Permit 1 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00157
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
TIGAR Parcel: 1 S136CA90000
Jurisdiction: Tigard
Site address: 10900 SW 76TH PL 45
Project: Brouillette Subdivision:GARD WOODS, A CONDO COMMUNI1 Lot:
Project Description: Gas furnace replacement.
7/31/2012: REPRINT to add installation of NC. Unit must be placed within approved setbacks per site plan.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: BROUILLETTE, VIRGINIA
4474 SE MILWAUKIE 10900 SW 76TH PL
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 805 -9724
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Air Conditioning 07/31/2012 $46.75
Type of Use: MF Furnaces < 100K BTU 03/27/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/31/2012 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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 1.800.332.2344.
Issued By: -/ �� / Permittee Signature: 0 €t'A -/ n-7 .
Call 503.639.4175 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.
•
CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00157
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
Parcel: 1 S136CA90000
Jurisdiction: Tigard
Site address: 10900 SW 76TH PL 45
Project: Brouillette Subdivision:GARD WOODS, A CONDO COMMUNI1 Lot:
Project Description: Gas furnace replacement.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: BROUILLETTE, VIRGINIA
4474 SE MILWAUKIE 10900 SW 76TH PL
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 805 -9724
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/27/2012 $46.75
Type of Use: MF 12% State Surcharge - Mechanical 03/27/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/27/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 1.800.332.2344.
Issued By: �- � - w ittee Signature:
Call 503.639.4175 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 , , I i r i ! . i -. i , , i . 1
City of Tigard
O r ` �- as j ''''IN' - - cD�
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II ,- 13225 SW Hen Bid, Tigard. arTigard. � Phi► *ha Parma
- k.. Phaac 503.6394117 j �
503,639.4171 Flog ` ' A q, RR �Q ruWar
OE GS`' Q Dos R H See Pass 3 fafsemaboa
O " : Meth o oat game fret' me as ,' value of soot
New con action :5 perforate* Indicate the value (rounded to the nesmst dollar) of all
D Dernolitiml 0 Other, TH..--7,,,,z, meebm+rool ' end tiz
. labor
{ r { ^ '.t i ill I L i ! i 'f ' . �a Y - - -. . I - °1'' f-
3 dw el C' omm�ipVmdustrtel ❑ Aitsot'Y building r - 4 '
�� - �d Malay � 0
13 Mold- family a Mash builder o Other Description Qty. Ea Total
l A OS 'T .oZ-�� Femme 100 000 BTU • -..• M 46.75
.� r 11 Flasaee 100 U I I B'ry ,..,... - ,- ■r1
5 doe/ ms -fit Pr at game: i. a 61.06
Cross strmethratio ns to job bite: Duct work Mil 2332
w. _.. Ele=PIIIII 23.32 • .
Residatlial boiler (radiator or
23.32
NM 46.75
_ 23.32
Subdivision _ Lot m.: Other: 73.32
Tax map/parted no Other fad
r 171 Weamr heater MI 23.32
Mil Mil
IrMIMMMIIIIIIMIMM 33.39 MIN
,
X23.
, - ^ !_ — . .•m M. 1.. _ lip �.;- i� 23.32 NMI
' .. 11•il= J d I ` I I ,. ` 23'32
Name: % d -1 0� .. ( , (t-'t T e. Eallroamegtar exhaust and ven01a*loo
Address. -" 1j -ilill
City/5t lealP: Clothed ' - echatm — 33.39 MN
Phone (C1 — a Fax: ) sort, • - 2132
iii7:- .. -_ - - -_ - __ r! :il :14'-- j_ - :. _,"ice - _ — '_— Mill
�_. , _ -- -- - .:2:_.: + - Other.. - ME 2332 MOM
Business ureic _
—
Contact name: $14.15 for first four. S403 for each additional
Address: Foresee: err. IMMO NM NM
cm heat ., .,,•. �]♦�
City : Waif .. . _ • • it heater MI=
Phone ( ) — Fate : ( ) 7. -. heated . IIIIIIIIIIIIIIM
E -marl: M
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&wialedb men= SE �H�e Air Coe�dldmlag On= MIN MEI MIN
f MIMI
7�
Address: 4474 SE bEl walde Ave l� - : - { r f • t : l! r_ _ :1. iii--
CitylStale/Z': Pertlaad, OR 97202 Subtend L`:r11:�
Phone: (54'3) 234 - 7331 Fats: {5a3) 808 - 9108 Minimum permit Lee (590.00) } p - •
Plan review (2596 of permit (cc)
t CCB lie.: 1441 State surcharge (12%of vomit fee) . • 6 0
` TOTAL PERMIT FEE UI • '
I,., / posh a tlas cap= If 'pay ' h sot obtained wldda 180
Authorized � 1, • ,rte � • eft afmr It has been accepted es ovethem
Print tome: - rift - N 1l911 • Fm eeethedaloyy ice by TA-County Salim lsdeaty S nica Bawd
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•
Mechanical•Permit APplication I
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:C ity• of Tigard . retrivol , Diadi4, 7/25//. - .1-',. , ' ' .o.. . tf6C42 OM- 00/5
I - 13125 SW Hall Blvd, Tigard, OR 97.223 •Van Review
' ' norm 503.639A171 fax: 503.598.1960 JUL 2 3 2 012 ages ..
. ). . Ogler Penni
1 tin Li
.nspecotte. 501639,4175
. TICAltD Due Ready/By% ly, % e, E See Pap Ifor
i r v- _ suoitemeeut lolarcoadon ;
Ingmar, .WWW.144140-0;401'
CITY OF TIGARD 14065 tameoloti - ,
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.t:•:•:: 'igliCI;i41 ,.. • -• '''' - ' w .. th:. . .,_...... .........,...... .. ..... ._ _.. -7.:,...........-......•.:_... . ,:.
Mechanical pennit fees* arc bzed on the value of the work .
O New construction . .)3Pdditionialterationireplacement . performed. indicate the value (rounded to the nearest dutherof all I
O Demolition 0 Other: mechanical materials, 9i:torn:la, tabor, overhead, andprofit.
'^'''';''1:;ii-eP;'''WK;i'jViiPP':■':.c't.4tigtslifOW.ij*1tii'fdglr1.f,I'kfggei'g..,''•1;..!';Yr','i!:7::qtq.i4fJ Value: 5 •
7:17- and 2-family dwelling D Cornroereiallindustriel 0 Accessory. buiWing
For *coal mformation 145.7 dited4la
- ,7 ulti,family DMus-ter builder 0 Other: . Description 1 C,Ity.. 1 F.". I _ Total i
P Hwinecooliin
_ •
r t 41-1 .1 Air conditioning .
t• , - ( 4 '/., 3 .
Jul) Au ad0C , IA_) T i • • • 0 ( - ' Otailivei. silo plantliuwitie. glatrateati I ' 46.75 I a... •
City/SmuAlP: .-- TA,Ct,.,reA_ , r)f._ . 3 -- ...... ) , P., Furnace 100,00D BTU Iductriverust 46.75 I - I
Furnace 100,000 BTU reccui,enu'i
5ttitabldg.hipt. no.: 1/ 3 Project name; Lt c-LcA_ % ‘ l ...:(:+.e... r___________
I
I Herd puma -I
. 61.06 ! • •
ITCross sinect/ditection. to job sac: 'Duct work 1 23.32 i i.
i
' /Wren ic hot water nstern I 23.32 I • I
---- Residential boiler (ttdiatal or
hydronic) r 23.32 I
- j
Unit heaters (iucl-typc, not electric),
r
i
r .
----- • •in-wall. in-duct. suspended, etc. , 46.75
--.--- Flueivent for ant. of above 1 Z3.32 ( I
Subdivision: I Got aw.:
Oth I 1 23.32 i I
. 1 Taxmaptparzel no.: • 'Other fuel a , • homes i .
!d",.,'..:44P.ZL.P..00-41ffir.70,6%14.0140its!4:4?ii4:Afailiiiie Wairr hCuler MI
Gns fireulace
i 33.39 . . 7
Flue vent for water hexer or
gas 1 i -,,
---...-
.fi •lace 21.'12 1
t. : (.. i I.k.., . , 0-1-1 ... e _
to. li tr .351 I . 23,32
/
.7 E S /Al ,EX/Y/ 7 Wood/wilt stove 1 1 33.39 . 1
• ..
- l<" .- C At/ 4 Val'A=IIIMIIIIIIIIIIII • Wood &enlac:iensert ---... / 23 ., 1
. ..-:::4 3. 1:14 : 4 r - 'o• 0 ./*1#0A***.t0Witrq•i! it.Tigiaiiirlgagaitit$: . .'.'. 4/R12W'fitAArre --- na.,..
I
:INIarric:
.,
: v o, 1
k . i 1 • • .t4t-j Environmental exhaust and ventilation I 23.32
z
. . ' \ `' '' a ) I _c,-; :4:t..t„..1 . .e.__ _
___." --- .1
1 1 -. 11
boodtathc kitchen
eipe
. 1 • p e ' t
equipment
33.39 1 _H
• City/State/21P: Clotlit.drver exhaust
•
• thane:130g' ) OS' ri ..- 1..L( • Fax; ( ) .
[.... ..
- sin mh...1 0 .0.,. - .1---- . ,
. toilet cantonments. utility raCiiiii) ,.. :13.32
g.V... .a I ,
.. •...1.':'!flial:414-0$11.Yi.j!r,......i? , 41..,aigaligt;i4174.40141...AgE. ' Au i nic rzwisPaCc fans .
_ • . _.......:" .
Businesionme:. Other: .23.32
• ------1
• . - 41.,aeldoiste
- .. . . - . - • . .- .1-
) Contact name: ! • 514.1.5 for lirst four; 54.03 fur Cacti additioual
- 4
. . 1_,L_truar.c, etc.
■krldress:
rca --- ' G W os heti pump
allIsurpcsultd/unii heater 1 •
I •
I -...----------...,
• w hcaim
I Phone: t. . 1 .1 1 ( )
Fireplace
1 I
., I
t t
Rangt I
_ ... .
1....,.'''ji;,.W.i'i::16,Ti....1?;,2..ka.PA;-Aii:3).:460t---,7....!........WeV;Ni.F5,7ii:::Viiii::.I2P,.::,...,670..cgi Balbecne 7
; tiusincs.s. name: Jaeobs.Heatiag & Air Conditioning . ' Clatricsiterigasi
___._.-..._..._...--...-..- . Other: I I I I
. I Address: 4474•SE MihvaukicAve r
1:1E- irtijkaigiltiiiiktiljlii0i
. - - _ . . ...,.... ... ,.... .. _ .., ..................• -...... • , „ • ..- •-,,
•
.. 'City/StatP: Portland, OR 9720 2 Subtotal • • 1
----.„--------7-----.7---c„,....,;
; Phone: (503) 234-7331 .
• I Fax: (503) 808-9108 Minimum permit [cc (590.00)
I -------- ."---......--,-.--,--■-•-•.--- Plan brtie‘C (ZS% of permit fee
lie 1441 )
16.r r •••••■•■ar. 1,•■••■•■■••-,V,, -
I / ... State ourchwgr (12% of peanit fcc) 1 0 • 4 . 1 :: . : 1
I CCB :. - . -
L 'TOTAL PERM1T FEE / CO
•••• ,i: ) ' -`....:-.... 'fills ocradt aoplitatiun milt* if 3 perlail ii nut ubtailted x Wain I St)
Authorized signature:. -- JR -Um/ days aficr it bas been accepted a; ruiapleit.
.........-..
F L Itattle:_4N .,,, i-.S ''' Ile' ‘ -On . - c ), .q,. .. I •.) . • 11/4e l i by Tn•Couray ituildiug linluil:). Sci*icc IhAini
I liadir.:1..?&entaLt.=•Feol.;.1A33434 :o.ot,:.s. . 441 33 ir: ir vez, ontwgx; C-/ ' 3 C S&
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-
PA /7.0 A9Vd ONI1V3H Soar LSZEZIEIE13S
GO:80 ZIOZ/EZ/L0
1 11 1 11 e ° Building Division
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: /1EC 2, 2/a od / fO�A - -e x�jug./kl
CWS Service Provider Letter Received: Yes ❑ No ❑ N /Ar z:.I/9NN A .
Routed Plans: �`
Original Plan Submittal Date: ,4267 .Z-
'
1st Revision Submittal Date: ❑ Site Plan Only
2 Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (/) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left onl • approved. /
Planning Review (contact at 503 - 7184'' 7 �Q or 9'. I @ti or.
L a Use Case No. 5i/A97 - 9t I �S' Name 1!7 a ` /JQ1
® Zoning p yi 5i ( /A)
❑ Setback I / Oa
Front Rear Side O Street Side A Gar
❑ Maximum Building Height .1" ------- Actual Building Height
❑ Visual arance •
❑ Ease is • .
❑ Sensitive L Type: /, - , f
Notes: r- ' / ! /N i f G % -!T ! vi f2 //tat
t t /
'' '.. v',/ D v% or
B7 i
Original Plan: Approved 2 Not Approved IN Date: 7 /0 / 7i•
Revision 1: Approved Not Approved ❑ Date: 7/ / / ?,-
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard- or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2:. Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard- or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
• Date Routed to Building:
Page 2 of 2
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