Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00050
r11� 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 1/26/2006
PARCEL: 1 S134CC -03700
SITE ADDRESS: 12436 SW WINTER LAKE DR ZONING: R -4.5
SUBDIVISION: CAPSTONE LOT: 004 JURISDICTION: TIG
Project Description: Replace gas furnace & A/C unit.
CLASS OF WORK: OTR 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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
BONNIE DEAHL Description Date Amount
12436 SW WINTERLAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 11261200E $72.50
[TAX] 8% State Surcha 11261200E $5.80
• • Total $78.30
Phone: 503 -524 -4177
Contractor:
JACOBS HEATING + NC
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 234 -7331
FAX 503- 813 -9258
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: 91
Call 503- 639 -4175 by 7:00 a.m. for inspections that business ti .
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.
.i
:•FROM :JacobsHeating FAX NO. : Jan. 25 2006 03:55PM P2
Mechanica Pe rmit :r i,LL 1.
City of Tigard V 7 5 • , E f p t - c 11125 S W Hull Blvd., Blvd., 'I'lgnrd, OR 97223 �" Review
Phone: 503.639.4171 Fax: 503.598.196 iz;,�• -1 Other Permit:
Inspection Line: 503.639.417S A N 25 5 2006 . � - - Dale Ready/By: ' ru ) i0 Sec Page 2 for
Internet: www.ci.tiganl.or.ur: Notificd/Method: ) 1 Supplemental information
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❑ New construction ® Addition /alteration ' . II - t Mechanical permit fees* are hauied on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. _
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® I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
VIM h' c • f'+n,) r n nrnit' , nlr. re 1$t , n n muw6 Ilan d rsl ; ' 1'14 n-t,
❑ Multi - family ❑ Master builder ❑ Other: For spacial J Hatt checklist.
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Description k P..n. I 1
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tl. 'C11�d1#NC , - +GSI;G�•�r1�dGd� s >>'• 8r. ar x •ru ,, 1;loatinyfcoolinR
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lob site address: Air conditioning or heat pump
`
I
� ( CJt.L) - . L '�C X 1_ _.. _, �/r• (requires site plan showing placement) 14.00
City /Stmt./ZIP: `„ w Y d b Furnace 100,000 BTU (ducR/vents) 14.00
Suite/bldg./apt. no.: : ` Project name: Furnace 100,000+ BTU (duets/vents) 17.90
- . - •-- __..__._ .. ,.... ............._-- -__ - -- Otis hear pump 14.00 _
Cross street/directions to job site: Duct work 14.00
HycMmic hot water system 14.00
Residential boiler (radiator or
hydrunic) 14.0(1
Unit healers (fuel -type, not electric),
in - wall, in - duct, suspended, etc. 10.00
- .._..._..__ ......_._ - . -
Flue/vent for any of above 10.00
^ Sttbdivisiom; - - -- Lot no.: _ Other: 10.00
Tax map /parcel no.: Other fuel a r >Ilancea
r>rt - ;,1 , ;i
ill 'mai 1 ii :Erli f ! ' 1 t n.# i �n .;:1 -.4. .. '. l _ i a ,. ; l F I' ... ',,It tI , liliy water heater - -- 10.00
' i i tins fireplace 10.00
3 • ' Y \OI,Ca Flue vent for water heater or gas - -
e - fireplace 10.00
I..og lighter (gas) 10.00
Woad/pellet sine 10.0(1
Wood fr 10.00
111 RI' f +^�Y' t�)p gnl P y Q9, : wu n r i t rnj a 9� 'r e , 1 I'1 [ r r ra i 1 r I ll • u� ��Au��;� r Chimney/liner/Rue/vent
/liner /Rue/venl lo.00 - - - - ^-
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+ 5 ; l} ..' 0 K1 #5 r9 -IS 1r li, :.',)11`,;. /.. 1lSll ,i��1 0 ' ' l I � 14 .,;Al so t I ) Ocher' 10.00
Name: ‘(\■." j ` O V Environmental exhaust and ventilation
Range horxl /other kitchen
Address equipment 10.0(1
Ciry/State/ZlP: Clothes dryer exhaust 10,00
_.... _ _ .. _.. , ....._. n_ _. Single -duct exhaust (bathrooms,
Phone: ( ) 3 y, 7 7 Fax: ( ) toilet compartments, utility rooms) 6.80
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i iultlit, 6 ; 3 fil ...14 ' sati assRtiiset ' i t aa=ttisisasissitittat loftiashu11 1 ..� ; Pa fi r. r' adiiims,d1i,iiati :Ri Artic/crawlspacctsns 10.00
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Business name: Other: 10.00
-------.....__.._......._._.......... _.._._.._------------ --- _._._.. ..... . .. - - -- Fit elillring
Contact name: $5.40 for first four; $1.00 for each additional
Address: -
Furnace, etc.
- -- -- - - - -- - . _...._..... Gas heat pump
C i ly /51aie/7.TP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) -- Water heater
Fireplace
l - mail: .... _.. - -
W TI 1 , t� , lt r t � lv tl + t w I U MI 9 , it �� Range
, l�rr I r h • s .' Vi i` , , � t , a Y 7` e I�,, i+ r i I tr{h + 11 gI r�� {� 1', i { t t `t �F 'j� �{��� a THE Bathe.
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Business name: Jacobs Heating and Air Conditioning Clothes dryer (pas)
Other:
I1yy}� �i { ', , n I 1 7,�` 1 1 n u, + r1I, rn, ? :'
Address: 4474 SF Mllwapkle Ave '1(1}tY��f419[jR t t 1 t! 0�t[J n tom+ ilk' F a{, t l'� s n _i.t
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City/State /ZIP: Portland, OR 97202 Subtotal
Phone: (503) 234 -7331 I Fax: (503) 808 -9108 Minimum permit fee ($72.50)
Plan review (25% of pet hilt fee)
I
CCB lie.: 1441 State surcharge (8% of permit Ice)
-....
7'O'.1'AJ. PERMIT }''EE
Authorized signature: •I Ili permit aa motuitiop expires if A permit Is nut obtained within 180
days after It bin Ileen accepted AF CIITpMte•
i Print name_ felumattA4eGerntiek £ NN ` t , • a r )ate: i v . I • Pee methodology act by Tri {County building industry Service Board
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z1-.... :JacobsHeating
FAX NO. :
T ‘,. . Jan. 25 2006 03:56PM P3
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CITY Of TIGARD -
BUILDING DIVISION PERMIT #: a 0 � to )
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639-,4171 , 1
Inspection Requests (24 Hrs.): (503) 639 -4175 ,_'!`� °TI I .. �� c...2.0.0 S —v00
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /� [ L ? /, '�" " CLASS OF WORK:
SUBDIVISION: 7 J t" LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
1
Inspection Request Scheduled For: Date: 3 - " /U '" 0 6 Pour Time: i �
Code # Inspection Description Confirm # Contact # Message
5 y 6 9 l 3q— 733
Correctio s /Comments /In ructions:
I= -
r i ` L/-e_ - ( /& 6_
/iv e,.. pAlie-L___ ze, ,4_74-1,
A- L u'v/r i1- t(7 H * 7 _,--,4_741
()..--4--ta _.-1-_-Aisf-ALL___ e .,;(,&,-, 7 , _Iii-e.._- '6,"2(/1 r re;ie
Li ST7nUfri I I a : 1-
The eiectrlcs+l installation defocts noted
on this report shall be corrected and
an inspantinn requast made within 20
calendar days per OAR 918-271 -0030
�
'. PASS M PARTIAL APPROVAL 1 c g ❑ CANCEL ❑ NO ACCESS
FAIL %,CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
f 3,/0.0----
Inspector: Date: Phone #: (503) 718- 2-
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