Permit CITY OF TIGARD MECHANICAL PERMIT
= COMMUNITY DEVELOPMENT Permit #: MEC2010 -00428
Date Issued: 08/26/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S111AD03200
Jurisdiction: Tigard
Site address: 8945 SW PINEBROOK CT
Subdivision: PINEBROOK TERRACE Lot: 29
Project: Hagelberger
Project Description: Replace gas furnace
Owner: FEES
HAGELBERGER, JEFFREY Description Date Amount
8945 SW PINEBROOK CT Fumaces < 100K BTU 08/26/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 08/26/2010 $10.80
PHONE: 503 - 639 -5008 Minimum Fee Adjustment - Mechanical 08/26/2010 $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: 4 f PV71 / L,9-77 -e7✓
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.
Mechanical Permit Anniication
City of Tigard
sil
13125 sw Ball Blvd , Tigard, OR 97223 ' `1,0�% 5pro 1D i% ► c' i.o i y 26 eo yap
Phone: 503.639.4171 Pax: 503.598.1960 ��gy Permit: Inspection L sere: 503.639.4! 75 p. Data Ready/By . Am. B ice 2 for
Internet wWw.tigerd�r.gov Notified/Method: `
• •�( Supplemental
llnformatioo 's
kfp H5
TYPE OP—WORK.. .: COMMERCIAL FEE* SCHEDULE — U8E • : t a {
0 New construction Additioe/alteration/replacement Mechanical 1 fees* net based on the value attic watt:
Wormed. indicate the value (rounded to the nearest dollar) 6 < ^; .
❑ Demolition Other mecesnical materials, • ui • ment. labor, overhead. and • refit wj"
CATEGORY OP CON ..TRE C1 V
Value: S :: %
IIEEMENTIAL EQUIPMENT / SYS EMS sus* '''' `.-
�
1_ and 2- family dwelling ❑ CommerciaViadnsaisl ❑ Accessory building
`� For special Worm/mon we checklist.
0 ulti- family .. ❑ Master builder ❑ Other: ( Qty. 1 Ea. T. "} '
JOB SITE INsoEmkrioN AND LOCATION lleatli/moli `
Job site address: al S co , L �11(1`Co (< • C (nxluirea cu placement) f 46.75
C `' . 0 Ii • • aim Furnace 100.000 BTU (4uotalvemb) j 46.75 d .
�' s Pans= 100.000+ BTti (Conan/ems) 54.91
SuiteJbldglapt. no.: Project name: 6 ► S :.r sleet
61.06
Cross straet/dirocdorts to job site: Duct work 23.32
NYdronic hot writer system _ 23.32
Residential boiler (radiator or
• ronie)
2132 _
Lint henters (fuel -type, not electric),
in -wall, in duct, suspended, etc. 46.75
Flue/vent tar of above
Subdivisions: Lot no,:
23.32
23.32 1.11 a ;;
Tax map/parcel no.: Other fuel aup�aees
•�N OF VYO$K . . Water hoarse 1 I� °? ' .'
t _ Gas fireplace MEM
. d . •_ • ALA _ . L As. ∎- Flue vent for water homer or gas
23.32 1111 .•
_' •:;
Wood/Pellet stove 33.39
Wood firadasetinant 23.32
•, .7•1y -i' i1: • El' TENANT .. /finer/8advent 23.32
Other;
" '1 • Q , b A- Eoviro l etthaus t and ventilation :, � • , • ( / � Range bood/other kitchen 1 ;
Address: . v !A.A. • L - •ai.. .' 33.39 i'_;
City/State/ZIP: ` i ._ .clothes . esbauat IMMO
Phone: ,• -• , 3 I4jO' Fax: ( ) t Single-duct 1ei -• ,.: exhaust (bathrooms,
uiih rooms) :Oiler �,,• •,., utili
;. N • . . D cotriAcr PERSON 12 23.32 - `;
Other: , IMMO ;•
131tsme66 name: -, • , _ _ • .. -. r Fuel Wade
Contact tune: ANUARRONIMIC 814.15 tar first four. $4.03 tar each addieiooal
Address: AL b i ; t :
NEwscnG, OR 97132 WM..
City/StatelZIP: �
Phone: (jt?3) 5a,; ,_ C'. Fax :: (�3) . t — $ i 0 16 S �#
E-mail: Ii Mar • '/ &O .S CP.', A •--..., 6 tA).-- . .
ill Business Haste: •/ Clothes di (gas) I; t: Other. 11117
Address: AND AIR CONDITIONI .. , , MECHANICAL PERMIT
City /State/ZIP: , , / a = _ ii - PKW Subtotal
Minimum pates; the ($90.00) g 8
Plan review (25% of permit De) .
' CCB lic.: 9 - 7 r Ste State surcharge (12% of paten fee) /A
C�C TOTAL lxF.>lvlE • r /
Authorized signature: r This permit vocation mph Wa oesmit 1s iT noe • .,
elay after it has bean accepted es campleta
Print name: bj ! i ! 'y Dater a : ( 1 • P•• madiadolesy set by T^•Cogaty swum hbust Savior : .
L .der taco 440.4617T0I/024;01.IIWER)
COO/6001B 99108C9C09 XVJ 81 :Z1 OL03 /17Z /80