Permit ;`?q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00396
DATE ISSUED: 7/28/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S133DB - 11800
SITE ADDRESS: 11371 SW SYCAMORE PL ZONING: R -25
SUBDIVISION: SCHOLLS FERRY ROAD TOWNHOMES LOT: 044 JURISDICTION: TIG
PROJECT: SHAVEY
Project Description: Replacing gas furnace, installing heat pump and modifying duct work.
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: 1
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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
DIANA SHAVEY Description Date Amount
11371 SW SYCAMORE PL
TIGARD, OR 97223 [MECH] Permit Fee 7/28/200E $72.50
[TAX] 12% State Surch 7/28/200E $8.70
Total $81.20
Phone: 503 - 590 -7077
Contractor:
JACOBS HEATING & NC
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.
Issued By :� L J Perm ittee Signature: ,agi
Call 513. • 39.4175 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.
07/28/2008 10:53 5038139257 e � JACOBS HEATING PAGE 02/03
N�echanlACal permit Application
City of Tigard Rcce
FOR OFFIC:1.: USE ONLY
2, C � Date /b 7 ti _ � Pcnnir No,: / Review ' 13125 SW Hall Blvd., Tigard, OR 972 . Phone: 503,639.4171 Fax; 503.598,19 0 \� A� t •n By:
1. Arm v w
Insp Line; 503.639,4175 V � �Ir/Dy: Other Permit: 'IIG ARI.7 `,
Internet: www.tigard- or.gov OS{��lV Date Ready / /By:
N sue y: Svc Pale 2 for
ohficd/Method:
r pp
G ` 4) r1 Supp1rmcntaIInfarmotlon
111 , f.!' , li rll :1) N , ��1 ..r r/1 ; l 1 * 1 x ' 11; y r >..I -. 1 r^' n„ — I Wr�,1 y1' 1 �i�lt / y'''r� , 1
j-r
. 1, 0 1.1 f �. ..0 �1,: : 11)1 1! � 1 � . Y Irl�., MYL� iAJ�' IIW��
{
❑ New construction permit Ices* are bawd sed on the value oldie ' work
� Addition /alteration /replacement p
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other
j!] i 1 dl 1 yyrv�f. �� ��yy �,���l�jjl !li i. mechanical materials, equipment, labor, overhead, and profit,
,... 1.1L1, _ . K! „ q 4R Lr�.r • l-W r. I tp',11p1WV i, ,., 1!1, , 11,1 :: ! ,Il'a' Value: S
: 1- and 2- fflrnily dwe]Iing ❑ Commercial /industrial Accessory building tl <I, , ".� I ....... �' .'r� �" r►'1SIli i S I :,
0 Multi - family ❑ Master builder ❑ Other: For specfa! information use checklist
f i i r l 4 l I i ii 1 • J� J171yV
1fl Description
liii 1 , (Ir .'. l 1 4 f I l, 40 ,. iv i t I 1 „ Qty. Ea. Total
_Heating /coo ling
Job site address: 11371 SW Sycamore PI Air conditioning or heat pump J /
wires c
rc ite Ia showin ,acementL L 1 _ 14,00 Al CAS
City/State/ZIP: Tigard. OR 97223
Furnace 100.000 BTU (ducts /vents) 1 14.00 14.00
Suite/bldg. /apt. no,: Project name: Shavey Purna 00+ BTU (duets/wars) 17,90
teat um 14.00 (1.4:170
Cross street/directions to job site: Duct work
—. 1 10,00 10.00
Hydronic hot water system _ 1 14,00
Residential boiler (radiator or
_hydran le) 14.00
Unit heaters (fuel -type, not electric),
in -wa11, in -duct. suspended, etc, 14
—
Subdivision; _ Lot no.:
Flue /vent for any of above 6.80
Tax map /parcel no.: 1 — Other: 10.00
� Other fuel appliances
,
l �!(`II n1Ul! , ;1•!, r 1 i s 1 oRis if * d> 4M1JRGit 1 ; , •r 1 {'S.•
Water hcatcr 10,00
(ias fireplace 10.00
— — Flue vent for water hcatcr or gas
replace gas furnace and fnstnil heat pump. Also, modify dui wnrh fireplace 10.00 ill
Log lighter (gas) _ 10.00
Wood /pellet stove 10.00 /insert 10.00
il,i1`.aif'''E�'''''' Iailt iC . t 1 ;,r , i Ij r i , , i•i;o 1 : • $;d!:.1 r,;) r '. . - C l /Inner /llue/vent _ 10.00
. Other: 10.00
Name: Diana Shavey _..� � -
Environmental exhaust and ventilation
Address: Range hood /other kitchen
equ ipment 10.00
C ity /StatefZIP: Clothes dryer exhaust 10,00
Phone (503)590 7077 Fax ( ) Sinele -duct exhaust (bathrooms.
Ifll.i „ �,�, ;,." 111 r , 1 1 toilet compartments, utility m l 6.80
Busyness name : c, „
Ph 1: . ' ''. ' , ' 0 Attic /crawlspace fans 10.00
,, � "'Cb�V'Y' J�RSIW'C ,r r 1 n i
Other; i 10.00
Contact name:
Fuel piping
55.40 for first four; 51.00 for each additional
Address: Furnace, etc.
City/State /ZIP: Gas heat pump
Wall /sus ended /unitheater
Phone: ( ) Fax:: ( ) _ Water heater
)F, -mail: _. — Fire lacc
I IEI1kkl( r Ru •, i -, 1( �' 7P ,il r r Y ,�,�, , r , y °age
I 1fi i 11hdtI1,1, 1 s ill : l t, 1 1! t.' titik.,. �,,, 1 1' ', r . :
! � FlI r 13arbecuc
Business name: Jacobs Heating & Air Conditioning Clothes d er as
Address: 4474 SE Milwaukie Other yY t f -! .�uw
i 1 ���1 I'l: 1 ;Iii Gtlill'#d4 t � till l 1�';CtO, (1 , i : i ) ,''t,i
City/State/ZIP: Portland, OR 97202 Subtotal 38.00
Phone: (503) 234.7331 Fax: (503) 808.9108 — Minimum perrnit fee (572.50) 72,50
1 —
CCB lie.: 1441 _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
i 1 Q p TOTAL PERMIT FEE 81.20
Authorized signature: 1 � ' /� / Thim permit application expires if n permit is not obtained within tao
} days after It has been accepted Da complete.
Print name: Michelle LeClair Date; 14") ' ) (0 " Fee methodology set by Tri- Counry T3uiidina !nth lcrry Service hoard
l: \BuildinEnPermita \MEC -Per, hApp, dor 01 /11)07
440.4el7r /CQM/Wtia) C 1\ l'1.,..-
cirri OF TIGARD •
. BU ING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MCC 00 00396
Phone: (503) 639 -4171 A4, , � i ���� 7/28/2000 Inspection Requests (24 Hrs.): (503) 639 -4175 - ±i "
INSPECTION WORKSHEET FOR DATE: 8115/2008 TIME: 7 :00AM PAGE: 19
SITE ADDRESS: S , CLASS OF WORK:
11371 SW �YCAMOO�.E PL .
SUBDIVISION: SCROLLS FERRY ROAD TOWNHOMES LOT #: 0M TYPE OF USE:
PROJECT NAME: SHAVEY
DESCRIPTION: - Replacing gas furnace, installing heat pump and modifying duct work.
OWNER: SHAVEY, DIANA PHONE #:
503-590-7077
CONTRACTOR: JACOBS HEATING & NC PHONE #: '. 113 234 7331
Inspection Request Scheduled For: Date:
8/15/ 2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 074216-01 503.2:4 -7331 Y
Corrections /Comments /Instructions:
a GI! AA i LIo2 ..i*/ ' Arl-e,i /,g -c-, #S — 1 73892 A l,
5— / 72 Z O'9
7 / /
PASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /f— 13 3 Phone #: (503) 718 - 251 --4,<
07/28/2008 10:53 5038139257 JACOBS HEATING PAGE 03/03
10
Ke(— "7}
SITE PLAN
DIRECTION
I-rouS, 00 '
afriallIVCC 19 1
° FRONT
STREET � �`
Job Name
Address S1hJ'
Model # 417-4 -0 qU'3
Make
JACOBS HEATING & AC
4474 SE Milw4ukie Ave.
Portland, OR 97202
(503) 2 3 4 -7331
(503) 813-9257 fax