Permit IN r CITY OF TIGAR MECHANICAL PERMIT
I I
s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00682
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 2S102BD01701
Jurisdiction: Tigard
Site address: 12830 SW PACIFIC HWY
Project: Davidson Casual Subdivision: FREWING ORCHARD TRACTS Lot: A
Project Description: Replace (5) ton gas pack
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: DAVIDSON, WILLIAM G & DIXIE L
4474 SE MILWAUKIE 8915 SW COMMERCIAL ST
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/26/2012 $235.31
Class of Work: ALT Type of Const: Plan Review 12/26/2012 $58.83
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 12/26/2012 $28.24
Stories: Info Process /Archiving - Sm $0.50 (up to 12/26/2012 $3.00
11x17)
Project Valuation: $6,000.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $325.38
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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 m obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. >
Issued By: 1 I/et 1161 Permittee Signature: e K/ rn e 6 L /2)
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 ApplieB ft1t E 1 V. E D Received
FOR OFFICE USE ONLY
_
NI g' City of Tlg�ll d Permit N
• 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: 9 II d-- L p( -dO(p�
Phone: 503.718.2439 Fax: 503.598.1 0E C ( 2 C r V 2012 Plan Review
Other Permit:
Inspection Line: 503.639.4175 D ate/By:
T I G A R D Date Ready /By: Juris 65 See Page 2 for
Internet: www.tigard - or.gov CITY OFTIG �RD Notified/Method: 11 4, Supplemental Information
BUILDING DN
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction [ Addition /alteration replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, I r, overhead, and profit.
Value: $ C 7 00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: l a$ O 5v„) p L h l (requires site plan showing placement) 46.75
—�-' J Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP:
1 �c i Y d � - 0D3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: `) IrSOn C Qs a , Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
n l � Gas f replace/insert
eat for 33.39
water i Y � '(�� �� Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
J
— - CONTRACTOR Barbecue
Business name: ` 1,40/ - _1-i 4 td c Clothes dryer (gas)
Address: I "'i 1 vvv l 1t-+ �(' 'c o i Lt 5 C� ., t 1 � l Other:
R ip I � �� i MECHANICAL PERMIT FEES*
City /State /ZIP: 6 4 r1 Y1(+ p p q' O Subtotal
tit Minimum permit fee ($90.00)
Phone: h • y MP Fax: by . i t A A I Plan review (25% of permit fee)
CCB lic.: I State surcharge (12% of permit fee)
e - TOTAL PERMIT FEE 3dS_ 3
jitiri / l� (�C This permit application expires if a permit is not obtained within ISO
Authorized signature: t days after it has been accepted as complete.
Print name: Ili f j IA, I ' II- r Date: jc?.c.91!0 ./ a _ * Fee methodology set by Tri- County Building Industry Service Board
1 : \Building \Permits \MEC- PermitApp.doc 03/07 /12 440- 4617T(t1 /02/COM/WEB)