Permit CITY TIGARD MECHANICAL PERMIT
,y. 4 DEVELOPMENT SERVICES PERMIT #: MEC2005-00201
�• DATE ISSUED: 4/29/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102DA -00100
SITE ADDRESS: 12970 SW HALL BLVD ZONING: I -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 2 roof -top units. Valuation: $15,950.00
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: S1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 2 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 0 <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 2
Owner: FEES
MAGNO - U M PHR I ES Description Date Amount
8800 SW COMMERCIAN [MECH] Permit Fee 4/29/200: $312.50
TIGARD, OR 97223 [MECPLN] Plan Rev 4/29/200E $78.12
[TAX] 8% State Surchaq 4/29/200E $25.00
Phone: 503- 684 -5464 Total $415.62
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202
Phone: 503 234 - 7331
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
or 1- 800 - 332 -2344.
Issued By: Q op Permittee Signature C.
503 - 639 -4175 by 7:00 a.m. for inspections 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.
.
13125 SW Hall Blvd Tigard, OR 97223
. . .
Mechanical Permit Applicatio , . - ' ,i ' FOR OFFICE USE ONLY
City of Tigard R _ IVA Received ,
Date/By: • ,I /
P Permit No.: 00 .a. t 6 _ 0 0:9.0 i
., „.
Phone: 503.6394171 Fax: 503.598.1960 i no. 0 0 liovhatii,\ P Review
Other Permit:
Inspection Line: 503.639.4175 Arr‘ 4 0 1 -; Lelt4:* A 1 ' Date Ready/By: NM 0 See Page 2 for
Internet: www.ci.tigard.or.us
VIWIV1 D *Y ' C 4 ;;S4 - :=;:4iiif*ft-ttt r.r0W0
G ITY OF T Notified/Method: Supplemental Information
,,,t),
1 ,5:irit,
0 New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
'
performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition 0 then mechanical materials, equipment, labor, overhead, and profit.
Value: S I - , C:
R-M . ,,,
P:t:; „. ,„ - , -- „ - ,„ . „......,, , "-- .,-.9
- - - - - - " ' - ' - ' ' gtdomtt ir 4itqo iN q,o4w s T*: ,- nte•
0 1- and 2-family dwelling (RCommercial/industrial 0 Accessory building
For special information use checklist.
El Multi-family 0 Master builder 0 Other:
Description I Qty. I Ea. I Total
0 ;,,#107,...iiiiSk#01li5JStipii ' ' ' Sra Heating/cooling
Air conditioning or heat pump
Job site address: 1 „9 q ..c.,) L a_ 4 _ .) i... jc::? 1 r al , „._ _ (requires site plan showing placement) 14.00
City/State/ZIP: - 71 - ;^ 9r --- 2 _ ,..r ...- c .-) (<:. Ci-c-.-r---2_.5 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: ry - Gas heat pump 14.00
Cross street/directions to job site: 4=11 --i- - rrIft - )6 -- 1 - C-_.S Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00.
Tax map/parcel no.: Other fuel appliances
-,n',:: _,:: ..1::::_. Water heater 10.00
tit ;..,.. Lk4AMEIONta.U.
Gas fireplace 10.00
- 17,---,s-i-r .4._ 3? -4-1_ , )(73 1 1 1.4 ..4 f: st- Flue vent for water heater or gas
fireplace 10.00
.4---,..---) a72. (......'r t2 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
c'f:, ;';.'W-m , „6,,,,,,,, - , ,,4,4,4,.. ,, ,,,, .. V ,':': ,,,, "::Mt"Illt* ': q!';''`g!tlifaiW'i mk:TAZ:',C other: 10.00
Namer')..- 4 Environmental exhaust and ventilation
Range hood/other kitchen
Address: • ■ 00 ° , . AAA -au , - _ ... _ - equipment 10.00
City/State/ZIP: .t..._ . j C) /‹.--
Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
, ,
Phone: (0 (_, 4-(_,1)5-.4 ( ( Fax: ( ) toilet compartments, utility rooms) 6.80
17 a1441C0144;i rcig , ( " fatat Attic/crawlspace fans 10.00
Other: 10.00
Business name -75 i ---- ) - , (1-4. r2-k' r 4, i'. / - Fuel piping
__)
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump _
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: Range
VONifiXeeferlieMZ Vi 'T"'
.m.,:.44-.-;4.0 .....a Barbecue , :: , F , m1>k!
Clothes dryer (gas)
Business narne:3 67,-51,-.. L___Ip C?---')e3 c..- ..--J/C' Other:
Address: 2 - k - 4------1 -- nr i : 1 1 -._)__.1___*_.__; Q.,. c tiLIV:1teji, A NICAL :PEOTA-FE,ES,'' ,;", ,';
City/State/ZIP: Subtotal
- 1 - 7 ---- --1 2 -)c- -- 4 j rill -.. =:-(- - ----)c -. -7
Minimum permit fee ($72.50)
Phone: --..j ( . 9 , / _ ..4 __ .... I Fax: ( / .3 _ c:3 - - j ,--5,Es--
Plan review (25% of permit fee) 78 .
CCB lie.: ,-.4-1.4.4 / State surcharge (8% of permit fee) -
-
TOTAL PERMIT FEE c://57 6
Authorized signature: •
This permit application expires if a permit is not obtained withM 180
2 C P41.-A--t--N-ct--1---Gz.--
days after it has been accepted as complete.
Print name: 1:) c_ 4---y- Date: z.. 49 * Fee methodology set by Tri-County Building Industry Service,Board
:.‘n..:■4:-,n-.....-:•,. sr, 11 A - .1 - I nen, ..”, Ael,m tl 1 in,in.-...iiirmls
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200S -00201
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/29/2005
Phone: (403) 639 -4171 D m M , n di ��nl�i �l� jlic`
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/21/2005 TIME: 7 :09AM PAGE: 69
SITE ADDRESS: 12970 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAGNO- HUMPRRIES
DESCRIPTION: 2 roof-top units. Valuation: $15,950.00
OWNER: MAGNO - HUMPHRIES, PHONE #: 503- 684 -5454
CONTRACTOR: JACOBS HEATING + NC PHONE #: J03 -234 -7331
Inspection Request Scheduled For: Date: 7/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 . Mechanical final 011868 -01 503-463-4500 N
Corrections /Comments /Instructions:
•
l
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FIR INSPECTION ❑ ADDIT ONAL EES ASSESSED
Inspector: ,soiok Date: 7 LA hone #: (503) 718 -