Permit C I TY O F TI GARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00032
°`` 4`'
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/20/2005
PARCEL: 2S103CD -00800
SITE ADDRESS: 11575 SW FAIRVIEW LN
SUBDIVISION: HOLLYTREE ZONING: R -4.5
BLOCK: 02 LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of furnace.
Owner: FEES
DUNCAN, PATRICIA A Description Date Amount
11575 SW FAIRVIEW LANE [MECH] Permit Fee 1/20/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 1/20/200: $5.80
Phone: Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
•
Issued By: 7 T ;Z2 , Permittee Signature: _S Q 9c p
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
FAX NO. • Jan. 20 2005 02: 10PM P2
FROM : Ja cob sHeat i n 9
'
, Mechanie I rermit A E I 1 1w ;:a. FoR orvicE USE. ON I ,V
.. City of Tigard U v r_.. mt Received ...--
DaleAlY1 ;y219 - 0..) '61---, Permit 1\1°'\6C.Ziadr-aa103,2
13125 SW Hall Blvd., Tigard, OR 9'7223
-
Platt Review
Phone: 303,639.4171 Fax: 503,598.1960 1 1 A hl r% n
1 111 - r '''''..' ,‘ Data/By: Other Permit:
Inspection Line: 503.639.4175 J1 4 u ,4 :1 ' ',! 1 .L Dato Ready/By. bus. WI Set Page 2 for
Internet: wwW,ci.tigard.nr.us
Notified/Melted; pi .126 Supplementul Information
I.
CITY 0 - - 1 __ _
Y - i$ Tr3pOtre*Wiii4 71Fip41,777,' - Ie."; ' pf.,,:,4.; lo l i n .... e r(urs T
4 _-.,., : • AtiLiii. t Vil.1144*.aul..11 ., ... r,r4ii" a:. :If lk. ; , • ILLNfise t .7 '.....,, "0 1 l
...'..1' 4 1 1 ! } .• • ...,;:, ...... • ... • • . • '' • ,.. • - I • •••• ' :,
Mechamcal permit fees" are based on thc value of the work
0 New construction D Addition/alteration/replaCemcnt
perFormed. Indicate thn value (rounded to the nearest dollar) of' ail
0 Demolition D Other;
mechanicaLmaterials,equipment, labor, overhend, and profit._, .
' ',',14'
!'V N 5i
: . 'N' 41 , i' . ;':": 4 t: 4 , • 0:!'" :.' 0;OK!,;,,,:.... i.: Valuel $
4.A...A.. elt..: A ti , • • •:.d ' • • ' ' •',' "— • •• '''''''••::—L2----' i.'0 ..' '.
Pi d 2fami
-ly dwelling D Commercial/industrial D Accessory building
W I SYSTEMS FF
4 0
. .
For special Information use checklist.
• Multi-family 0 Master builder El Other ---
i
v Deption I Q 1 . :.,t- ,
seli ty. I Ea. i i Mai
i ntliSP,' \ ; l ,'4 '11= 7 wii ' 1:-..V:- --. liti: ii.atng/i0011n „
, u,. , , r ., . •, - • 1. .” ' ' ' 10 ". I, . •,...). I: ..„.„.. ... _..... —
•••
Air conditioning or heat pump
Job site address: I '
teNIQ li _(rezires site plan showing placement) . 14.00 .
- _
City/State/ZIP: 1 4MINFI G71,2 Furnace t 00,000 BTU (ducts/vents) 14. ._
00 IIIP
.....
I 7.90
SUlleibldg,/apt. no.: • Project name: , N. ----Fut2-111 99°141-
heat pump ____ , Gas 14,00
_
'
Cross street/directions to joh site:
Duct work 11.00
--_____ . .,..__ __
— . _
. _ .... . _.
1-1y,,dronieiwt u! s s ett n , 14,00
- '
------- '
-,--- - ____,.. Residential boiler (radiator or
hytonic) , 14.00
- _,-
,._ ...__ .. Unit heaters (fuel.type, not electric),
in- in-duct, suspended etc. ., 1 ojo___
...._.
,._. „.._ .... _._ .._____ _______ ...
Fitle/v ow em _above 10,00
Subdi _ .. ...
vision: 1 no.;
. .... ._ Other:
_ __ 1000
.. ....,..
• --
Tax map/parcel no
Other fuel appliances _ ,,
'''irrigir"TIOPIrli.4 :. 7 AEI. L:., Water hcat 1
,,Iwilit ,.. 0
__, Jr,,,. .• „..;.,. , , ,. „ : 0 ,, . . ..,,... ic.riAly. 'in,•'.1,•:P;11:^!4•37,7:40'. .--..7...""h :-.. --
I G as eptace
Flue vent for water heater or gas 10.00
____
N $
firCplit ..
Cc 10,00
_..„. i.-.4.4. ..A.■ .
_ 1
- , Log lighter (gas) 1().00
Wpod/pelletstove _ 10.00
- ......
1,V92Afireplace/inacrt 10.00
4b .
t.
A.7.1$ ..3tatm570,1#,,N. , i‘.! i 1 1-.. ,, (1.1■2111incr/litte/vent 10.00
- 1'&11st ' ,isidan • . ..at. ',. • ;;A;8% oth
\ —...—....._...
A "
Environmental exhaust and ventila ion .,.
- •._._ -____ .--,
Address: 7),?_,. .,_ , _ (( e tA) 1--.
Range hood/other kitchen
_ . _ ... _1
...
City/State/ZIP:
C19thea dryer_exhaust
t c 0,
_.
Single-duet exhaust (bathrooms,
Phone: ( ) 6, ft; ' 3 Fax: ( ) toilet compartments, utility rooms) . 6.110
0 „ . : : ,; ...;.'"...,';"' ' Ntio. oil?, i ; ,..,.0,.. :Ii:. 4 t A tt itt/Eawls price fans 10 00 ._. ...
other: 10.00
Dustiness narn .
1j 2/... /1 ,
... .„. ......—__ .. Fuel 2 _
wir -
Contact name: Qn V-1 . V.40 for first four, $1.00 for each additional
- . — — fi - Puntace etc.
Address: 111.____T fr_1110:Dia f2j _________,,
Gtul heat pump .. ___ .
City/State/ZIP: .4, 1 ' 08_3Th j a 2._
Wall/auspended/unit healer
Phone: s5Cb X_ - 1 ,... 3 I Fax: : ( )•tiq. Water heater
1 ...
Fireplace
-----_
E-mail: • ,,. -......
•r_tgri
.tiv,;:\z•Mr4riv,;;reiwAympottoorgigeo P:Nr- . 1 , '40' . '...11' Barbecue
4:
. ',L1x , ';di?tarSulu , 414 , !kit.0 IA - `Attu 1.,.: 'i .`t Si ..: t.w.)..:4.iT •.g -... - ,
Clothe!: dryer (g) .._
Business name:
„.
Addres ''''----- Other:
s;
* iii' co M ,:.* todtp,—,4 .
- —
C'ity/Stateall':
Subtotal -1,24-C7-
_
----- .___ ..,
Minimum permit Ice ($72.50)
Fak: ( ),It_______ ' •
7
---4
_ l'ian review (25% of perinit fee)
CCB lie.:
• •
State surcharge 0% of perrnit feel ,.
..
TOTAL PERM1'r FEE
AutlInti2ed signatur - .
- p r ilt Is tun ntiZnined within t AO
At a complete,
-7I'P
S Date el I lit a d P ily c u a r tf ti: li tt ex li P a --i sTer i o rgl ige " 7tett
'-
Print name:
7 • Fee m i-C
methodology se by Trouitty Building Industry Service nnerd
--___ " -*A ,, ... . , I :
i: 12/03 445•46)7T (I i/tnicomAVR14) FT/til / —
CITY OF TIGARD -
BUILDING- DIVISION PERMIT #: MEC2005 -00032
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/20/2005
�
Phone: (503) 639 -4171 , u ° i h i ,,,, u ° '
Inspection Requests (24 Hrs.): (503) 639 -4175 .�.' `''!.
INSPECTION WORKSHEET FOR DATE: 4/0/2005 TIME: 7 :10AM PAGE: 91
SITE ADDRESS: 11575 SW FAIRVIEW LN CLASS OF WORK:
SUBDIVISION: HOLLYTREE. LOT #: 003 TYPE OF USE:
PROJECT NAME: DUNCAN
DESCRIPTION: Installation of furnace.
OWNER: DUNCAN, PATRICIA A, PHONE #:
CONTRACTOR: JACOBS HEATING + A/C PHONE #: 503- 2347331
Inspection Request Scheduled For: Date: 4/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 004072 -01 503-620-6593 Y
Corrections /Comments /Instructions: /� _
4 /� c /A.4 , is 2 AIL , S 35 /0O - .4�/��CLiCz/ZC'vr —
ASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I
Inspector: Date: -- ? dS Phone #: (503) 718-