Permit 4 CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2010 -00434
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/27/2010
. Parcel: 2S114AB05900
Jurisdiction: Tigard
Site address: 9325 SW MILLEN DR
Subdivision: KNEELAND ESTATES Lot: 46
Project: Wilcox
Project Description: Gas furnace installation.
Owner: FEES
WILCOX, DALE G /NANCY A Description Date Amount
REVOCABLE LIVING TRUST, BY DALE Furnaces < 100K BTU 08/27/2010 $46.75
G /NANCY A WILCOX TRS, 9325 SW MILLEN 12% State Surcharge - Mechanical 08/27/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/27/2010 $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: Permittee Signature:
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1
Call 503.639.4175 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.
08/26/2010 14:53 FAX 5035380165 Z002/003
Mechanitc 3�aE:: �p �
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Phone: 503.639.4171 Fax (` Y. V
13125 SW Hall Blvd-. Tigard. S0 9 7223 � Y� 1 po ?rrrr.:i:
�� Cj T. Internet: ww. 043.639.4175 , \ � ��`�`: Ba R T. rum• Et time Posy x for
1taG'ati www.ugmd- or.®ov : No sup pkmettnt tadontraden •
ME OF` K • )v- .. ' COr►11'4M 1AL FEE* SC EDULE - USE CHECKLIST
- • 1 Moc need permit fast are based on the veins o the waste
0 New construction 0 Addition/altamriode•Pla�tmt per:b :med• Indicate the value (rounded to the nearest dollar) of a4
r,.a
e:;.al roared:11s. e4uipmeet, labor. overhead. and profit.
Q p�tolitiOrt Value: S
CA`f"E4'ORg •OF' C ' • RESIDRNTIAL go(3YP'of Exr / sysrEvis war
' :4 1- and 2-family dwelling ❑ Commercia1mduatrial [7 ACcessc?y balding For *teal information we checklist-
0 molamily - 0 Master builder ❑ Other. Description I Qty. Ea } Taal
JOB SITE INITI3MATION ANDALOCATION !K4adng/eoellaa
•
" €X' tr is ne06 site i
s
I L'3: 1( le Ala>• }cow,ac nu: 0==Q 11 I 46.75
Job site addteas. j u
�j ,:•-asce MAO (duos j 46,75 ,.
r 1 Z1P: f ,. � c) K.. � a�' _ 1. Ft, 100.0004- Br.; (duciatvalls) , 54.91
c. Sueebldg./aPt• no Project name: i r Hex; clamp 8 61.06
'Duct wort: 2332
Gass street/directions to Job site: ,_- -- Hvdroaie hot water systau • 2332 -
• Residential boiler (recast' or or
hydronic) 23.32
- Unit heaters (fuel -type, nor electric),
in -wall, in-duct. suspended. etc. 46.75
i — Flue/vent flu - of above 1 23.32
Subdivision:
l Lot no.: Other i 123.32
Othea fuel appliances
Tax m plpar 119.: Odle?
heater 1 23.32
. .. 0 or W00g1L.. .
i- .: -•lece 33 -39 • Fiuc
tit for water heater or gas
WWI : •+ `! &wine 23.32
23.32
Wood/pellet soave : 33.39
Wood , - insert ' 23.32
•
• Chitnnev/Ih lilac/vent , 23.32
• ►. PROPERTY Other: 23.32
- Tvi ronme .tai eelftu= and ventilation
/ ,; - ' " ' —" bood/otbct Idicltcr.
Add: g . - r-t,l I!t..4 Dr en ; 33.39
r , Z :lot; as deter cxhau. 3339
City /Statel2:IP' O 2 1 Siagie -door exhaust Coatrooms,
_ : 4 : 1 * Fax: ( ) � 1 ! ziitt compare ects_ utility rooms) 23.32
0 AMMAN" . . . (] COATTACr PERSON - Atticicrawkpace fans 23.32
•
Other: 23.32 ,
Business missile: t
Feel oildna
S14.3S for tirst four: S4.03 for each additional
Ganda name:
.: . - • . ` .: -I' , . I. =seas, axe.
i Addrase: L d ip _ : .•., a 1 111 e INC. - G cm s r pump
1 t�,/State/Z1P: 1005 INDUSTRIAL PKWY walusrspcadoart mil. heater
. - _ .4t.. : ( ) Water hearer i
Watt nee
Zama: Rend
CONTRACTO* . . i3a. -baa:c
i Clothes dryer (aa)
:, . Bt�n� mule: • , : - , - _ . • , . - _ 1: - . _Clothes
`` Add'resa AND AIR CONDITIONING INC.
n r. eye r ., .
City/State/Z1?' _ _ •:: : ► Minimum permit . . • 1. e, a , ' el I ,u0 •
p Phone: ( ) Fa= ( ) Plan cavity :25% of pariah the)
State autoharps (12%o:' meth fca) `f 1g V
'TOTAL PERMIT FEE < L4
�, Ibis penult applleaden expires if a (raga is not . _ . s
ii J
! AutlxO d � :,. , A l i i + — � eay nite a eau nom, ,oee s oor eye loci
( r" ClailIPL - Datc: • d • Fan methodelow set by Tr;Coaniy Building industry Service Float •
1: noaelsa1A®intterd eftym.dee 10101100 440.40/1' (f I ..1tOM/WSS)
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