Permit 4 CITY OF TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00723
'�I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 D ATE ISSUED: 10/28/2005
PARCEL: 2 S 104AA -062 00
SITE ADDRESS: 12735 SW WILLS PL ZONING: R-4.5
SUBDIVISION: BELLWOOD NO. 2 LOT: 083 JURISDICTION: TIG
Project Description: Furnace and AC.
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:
LPG 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
TRINA JEPPSON Description Date Amount
12735 SW WILLS PLACE [MECH] Permit Fee 10/28/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/28/200 $5.80
Phone: 503 - 579 - 4198 Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202
Phone: 503 234 - 7331
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 - 001 -0010
through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: Permittee Signature: C2-7012.4 r / D ?t
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
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.
RE :JacobsHeating FAX N0. : Oct. 26 2005 03:03PM P2 /3
Mechanical Permit Ap f3E V E •, '0' to t: 1(: 1.1151 O\ IA
�
City of Tigard Dutr/ay "!�/ / �I/I Pcmdt Nt �/�DOZ5 ��7
13125 SW Hall Blvd., Tigard, OR 97223 , Plan Renew other Permit
Phone: 503.639.4171 Fax. 503.598.1960 OCT 26 20 1 '<' •�,_r�l�.�. Datc/By luiir ®9eo PaRe3ror
Inspection Line: 503.639.4175 •;1y Dam Readymy:
Internet: www.ei.ligard.m.us CITY OF TIG ' " = Nntifled/Methnd: Supplemental Infbrm:Uaa
BUILDING DIVISION y ,,,, , t 1 ,
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based on the value of the work
❑ New construction El Addition / alteration /replacement performed. Indicate the value based (mtmderl to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, crverboad, and profit..
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® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ' ❑ Master builder ❑ Other: DeSCrlptinn Qty. Ea. Total
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1 3� l � ` Air conditioning pl s o heat pump
Job site address: 1 (requires site plan ehowFn _ lacement 14.01)
City/State/ZIP: yc.\ -i bg_C-s: Furnace 100,0((1 (ducts/vents 14.00 „
h :urnace 100,000+ BTU (ductdvanta r 17.90
SuiteJbldg /apl. no.: Project name: Gas heat pump M 14.00 ,
Crass 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 -iypc, not electric),
in wall, in -duct, suspended etc. 10.00
Flue/vent for any of above 10.00
Subdivision: - Lot no.: Other:
10 00
'fax map/parcel nn.: Other fuel appliances
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ig ,� I i;�;Nti il I i n;;tln n'ol,u,7(IthM17 i;+ , ,let:, a ttt t i ; t i l• l,t� 6r
Gas fireplace 10.00
r + Flue vent for water heater or gas
f_ lfeplacc 1 0.00
Log lights as 10.00
Wood /pellet stove 10.00
Wood fireplacc/inscrt „ 10.00
,;, , ,,,,,,;;, •• 9N1 tll5'1C l r r ("�, ,,(t , „ r� ';1t nr. tmq: ,�: I 1 } ” Chim /Flue/vent 10.00
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Name: x - N 4 11O.db at.' ‘■4■ Environmental exhaust and ventlladon
Range hood /other kitchen
Address: Q 4= '11.• Se- . - , equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
- Singlo exhaust (bnthennur,
Phone: i 6 411r4 LA cjg Fax: ( ) toilet compartments, utility rooms) 6.80 .
I ' : y: . , p r ,, ', 4t(':ic,k340 N ,: , ,,,1( wll r i(t�ppi ,;{ , ;,•n@(r :iert tltpinlu 1- . mires, '(f 10.00
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Other: 10.00
BllSineLs name: -
- - Fuel piping
Contact name: $5.40 for first four; $1.00 for each addltlnnal
Address: - ., Furnace, etc. • . . -
.. Gas heat it :I
City/State/ZIP: Wall /suspended/unit heater _
Phone ( ) Fax:: ( ) Water heater - , _
Fireplace
E -mail: Range
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Autiness name: Jacobs Heating and Air Conditioning
Clothes dryer (etas)
Other:
;r r �{:;;n, r.: a ':: +tu ur8: l :
,,,,ri,n,;7��Ewm nn , , ,..� , � n,
Address: 4474 SE Mllwapkic Ave 1` t,. �,: r+I { JI i [ 1 a (h q i ''' ; ��((rrf t }' r(' ,i nu t'u�ru
W I � a; `1; tc 1'1' '
.. .. :ii.i '.; i ),,� ll! i li`Ir s:n.(Ih g IN,J,.;A i,:,3.i:p. -s l,1!'',Iiflf;iliG�,. mi„150,4
City/Slate/ZIP: Pordand, OR 97202 Subtotal
Phone: (503) 234-73M F3) 808 -9108 - Minimum permit fee ($72.50)
I ax: (503) , — Plan review (25% of permit fee)
CCB lic.: 1441 State surcharge (8% of permit fee)
TOTAL 1 ERMIT FEE sr ;3 • S
Authorized signature: a • Thio permit appllcadoa sicpires It a permit to not obtained within Ian
■ days after It has been accepted as complete.
I Print name l • . ± ,ai IC: r amp • Foe mctttodolo►ty set by't'rlLounty Butldms industry 3ctviee Bw
I:is(dlding6romd16"c-Pdmhnppdoc t2/a3 � / //1.°M) 44n44i 71'(1IPo2/CAMAWa)
:JacobsHeating FAX NO. : Oct. 26 2005 03:03PM P3/3
- SITE PLAN
1
•
DIRECTION
HOUSE
4 `r'
•
STREET
- Job Name •""iY'Ih Ol cSeppor
Address
•
Model « 3 Z
Make
•
JACOBS HEATING & AC
4474 SE Mllwaukie Ave.
Portland. OR 97202
(503) 234 -7331
ma3) 813 -9257 fox
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200 &00723
13125 SW Hall Blvd., Tigard, OR 97223 . — DATE ISSUED: 10/28/7005
Phone: (503) 639 -4171 ArreN. �
Inspection Requests (24 Hrs.): (503) 639 -4175 M
INSPECTION WORKSHEET FOR DATE: 9/21 /2006 TIME: 7 : 02AM PAGE: 71
, 1 Z, /Z1
SITE ADDRESS: 12735 SW WLLS PL CLASS OF WORK:
SUBDIVISION: BELLWOOD NO. 2 LOT #: 083 TYPE OF USE:
PROJECT NAME: JEPPSON
DESCRIPTION: Furnace and AC.
OWNER: JEPPSON, TRINA PHONE #: 503 - 579.4198
CONTRACTOR: JACOBS HEATING + NC PHONE #: 503 -234 -7331
Inspection Request Scheduled For: Date: 9/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # y- -, -
699 Mechanical final 036790 -01 503 -234 -7331
Corrections/Comments/Instructions:
• ,
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C the Date: Phone #: (503) 718 -4
lilaud ioaik- g 7ri -1 wres
CITY OF TIGARD 1,4.- -
BUILDING DIVISION PERMIT #: 0.-°OS- '-0O123
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:rn� •
Phone: (503) 639 -4171 4 i
Inspection Requests (24 Hrs.): (503) 639 -4175 -i ..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 0 Sr � ,// s et.... �3 ' CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: j (�
OWNER: t _ PHONE #: 03) 6 j 79 — i-liq
CONTRACTOR: lA/ t n. q J .fie P Se-L —. PHONE #:
Inspection Request Scheduled For: Date: L/- I-1 -- 0 1 ? Pour Time:
Code # Inspection Description Confirm # Contact # Message
rr k %.V. .
Corrections /Comments /Instructions:
i fl,t4rielliei ✓ P4/1fT e Jl e 'Lc / z. 6 �i 5 / . v
_ 1 _
•
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
K FAIL ❑ CALL OR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Af Date: 1 Phone #: (503) 718 -2 ysid