Permit a CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2012
Parcel: 2S 101 AD01400
Jurisdiction: Tigard
Site address: 12700 SW 68TH AVE
Project: Oregon Ki Society Subdivision: WEST PORTLAND HEIGHTS Lot: 31
Project Description: Heat pump replacement.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: OREGON KI SOCIETY
4474 SE MILWAUKIE PO BOX 2143
PORTLAND, OR 97202 LAKE OSWEGO, OR 97035
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 04/04/2012 $224.07
Class of Work: ALT Type of Const: VB Plan Review 04 /04/2012 $56.02
Occupancy Grp: A -3 Occupancy Load: 12% State Surcharge - Mechanical 04/04/2012 $26.89
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 04/04/2012 $7.00
11x17)
Project Valuation: $5,581.00
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 Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump: 1
Appliances
Vent Fans: Vent Systems: Total $313.98
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
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 9 01 -0099. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2 4.
Issued By — ` er ittee Signatu :• . '),E c.
Call 503.639.4 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 f Ti �� Rec eived
ty Tigard tir / P ermit No.:
1 1] 13125 SW Hall Blvd., Tigard, OR 97 • r_ ' 0 \' Date/By: 1 /{7 � a 'Od /gyp
Phone: 503.639.4171. Fax: 503. 1 % �' Pin : !. z �t
50 75
T I c \ R D Inspection Line: 3.639.41 �.� Day' 1...# ✓ I ' Other Line: a 3.639.41 Q L t��� �\® Data ` x
®( ` :\ Notified/Method: 3�%� El See Page 2 for
a Supplemental Information
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❑ New construction 3ddition/alteration/reCement Mechanical permit fees* are based on the value of the work
performed: Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other:
mechanical materials, equipment, labor, overhead, and profit.
.
... .�. y .. Gfy11T Valuej`'�
❑ 1- and 2- family dwelling L111 mmercial/industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. 1 Ea- I Total
_ L` - ~`' 4_ . .. _- _ :7b� , :4� �, °
:°�+ i t,--,. 1. ':!:. Heating/cooling
site address: t I a . t.A..) O O ( 4J �.) Air conditioning -
2 (requires site plan showing placement) 46.75
City/State/ZIP: �--‘� .� \ D ! dJ Furnace 100,000 BTU (ducts/vents) 46.75
Suite/bldg./apt. no.: Project name: 0.1 Furnace 100,000+ BTU ( ducts/vents) 54.91
t c/ 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
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32 ,
Tax map /parcel no.: Other fuel appliances
y: 'ham - _ _ f .,_ ;, i#P.. w. '1E_-_-''''t .32
,- -- - _ , _ Water heater 2332
Gas fireplace 33.39
Flue vent for water heater or gas
® -e-0 `� C,� 0 WI
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
# '1l'' s' �;_ :7:44 . µ x .. - Chimney /liner /flue/vent 23.32
�/_ ~ .
Name: 0 ( c y t SOC 1,
�� S S 1 Other: 23.32
Q �.] Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City/ State/ZIP: Clothes dryer exhaust 33.39
Phone: (� o3) 3-440 - 4(0 D Fax: ( ) Single-duct compartments, exhaust (bathrooms,
ro oms) 23.32
s,
1 . _ toilet compartrnents, utility rooms)
i,'.: • - .7 "• -. - - 1hP# o tikV r - Attic/crawispace fans
•; �_� _ . ' 23.32
Business name: Other: 23.32
Contact name:
Fuel piping
S14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
City/ State/ZIP: Gas heat pump
Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
E -mail: Fireplace
Range
--- z. - . - -- -' ''';;: r , V ; J. (O Q cam' _ - T : v : Barbecue
Business name: Jacobs Heating & Air Conditioning Clothes dryer (gas)
Other:
Address: 4474 SE Milwaukie Ave
City/ State/ZIP: Portland, OR 97202 Subtotal
Phone: (503) 234 -7331 I Fax: (503) 808 -9108 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
/
CCB lic.: 1441 State surcharge (12% of
, arge ( permit fee)
/ ,; TOTAL PERMIT FEE
�, �� i
Authorized signature : I 1a� I '' s This permit application expires if a permit is not obtained within 180
Print name: �ltV days after it has been accepted as complete.
�- Date: 3 Emil • Fee methodology set by Tri Building Industry Service Board
: \Building \amitaVKEC- PamitApp.doc 10/01/09 440.461Tr(11 /02/COM/WEB)
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