Permit CITY OF TIGARD MECHANICAL PERMIT
III :'1 COMMUNITY DEVELOPMENT Permit#: MEC201300599
Date Issued: 10/09/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134AA00700
Jurisdiction: Tigard
Site address: 11340 SW IRONWOOD LP
Project: Bennett Subdivision: ENGLEWOOD Lot: 14
Project Description: Install gas furnace.
Contractor: JACOBS HEATING&AIR CONDITIONING Owner: BENNETT,WILLIAM R BETTY
4474 SE MILWAUKIE 11340 SW IRONWOOD LOOP
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-234-7331 PHONE: 503-590-7117
FAX: 503-808-9108
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 10/09/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 10/09/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/09/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
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.
Issued By: Permittee Signature: 0/ 4170/06/6.9-770.1
4{
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.
10/08/2013 16:03 5038139257 PAGE 02/02
Mechanical Permit Application
City of Tigard •' Received
a 13125 SW(tall Blvd.,Tigard,OR `�� Dal : /t' 9 /-3 � Perim`" E2ef3°DOS9�I
mod, 9
= Phone: 503.718.2439 Fax: 503,598,19 ��13 review O h t Permit
1.i c;;-.1,i:) Inspection Line: 503.639.4175
��y:
Internet, www,tigard-or,gov V Qo Dste Rmdyrty_ r ' /! S See pear i for
C� oliOcd/Method; �,•(�f SapplemenLLllnfarmanon
TYPE OF WORK ��\ ‘3‘ .MM_, X
Meclumleal permit fees°arc based on the value oldie work
❑New construction In •ddition/altermion/11 ,1 11 ent
perlbnned.Indicate the value(rounded to the nearest dollar)of all
. ❑Demolition ❑Other
:CATEGORY OF Diti-uid 2-family dwelling ❑Commercial/industrial ❑Accessory building For special intronnalion use checklist.
❑Multi-family ❑Master builder ❑Other: Docription Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Hall" "
Air conditionin Job site address: 1 13'-f�0 r-(,J FCD,nlA !.∎ 46.75 UM
100 000: I 46.75 UM
City/State/ZIP: "—r--t !4,{f-ICJ? OR_ CI 7 • •,r Furnace 100,000*BTU(duets/vents) 54.91
SuiteMldg,Japt,no.: Project ntune: Heat um 61.06
" Duct work 23.32
Cross strew/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
dronic _ 23.32
Unit heaters(fuel-type,not electric),
in-wall.in-duct,suspended.etc 46.75
Flue/vent fbr any or above 2132
Subdivision: Lot no.: Other: 23.32
Other fuel a • lances:
Tax mapiparccl no.: Water heater
DESCRIPTION of WORK • Gas fireplace/insert" 33.39 II
Flue vent for water healer or gas
7/ r t' C Q - fireplace
Lott lighter(gas)
Wood/ Oct stove
Wood ti lace/insert 111 23.32
Chime fliner/Oue'vern 23.32
ERTY OWNER r ❑ TENANT =111.
En:roomer:0H c%Must and vendlation:Name: !. • (Ns_ Range hoocVoiher kitchen
Address: /
_ Clothes er exhaust 33.39
City/State/ZIP; Single-duct exhaust(bathrooms.
Ulm co .,, menu,utili rooms 23.32
Phonci ?) I O-1 1 1-1 Fax:( )
23.32 NMI
❑ APPLICANT. ❑ CONTACT PERSON •
Business name:
514.15 for firli S4.03 tor each addidonal
Contact name: Furnace.ete.
Address: Cas heat um
------ Wall/sus ended/unit heater
City/State/ZIP:
Water how
Phone;( ) Fait::( ) Fi 'Mee
Ran_e
E-mail:
CONTRACTOR Clettam d r :as
j Other, IIMMIMIl ■Business nanrcL=C;L - e /--Ni-A,
Address! �L ,e r}'1t 1t...J� 4�/ MECNAAT(CALP6RMlITFLES"
city/5later�tP: Sabtotat
t` i y R. 4-7-- . l�finimam remit fvu(59000) erO
Plan review(23%of permit fcc)
1r 3,D1 Fax:( S-C iCSi State surcharge(12%of, it fee) . ,l.)
1 ccn lie-: ' d+411 TOTAL PERMIT FEE IC1O, . '
- w TN permit apprteaaon expires If a pemli is hat obtained within IRO
��V�.4,J�._. ! C' ' ` r days set by has been accepted AP eomny Sc
Authorized si alure: 4 ' Fee methodology set by Tri•Caunty Ituilding Indastry Sen we tread
Print nanre:f>.€ }G,".•a --Y-It.../-4-y- Datc:I'D
._�l'jt ld al'%tIC'_PrniiApp„Ototitdoe r 4i0.61Tr(IlIn2/COWWfaL)