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16769 SW JORDAN WAY
(C CITY��� �� �1���D �MECHANICAL PERMIT
PERMIT#: MEC2003-0045.5
DEVELOPMENT SERVICES DATE ISSUED: 08/04/2003
131,25 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S116AD-29600
SITE ADDRESS: 1676:) SW JORDAN WAY ZONING:
SUBDIVISION: BEDFORD GLEN JURISDICTION: KIN
BLOCK: LOT: 062 --- ��- —
CLASS OF WOR r(: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF U:E: SF UNIT HEATERS: VENT FANS:
VENTS W/O APPL: VENT SYSTEMS:
OCCUPANCY G��P:
STORIES: _ BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 3 VIP: DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS'?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K rZT.': AIR HANDLING_UNITS _ OTHER UNITS:
FURN >=100K B' �' <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install exterior 1 t nine I to nut place "ulun the required setharks -
Owner: --
FEES
_�--------- — -- -_
Description Date Amount
LINDA MILLER _--_ --- +-
16729 SW JORDAN WAY X11 t I I IYn,,,t Fee 08/04/20 $72.50
TIGARD, OR 97224 I \ „ tit;,tr l a� 08/04/20( -- $5.80
Total $78.30
Phone: 503-W-2144
Contractor: — --- -
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE REQUIRED INSPECTIONS
PORTLAND, OR 97202 -
Final Inspection
Phone: 503-234-7;A I
Reg #: LIC 1441
This permit is issued subject to the regulations contained iii the Tigard Municipal Code, State of tyre
Specialty Codes and all other applicable laws P.II work vdill be done in accordance with approved
plans. I h.: permit will expire if work is not started witiun 180 days of issuance, or if work is suspended
for mot- than 180 days. A-11-TEN TION Oregon law requires you to follow rules adopted in the Oregon
t!tili.y Noy fication Center Those rules are set forth in OAR 9152-001-0010 through OAR
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)24C -6699.
Issued By: �i3l
>Z_ _� ___ Permittee Signature: 'r7 ----
9-4175by 7:00 P.M. for inspections needed the next business day
07/31/�:303 12:58 5036393771 CITY OF KING CITY PAGE 02
Mech.a�al. Permit Application Received1�;n;3
Date/13y; / d 3 Perm!t No. /L V°3-
n7lty:Ap ravel Building
D --- —
L3�235 -+�iA Blvd. ' 0 I� aM�iPermit No.:
Re
Plan Review Uther
TigaW-,Qregee-97223 �C,•} Qrg7�-I Datt/ny_:-_ J Permit No.
d Use
Phone: 503-639-4171 I ax• 501168-19150
Post-Review [aseNo.:
Da�c/D13y: _ Case No• _
Internet www•ei.tigard.or•t:s Contact curie.: see Page 2 for
24-hour inspection Request; 503-639-4175 NemelMethod: Supplemental Information.
.,, RC t12i`t+'Elr K'HEp{ ,1ri? 5 fl .�y, •,!
Fel*i41'i� (�; i �I� MF. iVI',1W\i14�:.a •ply; .,.I .t I sir -- - NSM _
aw
New const-uction Demolition Mechanical permit fees' are based on the total value,of the work
Addition/alteratiott/re laeement Other: performed. Indicate the value(raunderl to the nearest dollar)of all
t(.0RV?QF-CONST i1(7 - mechanical rnatcrials,equipment-,labor,overhead and profit.
2-Family dwellin Commercial/Industrial values S_ _ See Page 2 for Fee Schedule
u D _ ctA1,'>tr4vtpnc riT/s' Y t;�5 DULE
Ace-ssoryBuilding Multi-Family t4s
...... — Deacrtption Qtyee ca. Total
Master Blinder Other: _ Naarh! Contin
4 iM TIO :d't#i1" 1;1 JO i umace-add an air conditionieM;"• 1400
Job iite ad.lreiss: Gas heat pump 14.00
Duct work _ 14,00
Project Nam,;: i`' H dronic hat water system _ 14.00
Residential boiler
Cross street/Directions to job site: for radiator or h dronic s stem 14.00
unit heaters(Net,not a ectric)
in wall,in-duct suspended,etc i 14,00
Flue/vent for any of above _ _ 10.00 _
Subdivision: _ Lot#: Repair units
.� ____._���u'•1 Alf ianCiN'. �-
I ax ma / acne)#: Water heater 10.00
>C Vb A�: :�h :i' Gas fireplace 10.00
Flue vent(vrater heater/ps fireplaer!)— 10.00 _
_-- T — -- Lo li hter as 10100.
—— Wood/Pellet stove 10.00
Wood fire lacelinsert 10.00
--_ Chimne /liner/flue.�vent 10.00 _
Other: 1000
Name:
Mange hoodlother kitchen equlpr gent 10.00
Address: S I� ��
LU-1(o9 � '�' 1 Clothes dryer exhaust 10.00
Cit /StAtC/Zl t I Single duct Ahaust T T
P e. Fax: I (bathmotrA,toilet comp:+rnnents,
X11 '1 ! l'''i'?"ad.'?•^.Lw iii r AMC-"1PISYZS. {L. unlit roorns -- . 0
Attic/craw space cans —_ 100.000
Other: 10.00
Address:
Cty/State/Zip: _ C;,�_� _ 5A0 for first 4,51.0 each addittona .-
P11vQe: -- Furnace etc
•'
_ Gas heat pump
E-mail:N WalUsuspcnded/unit heater
R'/iN",
v,L,1ir Water heatel •• _�-
Business Name: C, r Fire lace "
Range
Address: A)G"'t K' R- aBg-- •� —
_City/StatC/V4 _)A 1 1L r- 1 .1 Clothes dqvr as
_Phone: � �•���. - `� z� � Other: _ »•
CCB Lia #. --'— 'rt,tal_ -
—Mee t eYil Permit*m.
Authortfui Subtotal: S
signatua.. Minimum Permit Fee 572.50
L>� — Plan Review Fee(25%o of!'ermit Fee). S
—) - state Surcharge 8%of.ilei mit Fee
(Please punt name) -
�� __ TOTAL PEI1tMIT FEE r
Nnti•cC This permit application expires If a permit is not obtained within •Fre methodology get by Tri-Coualy Building r.rdustry e c rd.
Igo days aftrr it has been accepted as complete. —Site plan required for esterlor A'C
i'4isis\PermitFortwweci'emutAppdoc Of N3
' N=�F:193771 CITY OF KI AG CITY PAGE 93
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