Permit 711 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT COMMUNITY MEC2011 -00333
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2011
TIGARD . Parcel: 25101 DD00401
Jurisdiction: Tigard
Site address: 6955 SW SANDBURG ST
Project: DocuSource Subdivision: Lot:
Project Description: Replace gas pack, like- for -like
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: SOURCE PARTNERS LLC
4474 SE MILWAUKIE PO BOX 230759
PORTLAND, OR 97202 TIGARD, OR 97281
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/22/2011 $194.93
Class of Work: ALT Type of Const: IIIB Plan Review 07/22/2011 $48.73
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 07/22/2011 $23.39
Stories: Info Process /Archiving - Sm Sheet (up to 07/22/2011 $7.00
11x17)
Project Valuation: $4,560.00
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $274.05
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
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, * is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Cen Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' ect questions to OUN■ c.11ing 3.232.1987 or 1.800.332.2344.
Iss ed By: f / 11 / // J / Permittee Signature: X
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.
Mechanical Permit .Applicati • FOR OFFICE LSE ON
City of Tigard d D ay -� y / ,, Permit No /
" 13125 SW Hall Blvd., Tigard, OR 97223 j r. �r -11031g
y
Phone: 503.639.4171. Fax: 503.598.1960 4 2011 01 Plan R eview if ,f Ocher Perm it:
J U L
Date/By: �� /1
T I G A RD Line: 503.639 Date Ready/By: H See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/M ethod: 7 I� j
/ /�� ■ supplemental Information
1 '1 Ill INI(' IS 01‘ r r. , t�,
9 ", �,,, b - - �. a i `' ..eke 'T r� c a 3 n 2 ^r il: r `s". - 3 - ,'� e .,. - k . *,,.
❑ New construction ddition/alteration/replacement Mechanical permit fees* a re based on the value of the work
performed: Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ID Other:
mechanical materials, equipment, labor, overhead, and profit
�i. b , = s" ,. Y " ` zr 5. z� Value: $ _ S
►itommercial/industrial ❑ Accessory building t � � =
❑ 1- and 2- family dwelling
For special informat use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
"'f ; GE's`" x + a - -,,.„ a „'u ` - "''x . as..zz. - . -.-" Mp Description I Qty. I Ea. l Total
,.- �. ,... . ...: a a,. 3 �mg ,�: v'- =. { � �eatlRg/COOhnp'
Job site address: 9 SS S U C \ b - ,,r- S ' Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: \ -0 Q R C 1 „2..'� Furnace 100,000 BTU (ducts/vents) 46.75
I Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldgJapt. no.: Project name: 0C LJL S Q7,(-• r,
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Flue/vent for any of above 2.3.32
Lot no.:
Other: 23.32 ,
Tax map /parcel no.: Other fuel appliances
.�� ; 9 1 ''' Water heater 2332
Gas fireplace 33.39
1 /� Flue vent for water heater or gas
g �p 1 GLC G�-S pu-LK fireplace 23.32
Log lighter (gas) 2332
2 i K t — -c - L.; K`e J Wood/pellet stove 33.39
Wood fireplace/insert 23.32
-. a ,`,: a� :": �' .'" other 23.32
. w - " - "�. 4 Other: 23.32
Name: \ () C l,l_ S C L .. C -� Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: (S (L3) ��� j Fax ( ) Single -duct exhaust (bathrooms, toilet ° � 3 ii:?, : ` ¢ -Y . 5- s'r `. 5:ff:7 : 7; r �r " e : . ,a t':� `. ':,,: � ,,;j Attic/crawls� fans utility ty ) 23.32
i rooms)
Business name: Other 23.32
Fuel piping
Contact name:
$14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
City/ State/ZIP:
Gas heat pump
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Ran_e
p 1p
M �'� � ���W�� ���- T. -.:i47; 4 �;�k� r�� pf,: Barbecue .
Business name: Jacobs Heating & Air Conditioning Clothes dryer (gas)
Address: 4474 SE Milwankie Ave Other: �.
4 � .- .xr�s�..� 54 .aw y � " � � y , w... :r>.'r
t
City/ State/ZIP: Portland, OR 97202
Subtotal
Phone: (503) 234 - 7331 Fax: (503) 808 -9108 Minimum permit fee ($90.00)
CCB lie.: 1441
Plan review (25% of permit fee)
State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: / � This permit application expires if a permit is not obtained within 180
r � � ��'u � "�� 7�� / days after it has been accepted as complete.
Print name: f 1 I L�>♦ Date: 7/1 3 / ( • Fee methodology set by Tri-County Building Industry Service Board
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