Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00025
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2011
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9718 SW WASHINGTON SQUARE RD F05
Project: CATHY JEAN Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Replacing duct work and install (1) exhaust fan in bathroom.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: PPR WASHINGTON SQUARE LLC
4474 SE MILWAUKIE 2235 FARADAY AVE STE #0
PORTLAND, OR 97202 CARLSBAD, CA 92008
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/14/2011 $127.39
Class of Work: ALT Type of Const: IIB Plan Review 01/14/2011 $31.85
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 01/14/2011 $15.29
Stories: 1
Project Valuation: $2,400.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Fumaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: 1 Vent Systems: Total $174.53
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: registers and
Duct Work: 1 grills
Fire /Smoke Dampers:
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 OUNC by calli 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: iOV �/��G -►� ( y // 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.
01/13/2011 09:34 5038089108 JACOBS HEATING " - '■_,E 01/01
Mechanical Permit Application F OFFICE IISF ONLY
City of Tigard Datc/By: ( i 3 Pe No. �, //— C,tip,"
IIII
^ 13125 SW lfali Blvd., Tigard, OR 97223 n n Plan Review = �� D W
' Phone: 503.639.4171 Fax'. 503.598.1960 r �t t �v Date/I3 : I : giber Permit: A/W - - e--
T I C A R n Inspection Line: 503,639 75 Date Read ' :..y: ....ply ( Sec Page 2 for
Internet: www tigard -or gov Notified/Method: (•a'� �,� I Supplemental lnfotnttatIon
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J,C�J( A value of the work
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e lit' n Other: Y' $ mechanical materials, equipment,
❑ l7 mo to �,,y�J �„❑ gyp. ! e �- , � In bor overhead, and profit.
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l- and 2- family dwelling Commercial /industrial k t t?�esss ry building
For special information use checklist,
El Multi family r ❑ Master builder ygi Other
Description 1 Qty. l Ea. I Total
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,. 11 , `�, Air conditioning
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Job site address: . 11 AMA IR 4 • `41 (requires site plan showier &cement) 46,75
City / State/ZIP: l Y. c it, • • 1 q Furnace 100,000 BTU (ducts /Years) 46.75
�` Furnace 100.000+ BTU (ducts /vents) 54.91
Suitctbldg- /apt. no.: Project name: D.-E -h I ` 1 J ea � Heat pump 61.06
Cross street/directions to job site: � __ `� Duct work 23,32 .
� / l 3 .... H hot 23,32
I �\ } R ydronic bo water iler ( r a system diator or
i � {J� P (I" (`I ydronic) 23.32
l `� e ' 1 Unit heaters (fuel -type, not electric),
k Y1 • (/'3611 in -wall, in -duct, suspended, etc. 46.75
Subdivision: ,y--- hot no.:
Flue /vent for any of above 23,32
Other: 2332
Tax map /parcel no.: Other fuel appliances
r 5, r'; G "'NR71;'':r ;7c n i r.rnnnrg
( 'i( r } + r : i, l l i,1;1 000 f ;OWzi7 i.1� r�r � fir riVi l y r , l �dr �l'ii '1rr s d lryi�r ri Water heater '23.32
r q'Y r rJr ,'� (hl r J ° ,_irl tr la'�sEl1';
\ C 1 _, (1) e�1 laky. a n nevi Flo fireplace wnlci g 33.39
Flue Ycveil( rVr hculci ui d5
n c On d (A CC Y log l 23.32 .,.._
,og ligh ghter (gas) 23.32
Wood /pellet stove _ 33.39
—
�� - ,,,,y� Wood fireplace /insert _ 23.32
r t nl,�,' li t<1� b[ill:'1' Q�''�.i,' 'l'r ' .Y" 1r,Et�, 5 ' !( lfl "rl +,rfl +' „i 1L'�Gi`1' 1 �rn� rrl • g 4, ,i1 r,•! Chimney /liner /flue /vent 23.32
:P 1'1i,.- -'"r,� , . ,,.n r;,1,0 ,A r, d ^'' ' r "d h;�CY4P llydl l�,, r,r l; , er un, da . •u,rll lw Al6i,lilk•• Other: 23,32
Name: Environmental exhaust and ventilation
Address- Range hood/other kitchen
equipment 33.39
City /State/ZIP: Clothes dryer exhaust , _ _ 33.39
_. - Single -duct exhaust (bathrooms,
Phone
( ))-� ,W Fax: ( )y y�y toilet coa
mp rtments, utility_ rooms) 23,32
r 1.'l :, r, r ' 1�tl.4j jt,, ;tit4'lV;01lH$;,l� i' ) "flllrl' `1t } ikt11 pKgti$1ir' {�'r<I'tlr1 Attic /crawispace fans 23.32 •- r i ._v- .r.i� „' l,r �r
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rr .,,r „I� ■ 1. ,e.r r, ra,,,, ,R,', r at
l3uslnoss name;
Other: 23.32 ,
- -- —. Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Fanatic. ciu,
Gas heat pump
City/State/ZIP: wall /suspended /unit heater
Phone: ( ) I Fax:: ( ) Water heater
- Fireplace
E-mail: � y
( Range
4! , i:ir r � li l l� l ( i f rl ;r:∎ '� � ql , ! o rrr lrj l'! � r . 1 ' , I rR(?il r '0 10 bl ot(, 'I°p" f {i 1 `f 11 1 i i 1 r,l " lr tlr l :r � l lrr i J, Barbecue
r, ,. t li,Il ^I / ,rtl!{ r� „ fl.i r., _
Business name: ` tiT , PIL Clothes dryer (gas)
1 1 Other
Address: 4� —I� ‘ ,_ A\ \\..) � /I "r�t i �� t '» 5 � �rll'� ;.
� , A� �. �� 11 i' ...I� i �r r l 1 l� 1 l V' r R, l ,l :,.:1';.11 r! r l
City/State/ZIP! r• Dik 4 &. • . • ii - Subtotal V---1 , •I
Phony 1 ' _ Fax: ( . I / Minimum permit fee ($90.00) ��
.�. Plan review (25% of permit fee) 31, gb
CCB lie.: 1 '-1 Li State surcharge (12 %ofpermit fee) }r.,. 2c:1
� tom► I T X11" --' TOTAL PERMIT to not FEE
Authorized signature: This permit application expires if a permit is ant obtained within 1
days afte it has been accepted as complete.
Print n ame: erf 1 D FG.a' tl I (7 gtE; . ( -' I •I • Fcc methodology sct by Tri- County Building Industry Service l3oard
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