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Permit CITY OF TIGARD MECHANICAL PERMIT ''`1 ' 4 ,'- COMMUNITY DEVELOPMENT Permit #: MEC2011 -00265 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/09/2011 Parcel: 25111 CC00700 Jurisdiction: Tigard Site address: 10095 SW CENTURY OAK DR Project: KALINA Subdivision: SUMMERFIELD NO. 1 Lot: 4 Project Description: NC installation. Contractor: JACOBS HEATING & AIR CONDITIONING Owner: KALINA, RONALD V & LAURA J 4474 SE MILWAUKIE 10095 SW CENTURY OAK DR PORTLAND, OR 97202 TIGARD, OR 97224 PHONE: 503 - 234 -7331 PHONE: FAX: 503 - 808 -9108 FEES Specifics: Description Date Amount Air Conditioning 06/09/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 06/09/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/09/2011 $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. i 1 Issued By: < " Permittee Signature: Ca 03.• .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. OG/08/2011 17 :13 5038139 JACOBS HEATING PAGE 02/03 Mechanical P,erlrnit..Appiic. ti e "�, ` f # FOR 0111.1" City f TI rd , ' a.,,, ruceivee! PCtntit td o . : a .(' 1312 of 5 SW Hall Blvd., Tigard, OR 97223 JUN z0„ Plan Review • F , Phone: 503.639,417i Fax: 503.598.1960 Other Permit: n te/By: T1 GARD . Inspection Line: 5D3,639,4 75 CITY ® t T6 ^ A ) Date Readyr73y: 1 : 0 see rant.: rut -` Internet wv w,tigard- or,8ov BUILDING' C9r t, ,Cj 14tt liiediMeilux1: � � supplements] lnforeiu ee D a� vis � r� 5., _ _ J -t,ft 5s :- ,.: a ,.r" ,.,�, ? ^a ,^ r� -. x,: + .. , 't r �r "�� u , ad 1 h_ l K , : ,ti.!:.,, r f . i� t!r!. a"'i Vr d1 tt .=.;.,.,e,, . w4 ; y "1 t1 iJj e i . t t" 1F t i t 1 t F' r t tJ I hr .L % t.� 1. : 't '. t l 4 ;'d rr, r. �uL.'r d.., tUi..xo s:e..r.. .:la},;� - „.:;,.,,6.,�� �� W,ut�.,i...:.�:..v .� %r w:l�:il4: 7...�'yl�xSt��iif� �'t:�4T1"!1�"G� 1• �kR' �t�T1Y� :'�iv'n�.�.",3�..�.�R:n.�•�.E�" ^.h�t� •' l�n�+, - ' © Ncw construction ddirion /altet'atiOnfrepineemertt Mechanical permit fees' trc based on the value oldie work performed: Indicate the value (rounded to Clio nearest dollar.) of all ❑ Dernoti.tion 0 Other: mechanical materials, equipment, labor, overhead,, and pri t._ it r`"}J - - 7 rv.'.- , : ryr� ' ' { _,F.f�1 {. t� -> 1 r Valise $ t 41t .t . ._ =,:u-: .:� �i,l;t t. . ".`.,L.h.a., e LI ,,,4 .:^ ' w rz�hl, i, , i..,' 'w3,L 1 •L �IU j ' ., f;,, .,. Y� '' • ',cu.+... 1 . ,r_ T�, . �. J_,l.r ^ . � i..t X t. , a. ^ -} ' k ; t l+ a ;t r , k �.7 �`A: :'t"'s '1' U"7.;1[7L - . • ::: � 3- and 2Tfhmily dwelling Q Commercial/industrial 0 Accessory building ii:. 11�r rr rl e „ ^ s_ ...,� ,,_ M Multi [� Master builder For spec/of information rise cheakJin. 0 ] Other Description Qt r,, rr,tnt ¢,, • :ro � r ,: �..i, t ly .. a 5 -r r1,9 :• I� _.. 2 "+ , , M t {ti ., yi r4tali ?rj�a /, iti.r4,. ,.` �-- h2,d• ri.� :ttJ...,... '.:. 1'va.. �, i� .,r.... = � ...�c ''= �L�k a,;. t 1. 5« �... .,+« �.. �, �1' w4iiJ14l .'b,�1�S..4tlrL"0.`•.r.3)� �QStin�fCt1011C�+, address: "" �` O.,-r.\ r Air conditioning onditioning �r t l t ." (,•v' ' 1�6! 1 l.. +�. i � . (requirCssite plant Arrwin,¢placem.entl I 46.75 r l i • �/.t ; .` Job tied ad' Cit /Starr:/T,)P: 7 " r . c?,, , 0 f,",,' 7 , r , _ �__ Furnace 10%000 BTU oucts/vcn s) 46.75 Fttmacc 100,000+ BTU (duets/w•eats) 54.91 Suite /hidgJapt. no_• `- Project name: r , 1 t � r:1/4 ... Hen ppmp 61.06 Cross street/directions to job site: Duct work_ _ 25.32 f _Hydranio hot waters test] 23.32 11 Residential boiler (radiator or hydremic) 23.32 Unit heaters, (fuel -type, not electric), in - wall. in suspended, etc. 46,75 Sabiii.v]t: l of no.: Floe/vent for nay of above , 23.32 - ,.. _ - - - -- Other.; 2.3.32 .1 - ._.. Tax map/parcel no.: . Other Nan fiances .,.,. -..,I _, pea, - - -- _,.- ........ „.J ��` }:i :�� iiSu i'+ l' �*:eu..a..ui r #ffE . ,�'... y �,. �- �.....T.I :F sa. ?�r,r�L,"u:17FRPP aqj { l W ` Water hente7 1 23,3:2 , i Gas fire dace 33.39 .j .. Flue vent or water heater or gas - : w . . �' M - ; ."\ t r\i ` L6 • A - \ : C (':.0 (? c ,l. `k- c-v) ..r- fireplace _ --- ---1 23.12 - holy lighter (iris) _._ 23.32 .� ._ _ Wood/pellet stout: 33.39 _ t Wood fireplace/insert 23,32 i 1 „lr.,.a i: ',: _.-.. ,.- .,�.,,.; .; _.. : -; °jtt. t' ^,.:7 :h Chirr>r] Ilincrffluelvetlt 23.3 a t �< - v � : �+ r ., . ... y , """"3i -z, �'rgtn.;r � r , - i , r y , .� c5 - i l,:nt.." �* } ..r C_ _z:`� t ' .- l t �•,w ,.;n�s a i - t I , rt._V+ 4:r ee iditt`i .{1it:s.s` Other• 23.32 - Name: pnenL & 1 - . 1/4_.1 - G., 4;\ 'l..,t \.C( • £ nv�irout [terttsrl exhaust a;nd.ctitilattion Address: �Rangc hoed/ether ldtebcn ' f cquu p nent 33.39 City /State/ZIP: Claims duct tothaust 1 _ „ --) 3349 ^� ...... . .. Single -duct ex?]asasl (bathrooms, Phone: r,L).S °' ` Fm: ( ) toilcroonr attmcrtr unlit rooms 23,32 T '1 I j� , ",s ! i r:�. :' "} ' . y < . , le'a R k 7'4 ii r s �.f lt <. rti. i+:7 `' A:ttichratwls -ace rims 7? .,. ,.w «..L ,..... r5 '_.:r' d:�W��......_. � ,..,, ten �, ._. r ,. ' ._,,,.._. .r.�uL:.St, > � iz . t. t L! 1t 1'..," 2 -. Business Irene: t7it 9,3: - ;� - . . - Futf piping Contact tame: S14.15 for flrai lour; 54.03 for each additional Address: ...- Furnace tic. .. Gas heat pump L., )r t o/Z : WWI/suspended/unit hem= I I j Pitons: ( ) Fax: ( ) Water heater L. L . I • Email: - Fiteplace ...... ,.- I T . _ ...� 1 � �'il t.. tt s { kt" 6 4" err -- {, � � � G' r 'CT ............. -_.... .i•Vi .e r. t,•.:a34'i: :sciZ °,:. t � siSr ..,, l4t4 4' s ,z.`. ;: +l «.w 7til.. tAi' if � a �a rt�a il l 3 CCUC . ,.... Business mane: Jacobs rkaifia.g & Air Conditioning Clothes dx'v lr lddrmesa: 4474 SE Milwaakie Ave ,: Other. -r, n rY 57.9 I mo - -N r - ._ . i::' 3 1, �y4 .'.. ?:' "`..zh4a'le,+S te a „ ".. "i� •Zi ^M ; ;l;j'� E l ' City /Stai&ZtP: ptlrt:laud, OR 97202 Subtotal i - _ Minimum permit fee ($90.00) ••/ i ;' , , .ty' --i Phone: (503) + ; 737333 I Fax {503'} SOB-WWI - __ _-- ._. _ .. Plan review (25.4 of permit fee) CCB lie,: 1441 1 - Burch ;e ( 12% ofpermit f ee ) 1 c) . .'. 1 _ TOTAL PETOI T k l�.F l Or) . i]'0 I Authorized signature: 7'" 1 �( K f Thisoci• eltapplication ir' dperraiiis 'notolraited t.^•h A f .7Lt'VC{,..,., (,,, days alter it'hd..c teeth ACCcpt,�d a1 Co'mp]etr Printttarte: i i G�'y, Date: "*'� l Pre ntrtb•d0)ogy ten by Ti:•Coesnlq SnilCin6 inlntray Srnics Board .. . "s3utt: tab ,'SPoixt;iLk{P.GPttnitA.DA.dPa t(tiro1•J? 1'' T (] SRrIJCO!.GY,'J ) '-'.-7'" / .2 1.1 :': ) .... .,) 06/08/2e11 17:13 5032139257 JACOBS HEATING PAGE 03/03 SITE PLA..1 • LJ DIRECT] ON 7-3 OUSE / 2 \ • FRO3 \TT 3 0 • • STPX • J ob Na PD1r\-_, F-41_ fr1 • Address Do 9 10 ' ,a • Alm& • A ModEJO • ,-CC • 6 2 2- m.ake _ Acql- 4.0013S T-LEATENG az AC 4474 SE _A „. 3:1:T02nd, OR S7.20.2 , rfl v,S4-7331