Permit 11 11 :
n CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00751
TIGARD DATE ISSUED: 12/31/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S125D6 -10500
SITE ADDRESS: 09585 SW SHADY PL ZONING: R-4.5
SUBDIVISION: THE RAZBERRY PATCH LOT: 004 JURISDICTION: TIG
PROJECT: WOODWARD
Project Description: Replace gas furncace.
CLASS OF WORK: ALT 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: DOMES. INCIN:
NAT 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
LENORE WOODWARD Description Date Amount
9585 SW SHADY PL
TIGARD, OR 97223 [MECH] Permit Fee 12/31/20C $72.50
[TAX] 8% State Surchar€ 12/31/200 $5.80
Phone: 503- 977 -5540
Total $78.30 •
Contractor:
JACOBS HEATING & NC
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 234 -7331
FAX 503- 808 -9108
Reg #: LIC 1441
This permit is issued subject to the regulations contained in the Tigard Muniapal 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 OU NC by
calling 503.24 - - • 1.800.332.2344. -
Issue y: . _ ` � , _ /d /� Permittee Sig ature: :,;, J: J / / //i re/-----
i
Call 503.639.4175 by 7:00 aim for inspections th . ' usine -, day.
This permit card shall be kept in a conspicuous place on the -job rte until completion of the project.
Approved plans are required on the job site at the time of each inspection.
12/31/2007 09:22 5038139257 JACOBS HEATING PAGE 01/01
1
M e c) ianicai Permit Application F•mR 01' 1 1('1'. um :, (ln'1.v
City of Tigard Dat i•Z 5/ D 7 Permit No.: tife/Do pe() 75/
111 I. n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax 503.598.1960 Dotc/By: Other Permit:
'1' 1 Ci A It r, Inspection Line: 503.639.4175 Date Ready/By: �j El Sec Page 2 for
Internet: www.tigard- ar.gov NotiBed/Mahod; fsi .- Supplemenml tvformntino
li .. , lr• 1' .. A:. .,v _ 'J,c . "t(Ni Y r h , i ,. B . S ri n t� t'l; t ;�'n ja 1.11 'a.' ii. 't ■ltt ' 4 v n; -, .'I�4 �. .7 r7 i i�'a , %fl:, T, r . t oq : • 'A - ..I. i "f ., n• . 't
'411 knit : la I+F ,ii il ;,,,Iii l std: n �r.�,•s.c.6 4 i ?;trA.. �-r J3t a !':�1c.. , ;,{3it? o. ? : o .�, ,i Nti, II,Y.6 d to IE� i,;i ! ,,e , 2 4; e: 1k4, ,!4.,mmw. it!R! ,loon , ,mint, t,g Arw rn:>✓te it 1
❑ Now construction ® Addition / lteration/replaoement Mechanical permit fees are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: I17� atly�p fJ1, mechanical materials, equipment, labor, overhp
ead, and
5. liU lt'ittthtllf rLi :''1, y •1 , ,, `;,L,.rini •tx«sVt,�i h ' t / nf9G7•T1I:It. �' . ,�ttl `x'11• il:h! a u. r. � V81lle: Sl�nrlfl�
I' .4I lF 1,;'lfir;:li l uio. �r,� g;', tr` � ` yrr 1 a ;a'ek I� 1 : 1 11 � h
El 1 - and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building ° .i laC:iin o,:,f,:i t .•y. . Win'! tit ar aro.i u
For special infnrmation use checklist.
❑ Multi - family ❑Master builder 0 Other:
Description I Qty. J Ea. I Total
o°rN; r ' I r1 ;;�r t' n ''::'a„iaL s v o i I'+ 7 n i1' lifpp ffn •i' a 14t419'; ryl ''tea l MY{ H ea ti eoo
Nli i��N a"� r�, a��± Sa 'rir� h. 'r�cln�rlri+ma a: rnlmd t�n n��ili�,: � I t :,J' ti' l � li ng
Job site address: 9585 SW Shady Ln Air conditioning or heat pump
(requires site plan showing placement) I4.00
City /State/ZIP: Tigard, OR 97223 Furnace 100.000 BTU (duets/vents) I 14.00 14.00
Suite/bldg. /apt, no.: I Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: 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, induct, suspended, etc. 10.00
Subdivision: L Lot no.: Flucvent for any of above I0.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
111lh''a+ . . ,,�1i1 jtil�'�311Cr' «`r' '�: F = .. ii . i} ,,�,, 'Al i �;,;,. pi , Water heater ^ 10.00
„ ,.,:�'+l�r r;4. . e ; m�s.'lt1 , ,y61N1i1Stinf��l,.�r 'fll . llh� '. Gas
fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Replace gas lbrnace. Log lighter (gaas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
r •.rr,cn r, I . , . - Chimney/liner/flue/vent 10.00
R t � I t't� J � "e^ u'xc"'�Y.1, ai ��1 I(Ir���,t r . • '1 • y. a „ , I'
i ^ r rte a Tr m lil. c ; ° . t ir►l l ,r �a,1f�4!,hawii!,�i.. . tr ' ll ti t risn 'r li ef;nO1� ∎ ? Milli ■ Other 10.00
Name: Lenore Woodward Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes drycr exhaust 10.00
Phone: 503 775540 Fax: Single -duct exhaust (bathrooms,
Phone:
( (! ) toilet compartments, utility rooms) 6.80
1t
tilt ''i? mi'{p''ti�j "11114' �H� } x '1.ii . '.`I'�':hi'#a Si'iT-llrm.f� itx' Ion..�fiiluc+�nnr,�'(��i ?1r�ing Attic/crawlspac 10.00
Other: 10.00
Business name:
. Fuel piping
Contact name: $5.40 for first four; $1.00 for each a dditional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: _Wall /suspended/unit heater _
Phone: ( ) I Fax:: ( ) Water heater
Fireplace
'' mail: {; gay yg�,�yyy�� }� p IMO Range
41111' 1 i1Arl >,"4�t A1QSRi ''dbn'ff�'r�•sRfTAm`u.,."'� l 11 , h I IN '.: 4 i '. 1 Dii [. IM '�fii B arbecue
Clothes dryer (gas)
Business name: Jacobs Heating & Air Conditioning _.
Other;
Address: 4474 SE Milwaukie ' I "'I `; "ii 'r'• �lll^` % , „• , ,5 i ,
Pliiiili }�t��ltdtll4��,frrR>r�b�C:u�1ir ,r_t. criahmKr�r.��!C!dlitid�tiv�' ��h � .6
City /State/ZIP: Portland, OR 97202 Subtotal
Phone: (503) 234-7331 Fax: (503) 808 -9108 Minimum permit fcc ($72,50) 72.50
Plan review (25% of permit fee)
CCB lie.: 1441 State surcharge (8% of permit fcc) 5.80
1 TOTAL PERMIT FEE 78.30
Authorized signature:. \ ( l i � This permit application expires if o permit Is Rot obtained within 180
days after it has been accepted as complete.
Print name: Michelle LeClair Date: 12/21/07 ' Foe methodology set s byTri- County Building Industry Soriica Board
lA lluildirpl�PormitAIKEC- Pam:tApp.doc 04/16/96 44M619t' (11/03ACOMAVEM q° 6 A f'] yT
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007- 00751
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 17/31/2007
Phone: (503) 639- 4171uQgy'�I�
Inspection Requests (24 Hrs.): (503) 639 -4175 s ' F __..
INSPECTION WORKSHEET FOR DATE: 2/11200B TIME: 7 :02AM PAGE: 59
SITE ADDRESS: 09586 SW SHADY PL CLASS OF WORK:
SUBDIVISION: THE RAZE3ERRY PATCH LOT #: O04 TYPE OF USE:
PROJECT NAME: WOODWARD
DESCRIPTION: Replace gas furncace.
OWNER: WOODWARD, LENORE PHONE #: 503..977 -5540
CONTRACTOR: T _JACOBS HEATING t A/G� PHONE #: 503-2347331
Inspection Request Scheduled For: Date: ?J1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 064345-01 503- 977 -5540 N
Corrections /Comments /Instructions:
. <« i . 04z s /1 4- 38 5 tie
& gL .- ,1- ii,CvLitlq,€11=_,
6 J ' _ 1 . : •i Us • _ Y - v co Cf24140 / , ,.v ‘1614..`"''
.614.. - .,W1 C? "‘----
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 7/
Date: 2– i— og Phone #: (503) 718 - �9