Permit p CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00622
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/26/2007
PARCEL: 1 S133CD -12100
SITE ADDRESS: 11889 SW WILTON AVE ZONING: R -25
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT: 153 JURISDICTION: TIG
PROJECT: JEPPSON
Project Description: Install gas furnace and a/c unit.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
TRINA JEPPSON Description Date Amount
12735 WILL PL
TIGARD, OR 97223 [MECH] Permit Fee 10/26/20( $72.50
[TAX] 8% State Surcha 10/26/20C $5.80
Phone: 503 - 579 -4198
Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 234 -7331
FAX 503- 808 -9108
Reg #: LIC 1441
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 OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue. ;y: /1/4- �J 4.4 j Permittee Signature: LQ/ , fi t .1 di /
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
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.
yti, •
1VIec1arAics1 Permit A. ! • _:�,c, -•- 1.()K ui i•i. I. (iS1 (,NIA
City of Tigard r,. i L%V J may: 0 2.4 0 Sufi PtuntitNo..p.�Fi:2007-_GY)(o2Z
114 13125 SW W Hall Blvd., Tigard, OR • ' 7223 Plus Rwmw Udder Permit;
Phone. 503.639,4171 Fax: 503 .T962 5 1007 Date/tly:
Inspection Line: 503,639.4175 Darr 1Zradyl13y. EMI 55 See Piige 2 fvr
Internet: www.ugard or.gov CITY OF FIGARD Notified/Method: Supplemental lnformalioa
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Mechanical permit fees* are bused on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other �p mechanical materials, equipment, labor. overhead, and profit
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® 1- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building For Information use checklist. l
❑ Multi- family ❑ Master builder ❑ Other: Description 1 I Ea. 1 'focal
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a i
III '+ i 'II "fi ! r .; , , °i1�'�c'a'4` I'f'e�'�:!� i 'c�w nTh 1 71. II ,. aching/cooling
'`rlj�llll'uli��t %HI�IU��11(rl `n�} ri{ I:• ��i` u�:. v,.:.):,.:, II.:.; �u? t,(,, f,,+ <:Ir,lm.,.lj11 >.,.u.t +.,slltr �.I!I�, Ys' w'
Au conditioning or heat pump
Job site address: 11889 SW Wilton (requital site plan showing placemaar) 1 14.00 14 00
City/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vests) 1 _ 14.00 14.00
Furnace 100,000 BTU (ducts/vents) 17.90
Suite/bldg./apt no.. I Project name: -
Gas heat pWnp _ 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) , 14.00
Unit heaters (fuel -type, not electric),
in -wall. in -duct, s . ndcd, etc. 10.00
Flue/vent for any of above 1 10.00 10.00
Subdivision: J Lot no.:
Other: J 10.00
Tax map /parcel no.: Other fuel aeiiances
V +i! 1' t u =u . v 1u y' lj 1 I 1! IpAI�l�II1, t• tiff Water healer aler 10.00
' , I I I n'" t I; •, II aa�i 1'• ii hlii IIG
rejig'
, P, um,�:: Gas fireplace 10.00
Install gas furnace and air conditioner Flue vent for water heater or gas
fireplace 10'00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
I'C �' L ..- c, n r ; I' r'I , ,p y I +l r, I ,, I 1•uri' {� � �� Chimney/liner/Out/vent • UI I p I , I!?EW a?F?rA'ImZ n F^nat li if f ij ;�1 1�;��,r P�VI$�� I Iltltll••.I._ !r,W C xgr;C r gI'�{�; �& l l . ; .t
N. ' I i I,;' , .y� ' 1 t. ai'''.' ' ".�,uuatt - . irlh. 1 , ''' w Other: 10.00
Name: Trina Jeppson Environmental exhaust and ventilation
Range hood/other kitchen
Address: 12735 SW Will PI equipment 10.00
City /State/ZIP, Tigard, OR 97223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503)579.4198 Fax: ( ) toilet compartments. utility rooms) 6.80
111' � p w' sav I 1 II r t I . a 'IlH'ill "' /crawlspace tens 10.00
IIEM d rIIli '.L 3 .�7- :c.!ll !�IUI 1� {:•.iIli Fwv IIL¢tin',.1,1 ' ;,.' ry "' , . ;,; Attie
' ,
10.00
Other:
Business name: Fuel piping
Contact name: $5.40 for first four; 51.00 for each additional
Furnace, etc.
Address' Gas heat pump
City / State/ZIP: Walhlsuspended/unitheater
Phone: ( ) I Fax: Water heater
( ) Fi re lace
E- mail: Ran_c
aura
I { . Barbecue
} I�I �, rl , i
iillii Ill rinpu,{(�mI It w"`4ss(ry,(lrri l.. l I 1 Barbec j UJ e�Y I'f'!} IH!71�° r;I 1' rl r �1,;,�11, "i'...,� 1LS +el;k: i ��I�iA�li!Itltll� {Pies- i4A,'il'.' r�. i�� I. �if! 1
Clothes dryer (gas)
Business name: Jacobs Heating and Air Conditioning
I t u' „�, ay , 1 r , J > ; :,.. Il gl
Address: 4474 SE Mtlwauku F aims' F ' '� .I m . S u l' r , 3 '....., ''+ : 1 G � . Uird , l .,.
Subtotal 38,00
City/State/ZIP: Portland, OR 97202
Minimum permit fee ($72.50) 72.50
Phone: (503) 234 -7331 I Fax: (503) 808-9108 ,
9108 _ _ Plan review (25% of permit fee)
CCB lic.: 1441 State surcharge (8 /0 of permit fee) - 5.80
TOTAL PERMIT FEE 78.30
This permi application aspires if a permit is not obtained within 180
Authorized signature: days after it has been accepted an tampions.
• P ee medrodotogy set by Tti -County Budding Industry Serried Board
Print name: Michelle LeClair Dat 10 115/07 ///7/� / ,,-� / t �]
INsuildi ecni ttalEc-rumirApp.duo amiss 440 -4017r (I1mt/COM/WEB) ( 1 0 ( ` 1
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10/25/2007 10:51 5038139257 JACOBS HEATING PAGE 03/03
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CITY 0 TIGARD .
BUILDING DIVISION PERMIT #: MEC2007 -Q0622
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10126/2007
Phone: (503) 639 -4171 law
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2!2(/20p8 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 11889 SWNWILTON AVE CLASS OF WORK:
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 153 TYPE OF USE:
PROJECT NAME: JEPPSON
DESCRIPTION: Install gas furnace and a/c unit.
OWNER: JEPPSON, TRINA PHONE #: 503- 579 -4198
CONTRACTOR: JACOBS HEATING + NC PHONE #: 503
Inspection Request Scheduled For: Date: 2/20/2Q08 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 066283-01 503-579-4198 N
Corrections/Comments/Instructions:
bbi, kAare A . — /47 2 �� — /4 A 7 �
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: f Date: — 2. 0—° '° Phone #: (503) 718- "2.!..4-2>