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Permit CITY TIGARD MECHANICAL PERMIT 4.:��� DEVELOPMENT SERVICES PERMIT #: MEC2001 -00237 �I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/27/2001 PARCEL: 1 S 135AD -05200 SITE ADDRESS: 10735 SW SITKA CT SUBDIVISION: TRENT TERRACE ZONING: R -12 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Installation of exterior NC. Must be set within the required setbacks. Owner: FEES PAUL MAR Type By Date Amount Receipt 10735 SW SITKA CT. PRMT CTR 06/27/20( $72.50 2720010000 KING CITY, OR 97223 5PCT CTR 06/27/20( $5.80 2720010000 T ' Total $78.30 Phone: Contractor: • JACOBS HEATING +A/C 4474' MILWAUKIE AVE PORTLAND, OR 97202 REQUIRED INSPECTIONS Final Inspection Phone: 503 - 234 -7331 Reg #: LIC 1441 EXPIRED This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through AR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9 • s . Issue By: % Permittee Signature: / Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex business day r • ir Mechanical Permit Application Date received 4 7 Permit no.: 0/•46,2 �1,1:11�1 C ity of Tigard ��``E �Ep / , .i 0 ProjecUappl.no.: Expire date: City ojTigard Address: 13125 SW Hall Blvd a , - O T( 9722 Date issued: By: I Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 JUN 2 7 2001 Case file no.: Payment type: Land use approval: Building permit no.: COMMUNITY DEVELOPME0' TYPE OF PERMIT AA: 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: ` 1:�ti t Q Indicate equipment quantities in boxes below. Indicate the dollar • Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ . Lot: IBloc I Su ivision: *See checklist for important application information and Project name: -vt�- �'� a , 3 I & jurisdiction's fee schedule for residential permit fee. City /county: \ .�a�`� ZIP: 2 FAMILY DWELLING PERMIT FEE SCHEDULE De n lion and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIP1MENTSCIIEDULE Fee(ea.) Total Est. date of completion /inspection: Description Qty. Res.only Res.only. Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM Air conditioning (site plan required) 1 I Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors , . • • State boiler permit no.: Business name: e0 . 3 hq HP Tons BTU /H Al: Add - ss: • 7 •+ St Q G hie Fire/smoke dampers/duct smoke detectors City. A Sta km' ZIP: 4 10:ID Heat pump (site plan required) ,,Airetinik1655 t► K . '"i E - mail: Install/replacefurnace/burner BTU /H Including ductwork/vent liner 0 Yes 0 No CCB no.: Install/replace/relocate heaters- suspended, City /metro lic. no.: 1... • wall, or floor mounted Name (please print): O"% i; 0 rM• C Vent for a r r liance other than furnace CONTACT PERSON' ' efrigeratton. Absorption units BTU/H Name: OAD y• liVI C. 0 r C Chillers HP .�,�A Compressors HP Address: City: • • K O S I S tate! O Environmental exhaust and ventilation: Cit Appliance vent Phone: Fax: E - mail: Dryer exhaust • • _ -. _ ... - _ . OwNER__ , ; _ _ , _ .. _ _ . . - - Hoods, Type l/ I I/res. kitchen/hazmat hood fire suppression system Name. 111 0.4/l ` Exhaust fan with single duct (bath fans) Mailing address: 10-)A )`7 � S Q Exhaust system apart from heating or AC Fuel piping and distribution (up to 4 outlets) tat I City: ��a iOD 3 Type: LPG NG Oil Phone: Fax: E -mail: uam• ' Fuel piping each additional over 4 outlets ENGINEER Process piping (schematic required) Number of outlets Name: Other listed appliance or equipment: Address: Decorative fireplace City: I State: ZIP: Insert - type Phone: Fax: • E - :;_ Woodstove/pellet stove Other: Applicant's si_ a •, 7.j_td1r'.IZANTf YEZE11111 Other. Name (prin $ AMC D L, Not all jurisdictions accept credit cards, please call jurisdiction for m n ore informatio Permit fee $ 0 Visa 0 MasterCard Notice: This permit application Minimum fee $ Credit card number: / expires if a permit is not obtained Plan review (at %) $ p1 within 180 days after it has been State surcharge (8%) . Name of cardholder as shown on credit card accepted as complete. g ( ) $ 5 TOTAL $ Cardholder signature Amount t� hql SICIrt EXPIRED • I j I I i l L aiu. lion) NauSE W FRomr 7J k STIZE.E� _MB Ni i77 rLC.� \ f fThapiat=e1 c.) 5u.) SA (7, T304-3 )- (noc LL. \LC U00 r 1L MAKE J?CoL35 147U * AlC qLf ?4 S.E. MiLwAuKiE I\V &. i� o/zr oR . 17zoz EXPIRED 503 - Z3/ - 733/ iax 503- 815 - 12.5 7