Permit CITY OF TIGARD MECHANICAL PERMIT
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Permit
- • COMMUNITY DEVELOPMENT # MEC2011 -00466
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 parcel 2S112CC01100
Jurisdiction Tigard
Site address 15800 SW HALL BLVD
Project Tigard Community Friends Church Subdivision 2002 -002 PARTITION PLAT Lot 2
Project Description Heat pump replacement
Contractor JACOBS HEATING & AIR CONDITIONING Owner TIGARD FRIENDS CHURCH
4474 SE MILWAUKIE 7130 SW BEVELAND
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE 503 - 234 -7331 PHONE 503- 620 -7836
FAX 503 - 808 -9108
FEES
Specifics Description Date Amount
Type of Use COM Permit Fee 10/26/2011 $182 65
Class of Work ALT Type of Const Plan Review 10/26/2011 $45 66
Occupancy Grp Occupancy Load 12% State Surcharge - Mechanical 10/26/2011 $21 92
Stories Info Process /Archiving - Sm Sheet (up to 10/26/2011 $3 00
11x17)
Project Valuation $4,193 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 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 $253 23
Hoods Comm Incinerators
Woodstoves Gas Fireplaces Required Items and Reports (Conditions)
Clothes Dryers Other Mech Units
Gas Outlets Other Desc
Duct Work
Fire /Smoke Dampers
This permit is issued subject to the regulations contained in the Tigard Municipal Code State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
iss ce, or if w• s suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
ility Notification Cente Tr• - rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 0 You may obtain a copy of the rules
or direct questions to OUN • calls ■3 232 1987 or 1 800 332 2344
ssued By ( / 7 %.4Z fJ / Perms ee Signature
Call 503 639 4175 by 7 00 a m for the next available in ection date
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection
Mechanical Permit. Application tuft orric car: 0\ I_1
City of Tigard �® "' A�
i ,. 312 SW Ha0 Blvd. , Tigard, Q16\1 • / iE7iir1,
I Bard, OR 97223
` : . phone: 503.639.4171 Far 503.598 pm Other Permit.
Plan Review
TI c -v: ❑ Inspection Line. 503.639.4175
Internet viww.tigardot.Bov 0 1 p11 xon 9 ad: sa p ee 2 tar
�, j , I f iD� p S upplemental tnformsdon
D New construction Mddttion/altei¢h.. Il k a t♦ Mechanical permit tees• are based on the value of the work
❑ Demolition ❑ Other: 0 ' v performed Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhwd, and profit
_ value:$ ba
13
0 1- and 2- family dwelling VP- ommermal mdush ial [] Accessory building
❑ Meld-family ❑Master builder ❑Other: Forspecml mjosmatiox use eheokltst — .
_ _ Description i Qty I Ea. -
i Total
. Heating/caoung
Job site address: (sb S ( • ct t 2 I t Arr conddtonntg
p (mnaires ateplan d, nlacemem) 46.75
City/StatgraR: T CLrt,� o R 9 7 ( Furnace 100,000 Em (ducts/tewa) _ ' 4635 _
Suice/bldglapt, no.: ti✓ Project name: —17 C. . C. Furnace 100,000+13N (ducrshvnfi) _ 54.91
Heat pump _ _ 61.06
Cross street/dueegons to job site: Duct work 23.32
Hydrouie hot water system 23.32
Rentham l boiler (radiator or
hvdronic) 23 32
Unit boaters (fuel -typo, not electric),
in -wall, in-duct, suspended. etc. 46 75
Subdivision: Lot no.• Flue/vent for am of above ., ., 23.32
Tax tnap/parcet -Deltas 23.32 r
Other fuel appliances
Wad he 2332
Gas fireplace
�� � I ., ,, ,, Flue vent for water heater or gas 33.39 _
(l 4p.a.� ei-(..V✓L10 fireplace _ 2332
�" ((�� Log liter (gas) 23-32
L't kC - - r - ,1_ K C Wood/pellet stove _ 33.39
�..._..__.. Wood fireplace/iesert 2332
.. _ " - ChimneyNna /Ouelvent 2332
Name: - 1' - ', �g 0 .t' (� Oases: 2332
`- J \ `- ol t (- t riy 11S' C Lioce� Environmental a mak and ventilation
Address: Range hood/other kitchen
equipment _ 33.39
City /StatrJZIP. Clothes dryer exhaust
3339
Phone (563) . • — $3 . Fax: ) -- Singleduct exhaust(bathrooms,
toilet compartments, utility moms) 23 32
_ 23.32
Business name- ...-
Fuel piping
Other. _ 23.32
Contact name.
_ S14.15 far first fear; 54.03 for each additional
Addr<as - Furnace, etc.
City/State/ZIP: Gas heat pump
WaWsuspendcdlunit heater
Phone: ( ) I Fax:: ( ) Water heater
E-mail: _Fireplace
Rang
,' - Barbecue •
Business name: Jacobs Beating & Air Conditioning Clothes dryer (gas)
Address: 4474 SE Milwankie Ave other.
City/State/ZIP: Foreland, OR 97202 _. .. ... -
Subtotal j
Phone (503) 234 - 7331 I Fax: (303) 80&9108 - MWimum permit fee (590 00) (PS
CCB lie.: 1441 Plan tcview (25% of pesmd fee) (a G
State surcharge (12 %of permit fey) _ sl -
Authorized signature: ' '.*rte /' � TOTAL PERMPT FEE 2S/). a
/• r/'1r This petmrt application erpires ifs
kW permeasot obtained within 180
� 1 days after k been a�pted es complete,
print same: i h r . t . +f 4 --Vern I Date: 1 o ce p l ( • Fee methodology as by Li-County smtanglndustry Serncc Board
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