Permit CITY TIGARD MECHANICAL PERMIT
4.:��� DEVELOPMENT SERVICES
PERMIT #: MEC2001 -00237
�I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/27/2001
PARCEL: 1 S 135AD -05200
SITE ADDRESS: 10735 SW SITKA CT
SUBDIVISION: TRENT TERRACE ZONING: R -12
BLOCK: LOT: 002 JURISDICTION: TIG
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of exterior NC. Must be set within the required setbacks.
Owner: FEES
PAUL MAR Type By Date Amount Receipt
10735 SW SITKA CT. PRMT CTR 06/27/20( $72.50 2720010000
KING CITY, OR 97223 5PCT CTR 06/27/20( $5.80 2720010000
T ' Total $78.30
Phone:
Contractor:
•
JACOBS HEATING +A/C
4474' MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Final Inspection
Phone: 503 - 234 -7331
Reg #: LIC 1441
EXPIRED
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 AR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9 • s .
Issue By: % Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex business day
r • ir
Mechanical Permit Application
Date received 4 7 Permit no.: 0/•46,2
�1,1:11�1 C ity of Tigard ��``E �Ep / , .i 0
ProjecUappl.no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd a , - O T( 9722 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 JUN 2 7 2001 Case file no.: Payment type:
Land use approval: Building permit no.:
COMMUNITY DEVELOPME0'
TYPE OF PERMIT
AA: 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ` 1:�ti t Q Indicate equipment quantities in boxes below. Indicate the dollar •
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: IBloc I Su ivision: *See checklist for important application information and
Project name: -vt�- �'� a , 3 I & jurisdiction's fee schedule for residential permit fee.
City /county: \ .�a�`� ZIP: 2 FAMILY DWELLING PERMIT FEE SCHEDULE
De n lion and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIP1MENTSCIIEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res.only Res.only.
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
Air conditioning (site plan required) 1 I
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
, . • • State boiler permit no.:
Business name:
e0 . 3 hq HP Tons BTU /H
Al: Add - ss: • 7 •+ St Q G hie Fire/smoke dampers/duct smoke detectors
City. A Sta km' ZIP: 4 10:ID Heat pump (site plan required)
,,Airetinik1655 t► K . '"i E - mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: Install/replace/relocate heaters- suspended,
City /metro lic. no.: 1... • wall, or floor mounted
Name (please print): O"% i; 0 rM• C Vent for a r r liance other than furnace
CONTACT PERSON' ' efrigeratton.
Absorption units BTU/H
Name: OAD y• liVI C. 0 r C Chillers HP
.�,�A Compressors HP
Address:
City: • • K O S I S tate! O Environmental exhaust and ventilation:
Cit Appliance vent
Phone: Fax: E - mail: Dryer exhaust
•
• _ -. _ ... - _ . OwNER__ , ; _ _ , _ .. _ _ . . - - Hoods, Type l/ I I/res. kitchen/hazmat
hood fire suppression system
Name. 111 0.4/l ` Exhaust fan with single duct (bath fans)
Mailing address: 10-)A )`7 � S Q Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets) tat I City: ��a iOD 3
Type: LPG NG Oil
Phone: Fax: E -mail: uam• '
Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: ZIP: Insert - type
Phone: Fax: • E - :;_ Woodstove/pellet stove
Other:
Applicant's si_ a •, 7.j_td1r'.IZANTf YEZE11111 Other.
Name (prin $ AMC D L,
Not all jurisdictions accept credit cards, please call jurisdiction for m n ore informatio Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: /
expires if a permit is not obtained Plan review (at %) $
p1 within 180 days after it has been State surcharge (8%) .
Name of cardholder as shown on credit card accepted as complete. g ( ) $
5 TOTAL $
Cardholder signature Amount t� hql
SICIrt EXPIRED
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503 - Z3/ - 733/
iax 503- 815 - 12.5 7