Permit CITY OF TIGARD ItEll)SEQ MECHANICAL PERMIT
g / /?r
s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00421
T t G A. R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2012
Parcel: 2S110AA91231
Jurisdiction: Tigard
Site address: 10765 SW CANTERBURY LN 103
Project: Malnory Subdivision:TONDO SUPPLEMENTAL PLAT NO.2: / Lot: 12 -3
Project Description: (1) NC installation Must be within 5 side yard setback and approved rear yard setback
"REPRINT 8/9/12 correction of Class of Work and corrected Project Description"
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: MALNORY, KATHLEEN
4474 SE MILWAUKIE 10765 SW CANTERBURY LN #103
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE: 503 - 708 -6421
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
12% State Surcharge - Mechanical 08/09/2012 $10.80
Type of Use: SF Air Conditioning 08/09/2012 $46.75
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 08/09/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 Notification Center. 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Q� -�J�)
Issued By: \ �f1 Permittee Signature: // id (4 Tell e fk 1 1 v
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.
08/09/2012 07:39 5038139257 PAGE 02/03
- Me Permit A Ilea '
I r - n IC (11=1'1( I'ti!-: t > \I 1
City of Tigard ' sue° I - �1
Blvd, ,Tigard OR 97223 t ass q I 9-- 131zs SW Hall Perron No.: Li �.p a algal
' _ ' Phone: 503.639.4171 Fax: 503.598.1940 ( 0 9 2012 DatefllBy Review Otba Peamte
I I t :,t 1; n 10 on Lie: 503.639,4175
Data neater Internet: www.tigdrd. r,gov CITY OFTIGARD N et ® Base a i inf
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C] New construction L dditton/alteratioNreplaoat►,ent _ Medcedeal permit bees• are hosed on the value of the work
El Demolition ❑ Other Indicate the Wee (rounded m the mares
_ mechanical materiels olot dollar) doll
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. • ^ .�'?e= ?k' 1;:_y;�'L i%.;:. ,r,�",- ...:�� °.s1. ... ♦' t vet I Gy.�,, ;,� ,rrxe y, w Value: S
❑ 1 2.Qrnil dwelling utdustrial n I O hl t ' ' -te:
Y C ammerciall' ❑Accessory building I • � . - i�':� =i' ' '1, c;' ., „-
ulti••family 0 Master builder 0 — f , ,� : �.,<
Tom _ —: -. :, _ -- Tr._ � Description /ty.
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Job site address 10 Z �a0 l,�} [.x,11'} df 1=00 I - et 1* t o ' Ace conditioning
City /State/ZIP: f r - eI (!` d i -7 ? 1 - 1 Furnace 100.000 3 U (eomIwnir) _ 46.75
Suite/bldg./apt. no.: Project name: Furnace 100,000+BTU (d,. -- , - 54,91
Cross street/directions to job site:
Duct 61.06 III
23.32
Hydronie hot water saStem 23.32
Residential boiler (radiator or
hydroeio) 23.32
Unit heaters (fuel.type, not electric).
in.wall, hl•duct, suspen •. • etc, 46.75
Subdivision:
Lot no.:
sees of above 23.32
Tax map /parcel no,: Other IIIMMIMN
Other fud
. i _t�.IIR -n.c� ,� -= q � �.r_ - - ^. -. ,:.r r nPRtidOelf
4-0 _ ' a " ..s"�� } "tip ,Y"kss:, ;: waeethemer
111011y r cos Oreplaee �
Flue: vent for water [later or gas
firstlace II
23.32
' t :, 11111111!EFEN
,{+,.�LT;II•� -,j. �`y. : "�i� " •.r q- !t!+`�� . _ _ -- r,.- _ woodl lacermseri ��
'2 i. �•:_ - `�'' l : i = at ' ,5: - `.�.:' +f � L : t M t, i' ,i C� r i y G ' I Chi /liner/011 AM
� r^ r 23.32 �
Off INN 23.32 MIN
.#--/ le Environmental =haatst and ventilation
' / Range hoodfother kitchen
City /State/ZIP: " 33.39
Phone: L�.� '7 _ key p-i Roc ( ) Single- duel 33.39 III
� . ^< iiT >' `4 ti r ti fi, ' � = a�''', t =: � y 7 >p " ' i " ;- ; ;.� h Altid- toilet , . , , eats, utility rooms 2132
in' :;'w..-�rk, ':: T,� : ' - ,j42-T :i . -.� •, . .• f�
- - ,. ��:,:t� 1332
Other �
Fuel • iptaq
AddrssimismilEil St4.15 for tint (burr 54,03 for each additional
t:ity/State/Z1P:
GM heat .,, Mr`
Phone: ( ) Fax:: ( ) 'M�
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a.`4- a - ...r e %,�l?:'.w"'�.Y e `i: :1:217 2 2.1 ' _ IM��
Business name: Jacobs Heating & -- - .o: �_•.'�:�' � t�.�;�±!
B Air Conditioning
City /Stare/ZIP: Portland, O R 9 7 2 0 2 , : ` _ c : i __ t I -l'''` ., ''-- --
Phone: (503)234 -7331 Fax: (S03)808 -9108 Minim= Permit fec(590.00
Plan review (Mar penait foe) IMINI
Authorized sig rattae: � � TOTAL P l� . --,
n ''� Q c ..((Y ! This moll application PERMIT FEE CO. Print nanlC (Y1 • �� � a permit is eel obtained Milhle I20
c../1 .e.... ( � L. r- Dam t - ' Fee after /' bar t ows seapted a only l6
11 eulhimareclu.imPeortM coo mama m � �y�sld
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08/09/2012 07:39 5038139257 PAGE 03/03
•
SITE PLAN
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T.3371:47101-:
HOUSE
v3
FRONT
P
J o:, name • /�• 47W 7
aa: AGE �d P‘s J eo.A.rezefUxy litl # I0..7
Moab
JACOBS HEATING 8: AC
474 SE 1,11k+au?[1t ..:'t_
Portland, OR .717202
.�_4._._,.. (503) 6J3 -G25 ia;