Permit CITY OF TIGARD MECHANICAL PERMIT
.' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00008
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01!11/2012
Parcel: 2S111DD04300
Jurisdiction: Tigard
Site address: 15715 SW STRATFORD LP
Project: Warren Subdivision: STRATFORD Lot: 17
Project Description: Replace gas furnace.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: WARREN, TERRY
4474 SE MILWAUKIE 15715 SW STRATFORD LOOP
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 624 - 7974
FAX: 503 - 808 -9108
FEES •
Specifics: Description Date Amount
Furnaces < 100K BTU 01/11/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/11/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/11/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifica ••• , -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct qu: tions to O► C • calf • • 503.232.1987 or 1.800.332.2344.
Issued B 4 / // I PermitteeSignatu'• ' /
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 A iicatia t
FOR +> 1TfCE USE ON L
City of Tigard 6t0.-'. Ret:eived
i . - ',.'a 13!25 S W ' Hall Bl d ., Tigard,Olt 9 w\ 1`,.� Datel)IY: / // ?,,,c1 Prrrnitvo.: l j�0lv�-��DOS
Phone: 503.639,4171 Fax: 503,598.1960 \Nt Plaa Ret�ru
TCC;AItD IntP tion.Line: 503.639A J P G� O Uala73y:
Other Pamir
loteretet: >#wrv,ligaurd ar. ov e ` Date Readrity; ' '
6 `\ "' turi�: fee PAge 2 Cur
4 V � NatifsdRt'lclluxl:
� C, s°`� � ,
Supplemental lefurmariim
!t1,w1�;.ltij r �■�. lli ' �j�N; �j�)' �'' ururlt7' r�!�.°�I�lir.o�''�tc,,t�q,�ai ��,vya4 i� ah. , .a.
_..R ? 1tERZi u i , l i l� r l iii,!, + . •_ k ��'ahhll er ry '. I f . ° ,'Tau U r t u ai 1,l 5 -A F w ,,-. ,. ,..,r+4(]•f� � 7
'Mechanical
New c0netnLCtion tldltionfstltat�ti0tt /'replac�ttttetl , �''
permit an based on due value of the work
P
( Demolition Other: .
performed', Indietue dtc value clue (rounded W the Harvest dollar)
f =n ik, ' aJ , , ., : mechanical materials. e. . all
{�,i� J1 Lnatcri ui' Value' S
labor. avcchcrtd. ndL rofit.
.;':.''i;..e ^,. 'la' Eil��'121�}�, .�r`i'wV�1. �.�,,' ", ' , a � t q '"T i l {{(�11 <ll;upplyth'4(^!r 't a p'r'r`�. II �' aluc: .�...._
• ^� �. .� ,., y. � lyf,';�,�.r� "1 l ,l y �ir,r''.l,!ii,P ^.
r ll A l uan t f - family dwelling [] Commercial/industrial 0 Accessory i buildir,g J: r ;Yi ii i + {i c?; de ll T ;;.;,
amilY
�a{{ y; (] lvlattilt.r builder 0 C)ihcr: .For.special information use eheckha
¢ *'''j'i ..1' "r ;,." r t4., .,„. ,( . + t I'7CSCrlplt L
'
.L.,:. ,t ' 4 r � • '.;11 P . , 41 1 1 ' 'i b ` L:ll lll�ll� ' i1;4,,, :ss c o Q )Y r �• d l9[i1�
Job.sitg pdtirtoss: S.- ''..7.1 '�: '^ `� - 11'; '� ^� Hearin, Cuul[n -, I "-
a ' S L�,• ('�j `� Atr uutditivning
Ci[ylStslC2}l': t n f . ( re ciLares:iteplap,aowiuyplace/nem) 46.75
-
`� c r'c . r :.,� ( Fumacr 100.000 BTU (ducwvans) (
SttitubLd Japt. no.: pr 46,1! 73 ��l {� • r''
o3 name: L,�.I�.� C r 8 } Furore. 100,00 �B•TU t ......vo 54,
' Cross street/dime:inns to job site; Hem um 6I.06
Duch work
----------- � 23.32
Ilvdtonie but water system 23_
ROderuial boiler (radiator or 32
- it }'drank) ?3.32
" - Unit heaters (bier •type, not electric), -- I
"""` in -wail, in - duct. sus ended, etc. 46.75 '
Subdivision:
Lot no.:
Flue/veer for any of above 2132
fax map /pared no.: — . ^ — Other:
• 23,32
J'� ; %i:i !ijl( 'zj�S¢p Iva " Crly'� '^ rrt���� 1 pW �y1 • Other fuel appliances lia
.. a .'::,.,118, lidi$'Elklii7l':.1'l 17- ' 4 .; W Alta 4, u...,,q,l,g ., y tTfili} �Irl Ct? nCCS I • �, 3. 3 a
- Sue veer for water healer at tits . _ �; , r (1,-„, --c (� 1� S "}:'l, C..- _fireplac
25..3
,-`— — Lo,. li to ; • pa I . . Wood/ dirt stove `���� 9 i!;;I1 n,;11,, ! �r , sl Fur .. Wood 3,39
f „'r � ,t „ >Src• ucdinsert �-
mn:(�l: ','C•fY.r�k, {; 'k �� C07:,�(,V " r1 , ty� 1 � ';}% , .� � i �.�� • Y 6, . , 1, , yif iti7,'00 ;, l st ' NI Ai' � , I 6F; I ,,s," �f ” ` ge, E i 1'!i op, .i> Cbimncvilirter /t7
Name; t 1'"{�( )Zd ;111 ?l':.0 :,.,„ r;r iin:i« urJt °e 32 —
l,�c�.r'f —e Other:
23.32
Address: Environincnrrd exhaust and ventilation
�- Range hood/Other kitchen
^'�
City/State/ZIP: equipment 333y J
C
.._
Photo: : 1 } (4,-,, Clothes darer •
_.. exhaust r
(S r .3 Nix: ( Single-duet t hn 33.3) `
( (bathrooms,
� _
: .11r1i e , j" ), „, ia(fk d m1? 4�tptj::' .kI'jL� 11U 4 tiTr t}lf�l C Ut�r r � i l} il ;< c toilet awn l a nuents cuilii t4oms) 2132
I t ,, i. „, .. 1 . ,r. Att1C/CrttW&•ari f
I�U:WI= name: - , •.. .i,lf!v!i fns �3 37 •..
Other. --_,
Contact name: Furl i in
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_-_
Address: S14.15 for first four; .S4.03 for ouch additiunrl
Furrlaae. etc.
City/5 �-�-� _.
—, .. Oz hear • um
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Phone! ( ) Watl /sus end he 1LCr
7
Fes ( ) WSter heater
-mail: � -
,.. j r S. r lire•lace
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ii !!!'d'ill. tali it n+' i' , ,Jt i Ii hilt ,a 0 ,,..1 -. M41C a'. ^%i � �a . � lY l `, ii{j I'! PIS y ^ :i i „';,�1
Iiusincas n(uaid; ,l'r(cubttFfCAti I 1 I;t:.i a= r;!4ri;;;:: „,,�1FC,1,,, . "'- Z earbe_UU 1
nb & A h' Conditioning
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Address: 4474 SE Milweukia Ave - -
City/State/ZIP: Portla �aini.�.fJ�C ,MI„ t "�'.�w . "�"", ,,,”„ , ,�..^^I!.•,- , .I
._., Portland, DIt97Z02 !I. . ...! ; a • xp
..
Phone: (503) 234 -7331 ,- " 71- -' i1Q. 'W.;!.,;,' :
Fax: ($03) 808 -h10 "'• --�- Subtotal t...,/e... _ .
CC[1 hive 1441 Minimum pctmit ice (S90.0Q t;.
Plan iCvlew 2 ' )
( $ /o of fcr) I
Stwr SUrcharga (I2% of a
Audi r ��"� 1 - . + " � . permit Ice)
Authorized signature.: ' /,' ^
F / 'this pe nult a , plicatiou exapires if a portail i oat eL
?rill( n e:.„1- •
` day! after it t1ak 1/CCA xctcptrlr as com0 ul cd w it hin ?1$ D /
Cute: 0 ! 7i C lnett20 lOIO set by Tn• Bully:
as /
' 11 .,�4tntlPWC:pIAIFC.PumitAay.da: 1 luo ti09 -J-4•4 f Carmy Buily as Indusay Smdcr posm
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