Permit CITY OF TIGARD
MECHANICAL PERMIT
-441 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00568
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/20/2004
PARCEL: 2S110DD -09500
SITE ADDRESS: 15785 SW HIGHLAND CT
SUBDIVISION: SUMMERFIELD NO.6 ZONING: R -7
BLOCK: LOT: 311 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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace heat pump with same.
Owner: FEES
BALOGH, ALEXANDER + Description Date Amount
JOYCE I TRUSTEES [MECH] Permit Fee 8/20/200 $72.50
15785 SW HIGHLAND CT [TAX] 8% State Surchart 8/20/200 $5.80
TIGARD, OR 97224
Phone: Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone: 503 234 - 7331 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 -00 1110 throug 0 A R 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(50. 246 -6699.
I ued By: • / ,�/ .! Permittee a � j/ ,
all (503) 6 -4175 by 7:00 P.M. for inspections needed the next business day
---FROM : Jacob sHea t i ng FAX HO. : Rug. 19 2004 01:08PM P2/3
--- 4{ ,
.. • it
P' .. .
'echa Leal Permit A licatin , FOR OFFICE USE ONLY
R
ty..91 Tigard Datcmy: eceived • Permit No.! I fe ... A." 0 , -•'
25 SW Hall Blvd., Tigard. 0 Plan Review -, Other Permit!
ino: 503.639 4.,,, ..il ..,
.4171 Fax: 50 t' I ''', Datenr -
pection Line: 503,6394175 p a.. 'A I( ' Data Rea tly/12y t
fort • Fd see Page 2 Mr
•• ---•
tTnet: WWw.ci.tigard.or.un 1 tsintifled/IvIethod: te Suppientental Information
; ': 0.:'•IfigiiiiCiTte
7 5. 1 i':•'. 4t,''s i.4T
j, , :,Iill....' , •' . . 1 / 1 1 “„ vio,..!Impty.r.m.. 1 . - . ; .., -
fliAid ,44a4j.15 01.0 ''' .' ';,,:-.....2
X 1 -.
I New construction [§113Ndetibire I altNa i* placement 114 pe fees arc baseci on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
I Demolition El Other: „ mechanical materialp gverhead, . . _
.....n.,..„:1.:. . Value: $
/lIft414;,44,„4tiT v
Y.. Tqw.70*NTA_L:L ' ''''''', '''". ''' -------72- '. • . • •11.' , •
4,...6:okl,14. ,•, , . ikii., . , il: v . ,..i.Lnr,s.. , q,.., • .. • ..1... - -, -...;,,,,..:"' - .. ' ; • :".40S0)0744445 : ttityjZNif . / ,.. iV>'VgIVIS FEET'
''' ' • • • :1 - , ' ,1 ' ' 'Ll ,.:. ' '' " .
dit 2-family dwelling 0 C.ornmercial/industrial El Ac;cessory building 7 • .-- .
For special infermation use checklist.
3 Multi-family 0 Master builder 0 Other 1.)cscription, - I ( )' 1 Ea I Total
-,
Ifirleii'i;egiqiinifEranTirnargear' ..rie„:,;,:=',f6.:•',.0.y...,....: Heating/cooling _
,,,, T4. A ' 1 JO ' 44 li . , .LaJ., ...I,' '',I- '' . ' . , I" % ' ' L2,1a. ,
,11 aite address: '5 e i5":) . I. ::5 A") 11 - • Air conditioning Of hCat puttlp
14.00 1
(regmifes site Om slowing placernent)_ .... _.
.-.--
,„ .., •
ity/State/ZIP: ---1-- ',, , c•A (-I ( • I. Furnae.0 13Tiisauctsivents) , • . ... ........
---- - Pomace 100,000, EVIL! (docuivent) _ _17.90 ..._
utte/bldglapt, In oject name: : 1 Pr ,r di , i ---- -
........_ ..... .._ Gas heat pump ..... 14.00
rosy atreet/directionit to job site: Duct vvork 14.00
.._
'-- ' ' . '' - _.. _
1-1y hot wassystem 14.00
.,
Residential boiler (radiator or
- • ,
_hydronie) 14.00
. I trait heaters (fuel-type, not electric),
in-wall, in-duct, sussiended, etc, 10.00
.....
lubdi vision: 1„.L_ flue/vent for any of „abo I 0,00
ve - ,- • •
--- .., . ,..._ .. .._ Other:,„
... 10.00 .
_ ..... ...- • -
7ax map/parcel no,: other fuel appliances .,.. ..,-
--
1i . Att. . ...., ..,.. (.1..,. k•Its• A .,.,o ,•:, .,1 ,, „ Water heater 10.00
417iihitit . itiVidditlAtt,liiXift4, • •:,•.,.. EU,s'MPR 0,. 1: . ,., ..,,,41!1:•:•.•.:i:._,%Oty ..‘•
. - - .. - -- Gas fireplace 10.00 .....
• I - Flue vent for water heater or gas
- 11W • itrr fireplace [ 0.00
1 ._ --- - .--• _...,.....____ Log lighter (sit!) 10.00 .....---
Wood/pcllet stove 10.00
,
- : Wood fireplace/insert 10.00
_ ,,
r Chimney/liner/flue/vent 10.00
■'11(104 :11 :'c..`f f , ..11 Re iiiMINtp;7
.al.t Air . ....,':','Ai .: Alma* .', - 1,, • `..,r?.' al ..,l. Al , 0, Z• . I; ,i!'ll .1 , , ...L , 4':: •,:l o 10.00_
l'ame: All
i' , - .1, • _.,., _.... .
Ftw rn
ironental exhaust and ventila Ion
.„_
. - .. . ..
Address: .5_ , - rate ("--\
. . 11 Range hood/other kitchen
........ -
- _ ------ equipment
City/State/ZIP, v ... r `• -• --- C) l- Clothes dryer exhaust 10.00
._
........._ ..- •.: -, _ , . Single-duct. exhaust (bathrooms, '
Phon ISO ■ Fax: ( ) tot lot oortspartments, utilitron1 '
....
. niii""ifivii i117:'4' iVi' ..::'.. 'iAi'llit li' '.' Ws' iirgVfAiOigi>iti': . '.'!41,;,:)., Atli c/c ra wispace fans , 10,00
' s t - L - :. , . ' 1 '' . ...% ''.."1:'''::4L' Other: 10.00
Business nem.:
- ..- o 'i P
4, 41 RuelOpitl
......
WIF -
Contact name: .. - r ,.... 55.40 for that four; $1.00 for each additional
Address:
1 ..... .,
Furnace
, t -. III . , - i A I V ..e..„ - - _...__
Q
Gaskat pump --
_
Phone:
City/State/ZIP: -. ()A G n .2 0 Wall/suspended/unit heater
, --- ,.. ..-.- .
.,. --.
lip 11 j D I 1 ) 6 bq,),. Y. Water heater
-- • ( Fireplace MI • -
E-mail: --...„__.
Rime
ft7A IA ',f,e01 B ar b ecue
Ell -
..., ,
:.;;;:iti:l6rita,s:,,:it.:,z. . IRI:lale,',1,14 ■'-' 'V.E, . .. ' .
_, Clothes dryer (gas)
Business name:
___.--- ..._ Other:
Address: • "ir r ' Pl.w • , • • '. ' '
IOU 1 .. r • 1'7 itt., 744' . „
_ - , .,, . ',., 4 t......1, .• r .__
City/State/ZTP: , Subtotal .
I -
72)
.50
Phone: ( ) Fax: ( ) ip• dikI, _____ to
_ l Minimum permit fee rmit x) fi cD ..
CCB lie. Lai , , ,..........._ Pan review (25% of p ....._
State surcharge (8% of permit fee) .
---____ - -- .- --...-.... -
"r..r , TOTAL PERM l'IC PEE
Authorized riven • Ali ' AO
- . fhb permit application empires if a permit fti;Ol obtained wit
i days after it has been accepted ea complete.
Print name: ,M,'A mpg r ! Date:
Fee methodology set by In-County Building industry Service Board
..ii- • -,_ .
iAottnsteeu.ermitovroc•PermitApp.doe I?JO) 440 (11 /02/COM/WEB)
FROM :JacobsHeating FAX NO. Aug. 19 2004 01:09PM P3/3
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w � ZI
T . gin 1��� .
l') ►'1 h �(Qrny �s ��
SITE PLAT
- v
•k . 1 5.k t gi-vat DIRECTION
1
HOUSE
•
. .
* I%RON1'
c
•
Job Name
• _
Address S 7r c- 511'') (47‘5 Vl A (0 (5
Model # • 74 3b
Make -
JACOBS HEATING & AC
4474 SE Milwaulde Ave.
Portland, OR 97202
(503) 234 -7331
- (503) 813 -9257 fax
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 , MST
BUP
Received �` Date Re u sted � �r AM PM BUP
Location /G Suite MEC ,O V -5 &2
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner /5/1-11 l 0 .4Y ` 3 1 7 ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam %/ OPP- i "�
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi n1
PASS PART FAIL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
/ PART FAIL
RICA L
Service
Rough -In
UG /Slab
. Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line 9n �
ADA Date � Inspector Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL