Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00427
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/15/2012
Parcel: 2S114BA09700
Jurisdiction: Tigard
Site address: 16445 SW MEADOWOOD WAY
Project: Pietita Subdivision: COPPER CREEK STAGE 2 Lot: 50
Project Description: (1) A/C Must maintain 5' side yard setback and approved rear yard setback
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: PIETILA, LINDA L
• 4474 SE MILWAUKIE 16445 SW MEADOWWOOD WAY
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 639 -1428
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Air Conditioning 08/15/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 08/15/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 08/15/2012 $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 A I 4 f'� VO
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.
08/14/2012 13:37 5038139257 PAGE 02/03
MechanicalYermitApplication 1J3IV ri::i:0l I Ic:I: a_si- (\Lv
City of Tigard / /,S 112- s I' ma Ee.-.1oa -0c'1 7
L3125 SW Hall Blvd.. 79gard, OR 97223 AUG 1 4 21' >:.„
_ Phone: 503.639.4171 Fax: 503.598.1960 Y. Other Patois
i . I :; �, inspection Lime: 503.639.4175 a ReVBY See P 2 for -�
Internet trvrw•tigaodgr g p v CITY OFTIGA 1 , :,.. ,... a Sopplemeatel lefermation
BUILDING DIVIMi0N
ter J`'` c7•'.'J.7` — c' r -. , lr - ,: '2 ;[ 1<� lif: :7ni;i1:Fri'!r. - -ai.u_ : _: '7 i.rgz . %i]`3.a+•.� :::
ri J r_. 1 a ; I k 4 Gi ..4.11%. n `f, r � 1 . , 1 is r - in. M_ .' rt. ,.., iu�
� �- :•t,s.,�'�J: ' ^ "./ � . ._..., `•n ";n. c7X.:..•`T�.if_o„�.�.•��.: yL� lUl. :i . '�"�.: �:.
❑ New construction ddidon/alterationimpiacetnent Mi aia al permit ' based on the vane of the work
Demolition ❑Other mechanical perfumed• Indicate rho value (rounded 1Olho nearest dollar) of all
_ meccal materials. equipment, labor. overhead. and refit.
• -, r v
' •0.._ i `i a r `4� e- " :_-- ..._i ,7-7P;.,---.771,t7:.; -iii, _. . c� � r .- - w
end 2 : a g -.. f ` d i t i ,.4,,, - %I.:2 � . te . _:
DA - - family dwelling [ ] Commercial/industrial ❑ Accessory building . ._._ ,- _.. ' 9 0
❑ Masi- family ❑ Master builder ❑ ether Forveclaf he raearfon tiff checklist,
Description
- ; E- , , , 4 -1J -y . - - � — -- . �Qtv I EJ Taal '
?•_1 Ira1'o ' —•_ _7 L 7:: i ^'�7 L %5' •i i ZY ;:.,� k'J' :'.'n'�.' ' ,yr �.1
Job site address: t. k4OqL. 5 rn_Q a ' p • ...I Air conditioning
I vita site plan sharaut plammeen i 46.75 y (o•
city/State2iP: " . A , i Q(Z__ Gl - 7 4 / Furnace 100 000 BTU dantsAemts 46.75
ds ,� Ii� ` u:ilt�r �tttn, NE 54.91 EMI
Suite/bt a t. no.: Project name:
Heat pomp
61.06 II
Cross strut/directions to job site: Duct work 23.32
H • ' is hot water - 23.32
Residential boiler (radiator or
• , ie 1 23.32
Unit heaters (fiid -type, not electric).
in in-du - • , - - , etc. 46.75
Subdivision: Emu= Flue rent gm any of above 73.32
Other, 23.32 MO
•
Tax map/parcel no.: 7 ' ' _ � �,L+ Other fnd a limes i' ._• "nil .x ,. I 'ft - i � /� •_- •• T ISr�a i.•lA:, Water r r* �4L. Z_EY::acL.. ra i'rTM�..•
s_�.� _.l,�.r __. � :�� ";'t1 star herder _ 23.32
QL r .- ; • - t'1�] •,,� Gas r -, 53.39
2332
23.32 MEM
33.39
-, -. . - � r t:_ 23.32
- 3S •i+ ,-' ... � • : i: r -1,:! . }_ n-A- i�'=vj ;,•= - � .�� r.• -.
iriafudeent
: '= _ l:{. : i F,t�,!r� Pr '-..:tom 4 r _��� t! � �r,.i �
. t f.. �Gt�x O.
Name: i P; -e_+- - Enalronmenml gained and veataatdoo 23.32
Address: Ratlgc hood/other kitchen
equivalent 111
City/State/ZLF: dr r 33.39
ClOthtts
CZ 33.39
_ r - 1 Sia gle4u exhaust (bmhroo mum.
Pag� y "�` " ' r .'`, _ .:. �� . c_ • -. ; - _ _ tofld ..- �.. utih rooms 23.32 _
Bin
Nt`•r. La `"C l:; . , .- `� :r_ Tf. 1): ,r .� ' :- , - t � , r ! y - ` 4 • r+' Y . vine
r.. w. wC 1�- �'ri. r� has
Business name: r, ,,, . NEVEM
Contact name: Fuel ,
$14.15 for that four 54.03 for each additional
Address:
as
Ciry/Slate2lP: Gas beat 111111111111.1
W. ar it heater n--
Phone. ( ) Fax: : ( ) Wtuer heater
E -mail: Fireplace ��
IMIIIMIIIII
= n7!?t)_ v - ? L` �..' t�: T' �li�- - ...� r:t�T4 —�� r'w-^m --r �d;.��
a.l�. Y t i,- .fF ,I _ Y^cw - i,', 4 - ' .' Barbecue.
- -- .: / • , , .) ~�
City : Portland, OR 97202 � ._ _''' _ . .. __ t ' - "! � -
one: (S03) 23d - 7331 Subtotal
Ph
Fait: (503) 800 Minimum , 't fen (590.00) - • •
Plan review (2S96 of permit fee)
State surcharge (12% ofpermit the C s . -
Authorized signanaz:.l (1,,`Q ( r1-'fY ( p 4 - f - T O T A L PEIt11IIT F E EI I
, �� �j Mb permit a twine eta permit is art °bra led welsh 1ND
l Print - _••' v � , y � r � • drys a f t e r has been seamed meamplem
Date: • / i Z• f Foe flog art bS'r ty Balding Industry Serving Board
� 4404611T (i ulO7J[334no®)
08/14/2012 13:37 5038139257 PAGE 03/03
SITE PLAN
I
T
„la
" to V
.
me.a.iao140pa
/i/404
M. &Via ati
JACOBS EATThJG 8.r. AC
!!'•
31;
;r
'2.57 •