Permit CITY OF TIGARD MECHANICAL PERMIT
• .7 COMMUNITY DEVELOPMENT MECHANICAL
MEC2009-00304
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/24/2009
Parcel: 2S114BB18800
Jurisdiction: Tigard
Site address: 16183 SW 103RD AVE
Subdivision: RIVERVIEW ESTATES Lot: 34
Project: Adamson
Project Description: Replace air conditioner. Must maintain a minimum 3 ft. side and rear yard setback.
Owner: FEES
ADAMSON, MELISSA Description Date Amount
16183 SW 103RD AVE
PORTLAND, OR 97224 Air Conditioning or Heat Pump 06/24/2009 $14.00
12% State Surcharge - Mechanical 06/24/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/24/2009 $58.50
Contractor:
JACOBS HEATING & AIR CONDITIONING
4474 SE MILWAUKIE
PORTLAND, OR 97202
PHONE: 503 - 234 -7331
FAX: 503 - 808 -9108
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ee- Permittee Signature: 0-
Call 503.639.4175 by 7:00 a.m. for an inspection 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.
,r3G/ 23/2009 12:15 5038139257 JACOBS HEATING PAGE 02/03
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i'�"Y��echanical Permit A . tic EIVED FO R QIF ICE. t S E ONLY
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r 1 Phut. sw'HA Blvd,. Tinned, OJT( 9722NW Pl an Review A�
n SUl,G39.4 Fro:: $07.598.1, 1 pl 2 3 2009 ' Oilier Permit.
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nn Supplcmcnrnl'thrnrmatimn 1
TYPE: 'A "S dltla
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•perfprmcd, indicate ilia value (rounded to thcacarest (1tllfar) it all
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6/23/2009 12:15 5038139257 JACOBS HEATING PAGE 03/03
SITE PLAN
•
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• DIRECTION
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HOUSE.
• /7 - 0
•
FRONT
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STREET
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Job Name
Address f, f
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JACOBS HEATING & AC
4-474 SE Mi)waultic Ave.
Portland, OR 97202
(503) 234 -7331 •
(503) 813 -9257 fax