.:%r�:..4,.. .., .s., � �,�x...„k�a. . 0 _ �,,.,.;� ��•_ _r: Barbecue
Business name: Jacobs Heating & Air Conditioning Clothes dryer (gas)
Address: 4474 SE Milwaukie Ave Other:
City /State /ZIP: Portland, OR 97202 Subtotal
I Phone: (503) 234 -7331 Fax: (503) 808 -9108 Minimum permit fee ($90.00)
:'(B lic.: 1441 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: (VLF - . 2 nn.C.... r ( This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name Gin .t - ML M,,,. Date: - ( * Fee methodology set by Tri- County Building Ind Service Board
r '- .\ t 440 -4617T (11/02 /COM/WEB) I - y..yC 7R
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