Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00334
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
T [GA . R.O 9 Parcel: 2S110DA05500
Jurisdiction: Tigard
Site address: 10502 SW NAEVE ST
Project: Nelson Subdivision: ERICKSON HEIGHTS Lot: 16
Project Description: (1) NC Must meet 5 side yard setback and approved rear yard setback
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: NELSON, DARRELL & KIMBERLY
4474 SE MILWAUKIE 10502 SW NAEVE ST
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 803 -9236
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Air Conditioning 06/28/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/28/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/28/2012 $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: \ 1� Permittee Signature: D /t� �41PPu // 1 J ✓� C
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.
06/27/2012 09:58 5038139257 JACOBS HEATING PAGE 02/03
s tiga d..or
MechanicalPermit.A�DPL_ o1 0 E r7T pi t
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Cit of Ti ' � ��� z into.: /dLC e�712— :km' 13125 swxaII Blvd . Tigmd Plum: 503.639.4171 Far 503.598.196Q
oR 972l JUN 2 012 ' 2 7 r rater :InterneInspection Line: 503.639.4175
t: gov CITE T h , r lie se= ra x lb e BU' I �� , IG A A ,LJ st,ml tleraa
r id . .S'. -r :.rsl . - - `.‹, ;. :Ty:. ':r & :! .,i• 771' - --.: ��tr� -
❑ New eounniction n/alteration/replacement Me dm n ical pe Saes° are based on the value of Nye wwk
0 Demolition ❑ Other:
retained. Indicate ti a value (ev coded to the oemwt doller) of all
mecbaalcal plank, cataPotent. labor, overhead, apd pvofit.
7, 14- 1,1 - 1- - _. - -. —
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ZI ,
I. and 2•faamily dwelling 0 CommazinVmdustrial 0 Accessory building ,` ' .=.:::- ,- •- � .
0 Multi-Comity 0 Mester binder 0 Other Description
For �aeed►edfiu.
Fa Total
, .. -0 . -._ 1 _ _ I J HeagoWceni oll> L .
Job site adder A ir conditioning
t� �` 4L e- e. 1 i . •
C t •' t7� t e b , +a Perneee 100 000 BTU 46.75
Form= 100,0004- BM (dnttt/.eae) 54.91 II
Heat Ouse 61.06
Cross street/dieeetions to job site: Duet work 23.32
ibdmil hamier "ea 73.32
R boiler (snuSetor or
23.32
it bosh (tom cwt deceit),
io.wetl m4• sosaaaded, etc.. 46.75
Subdivision Ds no : Fhtdaent fee of above 23.32
Oil= 2332
Tax emap/pereel no _ Other fuel J • :. aess _
.✓ .T_1;r�c•,,.,_rJ -.. 7-- _ , — _ = "- _ - I .— _ ' f.= . 7.7.7 7.-' . :1 Water hinter CCM
- - — — C3as fireplace 33.39 III
Flue vent for water heater or gas
11111. / GICA._ % a , , ...fie
23.32
E=MMIIIIINE � 3339 NM
tc= _"�;' : �; r ; -.;1-' _ c - 23.32 MEW
.�,�� JC ` 'T. _ -.y _f' %i _ - - f . ,.1 1 .. n, )fi - _
t ; � -J - r-- err_ -_ - - _�}n,, r d; 23.32
Environmental mthanst pod venthadon
Address Range h00d/otllty kitchen
City/State22P: Single-duct es deer 33.39
Phone: ($j ) Q3- a' - 3 / Pax: ( ) eronents ms 2332
� 74P . `r- 7; —.,c— ^.,7, , ='i,_ ^ --- —�— , i � �: 7 — :7 1,.. ,— — . — -; Aube OC
:Ynn, 4i — .. -�• - .:. -, ., r; %� =Y� Nf7 �^- r`...�._... 4i � fie, faro — 23.32
Business name: Odle 23.32
Fed rdp1at
Cooeat name: S14.]5 far first four; $4.03 for each additional
Address:
Furnace.
OM heat
City/State/ZIP: MEIN
Phnom ( ) Floc : ( ) Fireplace r�
Fie�laee
&man: Ram
+'.J�;_^�;. r:, �__� � :: j;. _ _ - ? _._.�`� � � r _..�
: •. _ ` mi l:. - -: :- ,' Bathe=
_ .�� 1 -'': _.L: J .� I - -- . =L Clotbes drys I
Bose= min= Jacobs Heating & Air Conditioning
Address: 4474 SE Milwaukee Ave Ott - = - �
City/State/ZIP: Portland, OR 97202 Subtotal ' (,P • w -
Phone: (503) 234 -7331 Fax: (503)888 -9]08 Minimum . earnh flue (590.00) MIMI
Pion review 12590 of permit fee IIIIIIM
Std 9laduaxe (12% orpe rnit fee) le) , '7
TOTAL PERMIT FEE , .. 81�
r ER
Authorized si r Title permit ap plication e trptro as pcnidt b not obtoised within ISO
�'' '��s�a1 �'��� (� dU,afer It has bees a ccepted es template
Prim""' c ` 1 '.�IRM rf .d Rata: (I MO o Fee methodology set by ?rr .CC�Industry Iy Belding Industry Semi= Board
t: q ae„mp,v,doo 10/1510, tatu .:l 1 , C(
06/27/2012 09:58 5038139257 JACOBS HEATING PAGE 03/03
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