Permit CITY OF TIGARD MECHANICAL PERMIT
■.' COMMUNITY DEVELOPMENT Permit ft: MEC2012 -00111
Date Issued: 03/08/2012
T I G AR. .D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101 DD00401
Jurisdiction: Tigard
Site address: 6955 SW SANDBURG ST
Project: DocuSource Subdivision: SALEM FREEWAY SUBDIVISION Lot: 1
Project Description: Replace rooftop unit.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: SOURCE PARTNERS LLC
4474 SE MILWAUKIE PO BOX 230759
PORTLAND, OR 97202 TIGARD, OR 97281
PHONE: 503 - 234 -7331 PHONE: 503 - 256 -5554
FAX: 503 -808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 03/08/2012 $204.14
Class of Work: ALT Type of Const: VB Plan Review 03/08/2012 $51.04
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 03/08/2012 $24.50
Stories: Info Process /Archiving - Sm $0.50 (up to 03/08/2012 $6.50
11x17)
Project Valuation: $4,875.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Fumaces: 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 $286.18
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: curb adaptor
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
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: - rmittee Signature:
Call 5: 9.4175 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.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEVED riennit No.: Hedge,41,,,e2t)ll /
I !! 13125 SW Hall Blvd., OR 97223
l Ail ., Tigard,
Plan Review .: irt712RIEM Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960
Date/By: Al, ir
Inspection Line: 503.639.4175 I Fi 2 9 2012
TIGARD Date Ready 1. Juris: IZI See Page 2 for
Internet www.tigard-or.gov Notified/KM/MT
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(CITY /
OF 'FIGtRI Supplenl Information
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" ki, s - MFORM,
'7-2 1:. ''' 7 : :T ; .'=•- 7 -- ' *_.' -'* ...•;.-.-W: ''' itl4 -•
Mechanical pertnit fees* are based on the value of the work
0 New construction )
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor overhead, and profit.
. :
TOR tkif ----?:-.... '-- ''',::- - 2
0 1 - and 2-family dwelling onunercial/industrial 0 Accessory building
For special inforrnation use checklist.
0 Multi-family 0 Master builder 0 Other:
Description 1 Qty. I Ea. I Total
7 " - •;. 7 - 7 ' 7 ' , Vieligi : - .4: - . ''' - ' 7 - ofe. - i.,1 ) r; i.. l',C. ----7 - - 73,: P ,.-: Heating/cooling
Job site address: 42 55 Sw S a , n j_b u1/4.0 S+ Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: 1 ‘ct,( , 0 g 9 7,2,53 1 Furnace 100,000 BTU (ducts/vents) 46.75
• L
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bIdgJapt. no.: Project name: ID 0 C uL,S (71)._rc .e.... Heat pump 61.06
Cross street/directions to job site: 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
•
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32 ,
Tax map/parcel no.:
. Other fuel appliances
- 'Y' :,,:: ;:i: . :,, ,, , T :. --:•...,:, - :- P•::::::DEsgoo:***" ; ":. 1.4: ,•• -LT -k ..._,-; Water heater 23.32
1 Gas fireplace 33.39
Flue vent for water heater or gas
`g epiat, C-i* - POL-C V- fireplace
Log lighter (gas) 23.32
2332
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
- - ''''•----- "tyittireija‘rdivi4;61:'''-: '=•-= - - t . 4 . ,, - -: , :f - Tii.,.itti vintaAliy.r" . v.: - .;', . ''?, --' Chimney/liner/flue/vent
..:- 23.32
...,' ,-• -.:;,.- . - ,;••+. -,. : - • ,t•'. .7', r i - : - •;:,-, ,-;,:' zw„-,, _ :': -,'-; . -.
23.32
Name: D 0 C GLsoi,k_ cc_ Q._ i i e_-cc S C-Otf Environmental exhaust and ventilation
Addres
Range hood/other kitchen
s:
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
St4e4-- Single-duct exhaust (bathrooms,
Phone: (S ) c ,%s-6 ss-s-tt 4,1 j Fax: ( . .„, ) _ ... . , toilet compartments, utility rooms) 23.32
. 7q... - : ; 4 ',.. .:144:(* ;r, Attic/crawlspace fans 23.32
Other: 23.32
Business name:
• 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: ( ) I Fax: : ( ) Water heater
Fireplace
E-mail:
Range
::•-.'*',,,,,•"':i.;„::-..1,-*•r:-.J 0 ''.-1 . Barbecue
Business name: Jacobs Heating & Air Conditioning • Clothes dryer (gas)
Other:
Address: 4474 SE Milwaukie Ave
.z ". 1 . -, .. r -
City/State/ZIP: Portland, OR 97202
Subtotal Ae /
Phone: (503) 234-7331 I Fax: (503) 808-9108 Minimum permit fee ($90.00) -
Plan review (25% of permit fee) 5]. oq
CCB lic.: 1441
State surcharge (12% of permit fee) Aii • 50
---
4 etirt ii - Ft f, TOTAI.P.MIMFTFEE 4 . SD
Authorized signature: ' This permit application expires if a permit is not obtained within 180
4
ANI•erW;I •,..1■=' days after it has been accepted as complete.
Print name: ,,gmiggiaTium. Date: c 21627 , • Fee methodology set by Tri-County BuiltnLIndustry Sere Board
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ABuildingTerrnits\MEC-pemlitApp.doe 10/01/09 440-4617T(11 . COM/WEB)
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