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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00490 T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/16/2009 Parcel: 2S110DD04000 Jurisdiction: Tigard Site address: 15695 SW OLD ORCHARD PL Subdivision: Lot: 0 Project: Fitzwater -Henry Project Description: Replace heat pump. Unit must meet 3' minimum rear and side yard setbacks. Owner: FEES FITZWATER- HENRY, MILLICENT Description Date Amount 15695 SW OLD ORCHARD PL TIGARD, OR 97224 Air Conditioning or Heat Pump 09/16/2009 $14.00 12% State Surcharge - Mechanical 09/16/2009 $8.70 PHONE: 503 - 624 -0868 Minimum Fee Adjustment - Mechanical 09/16/2009 $58.50 Contractor: JACOBS HEATING & AIR CONDITIONING 4474 SE MILWAUKIE PORTLAND, OR 97,202 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: 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 m / »- -i L / C4-Ti o 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. i :MiChanical Permit: Application RECENE 10l, (:)F1-1CL liti( i)Nl 1' City a Tigprd . 'D it ®d •ii.Al pmmitNutigr OQ` -/ i '/. + PI wR y : t3l.''S SW i3nII 8t OR 97. i ' • ,•.,� 5 03639.at71 141x; S 1 200 y: P "° EP : {r76cr Persil: Tic; A h. o , .. 1t Pic.; 3 13.639 :4173. 1n ... ut ct wlvw:tl •ur G ■ '.dry' FY ) . •21 SeaEage:.far . c.i " C �F 11 i r�i► hod: • I ' supplemettminforetapm . a: ; ;:ki ..: i it:. 041' 01 u fi �:;1:C [� New:y4nseructton r A dduvaolaltt rant �::�-� —;ii ■� "!•� � :^. �p�j4'rirr•`..�H�C1:kLi5'1',. 'onfteplttt�:lrtenl : Altxhttttical permit Beet" ate based on dte •valuc.oP the.�tixuk L'J ikrrtotiiion �] Other i . perfor mod: i ndicate the volue.(mundhd.to td amesl dollar) 41311 . .. . . ... :.r :: ';:• 4 gy. 0:00tu ,fir, ::;, . d +vtrllit► `� lyOdttJ Y S Q.Commacialli . ©Accessoty.built9ing . `.: 'R�E��'U*`�4�. /:S'YS7'Ed7S ?)nEC •::.•:,:- ,.. ,[ :Ivlulli-fumily ❑' master"litiild For s i • ... • . . .,:1:.,; . n W��AND�IC1C,�T1QN.; ; 415 >.:;; <u���;: . ;, Description � Total, Jo b �ue'addrras.:; f� • . i �� S :S:tw/ i rc on ilit i ol a n .o rb¢at � .•�r "� A eiransue. ... toat> 1... 1�F. . P - c2: - ... ri mace 100.00013TJ (ductsntims ' ro'ccan 1 +00 J atncr :; 7 Fumacri00.00Dw BTU (auetswcaw 11;90 • • G►vssaYrt>rVdi ot Gas has neclt ... site la:0o. . QucEworY . • 1 0:00 14:00 �. • Unit Caters (fuel - r ... cmat •elCCUic), mi all in d,tct sus • etc. 1:7 00 • tot 116':• Fluelvent for an vof above - • OrltLr' M 10 ,: •: . r '1! I O'! :O '. K:....'' :, • t : .. flue l .. . - . �.;� N.. F veot:for x�41tcrdt:ateror�t Ei t" ' '. ..K}'1 0 •. .. • : Fi . r0.U0 . MIM tO,UU . . 1U. Wood' ;lace/insert � II � ;' t n: ri. ;.,a; Cli 10.00 .. :; :,, .: .a, �;�:,.��... tmnC /lines/flue/vent ; .:• � ;IG?�111 }k1Vr� ,: • u u lQUO � Othee . • .. ... 11 Environmental - exhaust and- vendlotion 10 OU Address ! • • •• Range huod/oth• kitchen :Clty!$.tptr./Ltl': • . ui,mem Iu.OD' • Rht - — Single -duct drnr cx.haust 10,00 . ' -.. : O CO : exhaust (bautroovt,,, ,:� t .(' •. �1'•' .: y, ',t_:s;n'I:� -�.�I :�;y14n,iS } .. .IOi • nests tai rooms) ___ 6.80 MI • Other. IIIIII 10 ME C ... 10.00 AdtlresB: r first four: MAW for mt� our• 1. r NWi4 u FtagaCe,.otG aal INNIS • CiiyiSwtrlL'IPo •WiU/su , . ended/u6h heats: Water heater: . $4x+nas itam,. Jiuolae'Hcaliag : B Air •Cant i . ��� Cliher �� • Ciiy " • .ip : °I�grtlau .. , .. i4t0rA1111• Ph&1Ni]'f of I 1 'houc:'(SOd ??34.733T . ..Ali: (303) 808.95198 Snbt on 1�4inim permit fee . (S72:50) Plan review (2.5 %of parotir fee) �' dig 'Slaw surd mpx (a%ofiertnit fix) A • tiri ed:sig►tatjtre: • �► � TOTAL YE�RMIT FEE 7 •" Thic grater J.. �.D ,/ Autb �- P app. icaGana sp; RClrayarmG.ym,.�uaiaau _ N;wo:tar • . • 1 to i . • Jiro, ..rs�i 0a1e: p'— + utoe aft 1t ri- becc ne ul:Min arwmpkm• • t. ..: oinssoi • � Fey • . .... ! Sm'iecBaard .. • I 5141- t61T1' (IIW- K'O\Y.W�p) J 9.. E0 /Z0 39dd cJNIld3H SHOOGf L5Z6EZ8E09 BE:Zi 600Z/ST/60 • S• SITE PLAN 4( DIRECTION HOUSE FRONT STREET' )07 r Jab Name - r S#! _ L I . Address Martel # Make JACOBS STING & AC 4474 SE Mflwaulde Ave. Portland. OR 97202 1503 1234-7391 (50.3) 8 13 -9257 tax E0 /E0 39174 9NI1C3H S3000I' L5Z5ET8E0S 8E :ZI 600Z/Gt/60