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Permit CITY OF TIGARD MECHANICAL PERMIT 3111 COMMUNITY DEVELOPMENT Permit #: MEC2013 00072 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/31/2013 Parcel: 1 S133AD11800 Jurisdiction: Tigard Site address: 10740 SW 127TH CT Project: Sele Subdivision: AMART SUMMER LAKE NO.3 Lot: 174 Project Description: Replace gas furnace. Contractor: JACOBS HEATING & AIR CONDITIONING Owner: SELE, STACY 4474 SE MILWAUKIE 10740 SW 127TH CT PORTLAND, OR 97202 TIGARD, OR 97223 PHONE: 503 - 234 -7331 PHONE: 503 - 590 -0338 FAX: 503 - 808 -9108 FEES Specifics: Description Date Amount Furnaces < 100K BTU 01/31/2013 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 01/31/2013 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/31/2013 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: . 4 • - Permittee Signature: e /, /e/5 Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 01/31/2013 11:09 5038139257 PAGE 02/02 1M1echaniic:a Permit A pplication ��rr ; , , ,, .,. i , r ,, I IN r4 r . , City of Tigard j�L�I.EN • , 13125 SW Hail L11vd., Tigard. OR 97223 • ��.� l No • 6-42241/S —pap , Pin Revtew Therm 503.639.4171 hoc 503.59E1960 JAN 3 1 201 : r Other Pamit III I , Lott Lin= 503.639.4175 Inns= weevAtigardin.goe C >7m°"°"'b'/gy 0 see IT YOFTIG' ' kin sw iIafot ❑ New constructi )addidon/alteratinnfrepiaCeMent Mechanic permit thee are b ase d co the value of the w o z k ` ° 0 Demolition 0 Other lttdieste dm vahte (Pounded to late neatest dollar) earl t I t ' I .,I r.I.. I i .• t , 4 L I L 7 ;1, 7 j �T-, f „ labor, and - and 2-lbmily dwelling 0 CommercialJmdustrial 0 Acce building sa'� �] L - El - Y ❑ Muter builder ©otter J t r!>= __ .. � ._ ' (4--`'.'-- • Iri '; I ' }I ',, � .. �� Job sits address: S ..y - ! - _? C' 1$laca/�: • f y U.:.. . . _ ... - :.•.,I-: 46.75 ' �Cl� r ` Furnace 100 000 117 0 : _, al 46.75 la Suite/bldg./apt ao : p � Furnace 100000+ mu ductrPoeab 54.91 t Cross atneet/d'ueetiioas to job tulle: Heat pump 61.06 Ile Duct nude 23.32 If , eie hat water system 23.32 Residential boiler (tadietor of hfdroniet NM= —„„ Unit haters (1ttck pq n of alecn lc) - in ',. - ,. . 1 - . etc. 46.75 • Subdivision: ate �ito.: Plue�reot Sr m_y of above 23.32 MEI Tax »ta 1p e1 no.: • ,:n._ - • Other fuel a ,:lancet ~ ?3.32 NM 277 Gas L -..I, 13 39 MN ' Flue vent water beater or gas ' . a, tinplate MI 23.32 Lag Genet {gas) EMI 7J-32 MI Wood � � � r ; WV MIN ...I - 1 e 1 � - ' f J f 1 ' �:. . I r I 1 f . :� ,: F i i�er�Qaef�ent 2332 �2 ME ,: other. Millr Hovaroumaatal ablaut cad veaefilado — Address: Raw hoedlotherkitchgt CltylStatel�lp: ~� 124.. Ming 3339 Phone. i$f13 - Clothes ethaust 5 a s e= `i �1 _� r - ' � I I I 4" t � r .. l r � FT' - '1,- - r torlet `• .��... ..v.. mi. 14pma m� p,, _ _... a } r '.',L ! _rc .h t f 1 7, �!J } � + Mt1 CtAW1ipeot fins .Z Business I ` -- . . _r.'. ;' 1 :. Other ME 23.32 NIIIIII Contact : Fuel . irk Address -- 914.1.5 for Oral Mori Sa.03 for each additional eta City/Stame2LP. On hear • JJ . r NM Me Phan= ( ) Fwic : ( ) Water heater heater ~ MIE : Ii! _ ...... I �f'� d1 � r '' l ;' 4 r- ' 't '''1-_?,,,'..-,':;! l f{ r, � lysine's mote: Jacobs Resting & Mr Condlti0ojp ..._ ' !'; w I ' ` ''' listbetue 1. L. -- • • 4474 SE Myna Ave g Other: dyer f :1.; �� rrr . • -I s•: Portland, OR 97262 L :r ' ' .r_? _ •_ I :•:. rl ` ? 003) 231 -7331 Fay: (303) 0113-9108 WRIER I CB lie.: 1441 Plan leview at permit fee) MM." state ttlsarrxed ei rcte g� � , rr , - r TOTAL P m. EE - / r ` • ! • Ella Data Thb ter � ate it hoe been accepted tee within MO 7cmroo , Fee ' +et hYTritb�ygeeteduraySuniae1}� • ,>r n i aco,Lr wro 1 C -7 I