Permit ,,q CITY OF TIGARD MECHANICAL PERMIT
1111 3 ' COMMUNITY DEVELOPMENT Permit #: MEC2013 00008
Date Issued: 01/03/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S112CCO2900
Jurisdiction: Tigard
Site address: 8100 SW CHURCHILL CT
Project: Baber Subdivision: BOND PARK NO.3 Lot: 57
Project Description: Replace gas furnace.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: BARBER, TRACY R
4474 SE MILWAUKIE BARBER, STEVEN M
PORTLAND, OR 97202 7010 SW RICE ST
PORTLAND, OR 97224
PHONE: 503 - 234 -7331
PHONE: 503 - 747 -7855
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/03/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/03/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/03/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , Permittee Signature: / 3 4 /. ' ?L / Cff - /MAI
` �' Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01/03/2013 17:53 5038139257 PAGE 02/02
Mechanical, Permit Applicatioh 'I 1 I i ; , I 1 , l � . i l ,, l : I ,
City of Tigard 1d Received ,.. Parait • • , , i
13125 SW Hall Blvd., Tigard QR 97223 ,>a r ® ��� ' 0D •,
N.. Phone: 503.639A171 Fax 303.591E1960 JAN 0 3 2013 Dm /B Odom Peewit
I 1, • -, 1 . I , Inspection Line 503.639.173 Dan Rey,
Internet vetted igard.orgw CITY OF TIGAHP xcItigailMatod , HEBEIBEEI
_ C
I __
' =Thc§1. �'i� .. t y .:.i : -.1., ' - :J - ,. - ,: ;, _� :� �. :I'- 7 j�; � : �•
❑ New construction ddition/altertdonfrcpincemcnt '•y'� P ate heed on the value of the work
❑ Demolition ❑ other performed tndicsx the value (rounded to ahc nearest dollar) of all
=shirtiest aialdials, etraipmeet, tor, overhead, and profit
yi �•$.:i, -- - •'.. v„ y r . - ..�. "--- .�?'.... - r.. r " Value: 5
• I l • , 1�1!C . •. -a ' :',,. . ;: 1 � ; .I .. ..:-1.- 1. of : i, 1 � }1 . .. K3. . .
L ,,1 . : _ t r - �- �vx�
and 2-family dwellin F:a .. •_ _ .._ :_ -..
Y $ ❑ Corrunerc[al/indasatr(a1 ❑ P,ceer�ary building
, ' I I `
' ` :., :. 1.;„ �.
El Mul6- family ❑ Master builder ❑ Other. For �eclal asa checklist.
;,, :T, - - - - - - - - _ - - P I Qty. �Ea. , Total
F� I tied _i- . -5 „- ti .
Wi t :.: `- ... _. -• ' . _ - ' . _ :t.L /'f- HcatiaWcao it4 •
r Ot r + Q u r c t _` l k adiCictung
4 W Irl { Air ca Nelms ox Pia shows& d j 46.75
City/Seau/ZIP: t t a r ■ Flume 100,000 BTU(dtotsfveata) I 46.75 - .' *
i ' /� Foliate 100,000' BTU (docalreata) 5491
SuilefbidgJapt, no.: Prd r • eCt nom de LLB C Heat sump 61.06
Cross arreet/direetiotla to job site: Duet work 23.32
• - Hytlteedc hot water mitem 23.32
_ Residential boilw (radiator or
fu 23.32
-- w c ait hated ( el -type, not electric),
in-wall, in-duo, suspended, etc. 46.75
Subdivision:
Lot
no.: FltlNveot for nay of above 2 3.32
2 3.31 i
Tax map /parcel no.: Other Reel apollaaces
ca .L: ;,:uf : : 4 ���.. i .� � z . ^ ,� 1a5.'2 ' -- h =at�r 2332
Cras fireplace 33.39
1 Flue vent for watts httper a aaa filalLiace_ 23.32
•1 L s S r d C' (us) 23.32
Wood/kr now 33.39
Wood llzeplrcerinsen 23.32
. � ; ' ..v '•;Ifi" •,f- - • :err.; r _ : - -- T -,.:- "+^Y. - r .'•i1 �y/ iner/Auelvem r 23.32
e v other _ _ 23.32
A� ��� � Environmental ahaast and veatl 4ltioa
Addrcae: Rank hood/other kitchen
' erfulP ent 33.39
City/State/ZIP: Clotho dryer exhaust 33.39
Fax ( ) Sing)rdaa =hone (hismowaa,
Phone: (� ) _ _ -
11 , toilet compartment', utility roams) 23.32
'x ''''.1: .:..w" :�_.ti 1 .'niilc�� lam l.'S�. : ;.I+ err 7'•_? i J u � ; .4.40' Attl fans I - - � 23.3.2
Business name: Other. 23.32
FUNJtiping
si
Contact name: 514.15 for first four; 54.03 for each additional
Address: Furnace, etc,
Clty/SutelZlp:
_Gas beataytunp
Wall/ s dedtomi boater
Phone: ( ) Fax:: ( ) wares beater
E-mail: Fhsplacc
i : � ' p �
":x :. a .� '.f :, 'Y : ?o':i4; - 'a: __ - ;-.7,-..,, _ Range
, _.: ' s. . ' .'fir ' -.i .:6?• - �.... . _L •-i - ..... +' ... C. S J l .,, , _ - - - � - - �' fi t _Barbecue
Buainem mover Jocoba Homing Si Air Cosdlllattiag - aoews dryer (gala) __
Othe
Adams: 4474 SE MtManhle Ave ` _ _ _
CIty/Stue2lip: Portlaad.0R97202 . ` _ ' .1 - .- , - - - ' - : :: : , : _ _ i t ; '^wM1 _ . :4 . :.1 `" -".+.
Subtotal
Phone: (S63) 234.7331 I Fax: (503) 908.9106 Mumma permit fire (590.00) •tel • ov
CCB lie.: 1441 Plan review (25% ofpertait fee) -
State arrant (12% of permit fee) sip
f TOT PER110T FEE ) � p
Authorized aign:Mae nit pins* a 'Z�
: `-. fi t ' dn f to LM Wog accepted b r a tempter., g �� �tMa Ito
Print BMW: M ii I � Data I° W • Fee methodology ter by Td �� . -- C Belton 2aduery Service BOerd
Ii do. 100 IMP ITr (II 1DN0a*AVbg) 9..S to