Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe
COMMUNITY MEC2011 -00003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2011
Parcel: 2S104AC10600
Jurisdiction: Tigard
Site address: 12594 SW MORNING HILL DR
Project: Fulitano Subdivision: MORNING HILL NO. 9 Lot: 249
Project Description: Gas furnace replacement.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: FULITANO, JOHN
4474 SE MILWAUKIE 12594 SW MORNING HILL DR
PORTLAND, OR 97202 • TIGARD, OR 97223
PHONE: 503 - 234 -7331 PHONE: 503 - 579 -7972
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/04/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/04/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/04/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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.
y i
Issued By: / Permittee Signature:
�J
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.
12/30/2010 19:36 5038139257 JACOBS HEATING PAGE 02/02
Mechanical Permit AnDlicationREC 1 F 1 vF a.
FOR OFFICE 1:SE MEI
City of Tigard :ii i ).."
" , _ 112/1§1111e mit No.:
IN,TEC ,
7. ,0„,
N.. 41 13125 SW Hall Blvd.. Tigard. OR 97223 DEC 3 0 2 010 Per
Flat ReView
• I Phone! 503.639,4171 Fax 503.598.1960 CITy OF. -T omtAly, , Other Permit:
Inspection Lire: 503.639.4175 i IGARD Date Ileady/13y: has, $1 See Page 2 for
Inmitnet; www,tigankr.gov BUILIMe DIvISIOi pcmin-itmediud 74 :6 snmorm11.1tanryn.fion
• f.`7 , •,';:i:' , i - IIIi`,7:: . .''fs , -.1139,i''' :V•igiT.P ,hz.: .7.,. iLT": ':: I
Mechanical permit fete roe based tin the value oldie work
0 New constructiOn "„Er.i■dditicmtalterationfreplacetncat
petfonned. Indicate the value (rounded to the nearest dollar) oral'
O Demolition 0 Other: ancChrIlliCal materials e • ei onent, tabor, overhead, and . Kira
m Value: $
, .. , ; '14-72Mailik:.1 7 i...
iszp and 2-family dwelling 0 Contmereittliintlustrial 0 Accessory building
Poe apeciai informaticor use chock/Or
O it/Wilt 0 Mater builder 0 Other; Description , I Qty. L Ea. Tou'Id
:.iliigPci 11114g....g U.i 'Ica thigicn°
Air condititming
lob site address: ,:-,2,. 5,3 C- 4 ‘ ( ';."."_•_; e. u r ,
t '.4 ,.0 Dr- re. 'etc site . Ian showinl Iseement .16 75 „,,,,1
CitylStateall": -- 1" -. ' Ck ef.,,,r-c.;„k ( 9 7 .i92, Furnace 100,00D BTU (dOetdvents) / 46.75 1: (17: 14
1 „ Furnace l00000+ BTU (duds/veers) 54.91 )
Suite/bldg./apt. no.: '-..--• rroject name: '4 . l 1 .1-A..../ i ....7,
Rent • um . 61,06 ......
1
Cross street/directions to job sitc: Duct work 23 32
H drank, hot water . tem 23.32
Residential boiler (rediaimr dr
Irtdrottie) 23,32 -I
- Unit heelers (fucl-type. not electric),
ittowall itr-duCL ssik .. ded. etc: 46.75
Flue/rent:for any or above 2312
SubdivIsion: I Lot no.;
Other: I 2332
----..,
T,2x mop/parcel no . Other Peel autism ccs
' Wrcer "thcf , 23,32 — 1
Gas fireplace 33.39
Fide yen! Ibt water heater co gas
i ■ - - - fireplace 23.32
11,, I? ' 1 r e
Ct. ' 1 L _73 r yn CA. 1 4 ::_,
Loajighlet Spas) 23.32
We:Pad/pellet stove I 33,39
I Wood fireplace/insert 23.32
Ohtinne ner/flue/vent 23.32
.. .1 f.1 .........,"....an-w.ft,t.bi.roszeta; ';;,. 'd4zza z ' . c 4 44A- Other: 23.32
k n 1 ..
0... ,_ k - Pl Environmental eaehaust and ventilation -
Range hood/other kitchen -----
Address: equipment. 33.39
,
City/State/VP: Clothes al exhaust
Single-data exhaust (bathrooms,
Phone: i.. ) 2;" --1 ( - - 7 9 "j.. Fax: ( 3 toilet comortments, utili rooms) 23.32
!' Attickrawlspace fans 123 I ___I
Other 1 1 23.32
Business name: 4
, Fucl .1 In
Contact name: S14.16 for first four; $e4)3 for tech additional
Pomace, etc.
Address: . Gas heat . um .
City/SlateraP: : 1 heater i .
Phone: ( ) I "Fax-. : ( ) Water heater . 1
— Fite Ince
E-mail: Ranee INN -
.1 -:;'''':F:117.2fraMIPISitarea1gA Barbecue
r
Business name:. J Clothes (1 e (gas)
Jacobs heating & Air Conditioning Other.
Addrask; 4474 SE Mihnakie Ave • . i '''°,.. - ' 14 .7 ; ;T:A.:::''. i . i ::;
C ity/Statc/ZIP; Portland. OR '97202 • ' 5libtOM1 !-I
f
Phone: (503) 234..7331 Fax: (503)110a Minimum permit ce (590,00) q
Plan review 5% of can't (e) -,-
CCB lie:. 1441 _ State surcharge (12% of permit fee) 1 / 0 • 1) 4.)
. .
A ,z,____ TOTAL PERMIT FEE I 1: 6,1n ,rilY)
Authorized signature: _ 4- _fyii" r. 114, prrmlf Orpfication ttpirts ir P permit it nal abroined wait, MO
days otter It has been accepted si cam
p „ me: ah, . , I:, EMEEMEE.1.11 Date: .2 . -z 0 I ,p. • Fee methodology set hy Tri-Comty Buitdin Nthi,st17 3ervice Thla,td
t ,IvicaarittoatraMEC-Petrampl 1 CVOI tO4 440 ( lietrvt&rartat
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