Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00186
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2013
T t �' "� R O g Parcel: 25111 8001801
Jurisdiction: Tigard
Site address: 14850 SW 100TH AVE
Project: Odell Subdivision: ALDERBROOK FARM Lot: 5
Project Description: (1) A/C replacement, (1) gas furnace replacement and (1) chimney liner 4/4/13 REPRINT to correct description to
add the following: Placement of A/C must comply with manufacturer's clearance requirement
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: ODELL, ROBERT CHARLOTTE
4474 SE MILWAUKIE 14850 SW 100TH
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Air Conditioning 04 /04/2013 $46.75
Type of Use: SF Furnaces < 100K BTU 04/04/2013 $46.75
Class of Work: ALT Type of Const: Chimney /Liner /FlueNent 04 /04/2013 $23.32
Occupancy Grp: 12% State Surcharge - Mechanical 04 /04/2013 $14.02
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $130.84
Required Items and Reports (Conditions)
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 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / / n
Issued By: � d' f Permittee Signature: )4 A�n "P�-/ e4 - 7740d
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.
PAGE 02/03
04/04/2013 09:40 5038139257 am
Mee ip cat B ECE+I V `j E1 rt)l: or r.1(.4.. I''- l_ (.)\ 1.
City of Tigard Reeti"ad 1 3 S
13123 SW Hall Blvd., Tigard, OR 97'223 : '-' R 0 4 2013 tamer
.14.., ' . Phone: 503.639.4171 Fax: 503.598.1960 Ply
Inspection Line: 503.639A 175 DernrBr: 6` Permit:
`: a `t"
Internet .t .ti CITY OF TIGARD °�
g� -cr'0cev Nodded/Method: 9mPage3for
BUILDING DIVISI� :PPkmeatal Iafaets,rltlaa
F - FT,Cr_.:; 37 -, 5-: ; .•p.v6IA ...-2:::::;2. i r; . :: .1 ' 'T • `rh`29t. • a: -.7 " . -' r °- -
.: s.. a � r : ^... ` nr . 5.: ` a : . 1 .!mow. 1 y
.:,r1: ... 1 ..:� � :._1a: �: . : .Y � .� w : y , � ! S: , . s � . • '�� G _S I � �.�•vr r1 . - � - � / ry
CI New constructi ►- 11ry 1 dit,on/alteration/replecement
Mechanical permit free are based on the value Of the worm
❑ Demolition Other: per med_ McDade
materi• i.,ge the value (rounded to the ep.d newest dam) ..fi of all
=r `� l,__, labor overhead red ..fie
iff. � - ?ie�1 `L'r4 1 1
71�h 'ti. ��j`.r:�� w �.: ::. `1
:'. - - -_ _.dJ� •.m ce...:^t':.: r. •a, .. ' r . - 'r !a Value;
and 2- lbmily dwelling ❑ Commercial/ind al Accesso b " + �'' - 1' Fi n,t , 1 . : .
� f ; ' h
' '' ❑ rl uildi eg stc :114: 5_a_. _.:.. 1'` !.;. Z ,5' r
❑ Multi - family ❑ Master builder 0 Crthcr
Far > l ullorrrsoAdv,>era dietNtst.
r . .,, , : ;.rc:- ^» -:; :� ,., _- _ Desrn , :on I Qty l fin. Total
-Y _ •-•JJ.e .w._ -i-:- � .;:[' s.... . r r -• - � ^ `" • ,7,43:% . _'' giiE 4 fiatf�/eool
Job site addheas i J lJ r� • _ j V A ir conditioning
°fry/State/ZIP: �( `' 6h ' ••• .... 1 46.75
l (� � f Furnace 1 t s t e BTU detra: 46 . 75 •
Suite/bldg./apt. no.: -J • ` Nod Oct , e �l Franca 100 1 1 BTU (ds � 54.91 im
1 pump 61.06
Crass Strett/dimtions to job site: Dun work
23.32
H • • .. e hot water system 23.32 In
Residential boils (radiator Or
dtvrric 23.32
Unit hooters (fuel -type not electric), -
in-wal in-de - ... dad toe. 46.75
Subdivision: ao : Flue/vent fbr any of above 23.32 r
Other 23.3,2
Tax num/pram! no.:
, _ Oilier fuel a • .Planets
t'• °4;ir am X'!'!V`_.".=5;T ^t rr •g•Wi',/7-. �6):f - a.:- ....t.r.:R7 •'7� -
n:tt.� K ems: - .. ... _ ..L e - '
� r �� r � ::'-:.nr'� -.+.,. � Y� ., ' . -. heater 23.34
Gar fireplace 33.39
l Flue vent thr water heater or gas
0 l e �.- ... • • e `� fireplace i ♦ I'oR lighter WO 2332
IF/1
Wood/. Bet stove 33,39
= . . �. _
' - �' :~ l A:..�;,• •rr.._ ,.,., .,...' nr .. .� •. . _ Wood 47th, rt 23,32
w r .,��': •_N : � : _ = .. : :.:-... . ler :
. ri.; ...i�.+r :.ti.:! %.�fr_ ::.' :_..... ,.•�� " i , �,.c•.•.f.. Citimn inn/Rue/vent
'. ;`.. ... }- -rrak ;fx: :'X-L s..:•%.77i' Other 23.32
Name: - G A.c 23.32 NM
• E a.ironmerrtal exhaust oarl watitwoa
Address:
hoodJO• kitchen r PIS
City/Smear: ui- trK
Phone: (5 - ` Fax ( )
Single-duct i lee t:ta exhaust ( 3339
� �� ....,:,�,.. • 23.32
L•!iC :. r..._2'Jt 2 f.- s { a:.•r:= . .1i'Eco 'Oita' .g.4 ' • : 1 'jC; t ` ' . K :: ' 7 �..- .` i lc: 1: .7 jy�, ♦ � has 2332
..iA __. .:A'TWs1w. ...'}:�AS .�:11 �•�y1,y •�W� C�r�SV�QpaCe 10115
Benen,�s name;
Other.
name: Ihiel . 23.32 IIII
Address:
S14.15 for fir rt four 54.03 fbr each additfonei
Fun
•.. ate -
City/State/ZIP: _
Wall/ Gas brat Pump ���
Phone: ( ) I Fax:: ( ll/ dodluna heater �
E-mail! ) MINIM'',
Business name,: Jacobs Renting & Mr Conditioning V .1 �s� G .: 4:-:_ Clothes d _�� V C31.
Add
rrsf: 4474 SE Mllwaakie Ave _Other_ dryer ��,. ���
City/State/71P: Portia OR 9720! fi
i . a � 5 � i•- c ; i •' ° _ f �� !!�^�
_ _ :.� r- T3:A
Phone: (503) 2,34-7331 Fax: (503) 808 -9108 Mitirnain • _ «
n fLe (490.00)
CCD 11c.: 1441 Plen review (Mc, • - • it fbe)
State setrchergc (12% O r
f permit fee) zicli
Authorized signature:
IrritilW �-T TOTAL PERNH1 FEE intm
Print 'a' • • t nil PAM applfnnoe a:pfrp tr a ml where
re IIti.'1riv Date: t� �4 dm aner k ti,n b sa oplrwe t b w 00! cep d:p,}
I ale i0001/00 Fe e methodology u! try TM1 Ce.mtr SWdiog
lad Servior Moan!
440 (11 • ••A rents)
04/04/2013 09:40 5038139257 PAGE 03/03
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