Permit IIN
a CITY OF TIGARD
MECHANICAL PERMIT
a'J„ COMMUNITY DEVELOPMENT Permit #: MEC2009 -00666
. 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/15/2009
T [GAR 9 Parcel: 2S110DD05000
Jurisdiction: Tigard
Site address: 15650 SW OLD ORCHARD PL
Subdivision: Lot: 0
Project: Barker
Project Description: Replace gas furnace.
Owner: FEES
BARKER, CAROLYN M Description Date Amount
15650 SW OLD ORCHARD PL
TIGARD, OR 97224 Furnaces < 100K BTU 12/15/2009 $46.75
12% State Surcharge - Mechanical 12/15/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/15/2009 $43.25
Contractor:
FOUR SEASONS HEATING & A/C INC.
1005 INDUSTRIAL PARKWAY
NEWBERG, OR 97132
PHONE: 503 - 538 -1950
FAX: 503 - 538 -0165
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: AA R i n �l a / Permittee Signature: SS N
Call by 7:00 a.m. for an inspection that business day.
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 A lication 1 (11: 01 1 it 1 1 1 i)\1 1
City of Tigard ECEIVEl ,l PlamitN°. V_ He 4 .00 II
13125 SW Hall Blvd., Tigard, OR 97223 plan RcvieW r •
' _ I Phone: 503.639.4171 Fax: 503.598.1960
DEC 1 4 2009 �g alt:
\ u , Inspection Line: 503.639.4175 Date Ready/By: Inn SI So Pip 2 for
Internet: www.tigard- or.gov Notificd/Method:
CITY OF TIGAR • Supplemental Information
.- r ' TYRE c N( 4NE IIING'
Mechanical permit fees* arc based on the value of the work
❑ New construction , Addition/altcration/replaeement pied_ Indite the value (rounded to the nearest dollar) of all
J Demolition ❑ then: mechanical materials, equipment, labor, overhead. and profit
• . Value:
• dwelling iiridu h al El Accessory - , ', y g ❑ ry build Rl�&Ib�Et�KL.EJIPM�t1Ti ! $Y;Mf FEW 1 - and 2-family -
For special information use checklist.
❑ Multi- fttmil Y El Master builder 0 Other: Description i Qty Ea. ! Total
JQB 81T .1NFOR'MA � ( :AANH,,' ' LoN Q _ Heating/cooling
cl i
Job site tutldress: 5(OS0 . 50 Q tC7l ' c A Y 1f C Air conditioning p
(reserves esitte plan showing placement) _ 46.75
CitylStatc/ZIP: 0/r 1 Furnace 100,000 BTU (ducts/vents) 46.75
Suite/bldgJept. n o.: Project name: Q�� ,�� ��j Furnace 100,000+ BTU (duets/vents) 1 54.91 API,c1 f
l•.Jt1T,4 Heal pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydmnic hat water system 23.32
Residential boiler (radiator or •
hydronic) 23.32
Unit heaters (fuel -type, not electric), '
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.:
Fluelvent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances
,, , DpSCRlPT1O$ :!(AE 'sy0R .' ,; • Water heater 23.32
j� Gas fireplace 33.39
j �.(1 `(S. 80 f U,r- Ait .`e Flue vent for wader heater or gas
�" emplace 23.32
Log lighter (gas1 23.32
Wood/pellet stave 33.39
Wood fireplace/insert 23.32
- Chimney/liner/flue/vent 23.32
U.!-PRo#r,1CPY OWNER ,h1'.' '0T. ,
Other: 23.32
Name: O. t � J i.i..�� Environmental exhaust and ventilation
:
. Range hood/other kitchen
Address: I `, 0 . • r. I 41 I I ! -e. - equpment , 33.39
City /State/ZiP: i , Q, f-dt, 0R - 1 clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) ■- 016,q61 Fax: ( ) toilet compartments utility rooms) 23.32
!• .:APPL CelNT CXEKTACT iIRSON " Attic/crawlspace fans 23.32
Other. 23.32
Business name: k-rhII $ A$f IIJ KEATING Fuel piping
Contact name: AND AIR CONDITIONING, INC. $14.15 for first four; $4.03 for each additional
- 10051NIX - JSTRtAt "PKWY Address: Furnace, etc.
NFWBFAC, (' 1 471=x2 Gas heat pump
City /State/ZIP: WalUsuspended/unit heater
Phone: (566 ) 5 b$-I1 C ) I Fax:: ( ) 5 g ^o 1 Cow Water heater
Fireplace
E -mail: Range
Barbecue
Business name: Air AIR 'HONING `I�VC Clothes dryer (gas)
VY other:
Address: 1005 NM) TRIAL P enaNicA1, PERMIT Fes,
City/State/ZIP: Subtotal
FSx: ( ) Minimum permit the ($90.00) eye , o-b
Phone: ( ) Plan review (25% of permit fee)
CCB lie,: y �j • State surcharge (12% of permit fee) / O , _
9 "1 �� ' �/ TOTAL PERMIT FEE /p0 Xt,
Authorized signature, : This permit application aspires if a permit la not obtained within ISO
days after it has been accepted as complete.
1Y
Print name: 11 i 1 , L__,, , . Date: o il • Fee methodology set by Tri•Courtty Building industry Service Board
1: 1BWIding \PMaim<ttac,PatmltApp,doe 10/01109 4404617T (Ion /COM/EB)
E00/E00 Xb'J 917 gl 6002 /b1./Zl