Permit CITY OF TIGARD MECHANICAL PERMIT
14
>: COMMUNITY DEVELOPMENT Permit #: MEC2010 00479
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/01/2010
Parcel: 2S103AA01914
Jurisdiction: Tigard
Site address: 10490 SW JOHNSON ST
Subdivision: Lot: 0
Project: Baker
Project Description: Gas furnace replacement.
Owner: FEES
BAKER, DEBRA JO Description Date Amount
10490 SW JOHNSON ST
PORTLAND, OR 97223 Furnaces < 100K BTU 10/01/2010 $46.75
12% State Surcharge - Mechanical 10/01/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/01/2010 $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.
6 =car,„ , e rd e., ,, ‘
Issued By: -.00- ` Permittee Signature: �� iN
CaII 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.
09/29/2010 08:32 FAX 5035380165 12002/003
. :
Mechanical Permit AntolicRaC ED 1 i ,I, „I II, ,. 1 ,1 ()NI I
Received
City of Tigard DatrJBy; q 411115EIMI=
13125 SW Hall Blvd., Tigard, OR 9 722E P 2 9 2 0 1 0 ,.)
Plan Review
r Phone; 503.639.4171 Fax 503.595.M ,-,,, p a on Date/By. faher Permit
1 Inspection Line: 503.639.4175 C11. t vr 1 iu mu/
PM Ready/By: IV See Page 2 for
i'
Dam* wymtigard-mgcni BUILDING DIVISION Notified/Method; IliiM Supplemental Informed=
' 1 ; 77 . .7. - .7 7 ' 7"r. !. :...- figfir4fIr11,7;r ';:lt' 1: rcTiviier*O0110 . . . . .,§WiNONFI
Mechanical permit fees* are based cm the value of the work
D New constniction Addition/alteration/replacement performed. Indicate the value (rotmded to the neared dollar) of all
i CI Demolition Other: mechanical materials, equipment, labor, overhead, and profit
i ;i , ;.: •:: : , C: :" :: :' :..tAiii49 ilitie: .I:',r::::::::.:F; Value; S
At l - and 2-family dwelling CI Commcrcial/industrial 0 Accessory building
. . Description For special information use checklist
Multi-family 0 Master builder 0 Other: J Qty. 1 Ea. I Total
i tr. 7 ' ::,-rtl Heatiowtooung ,
Job site address: I 0 i„./ C, 0 5Ai John SOn „Si- , Air conditioning or heal pump
(requires site plan showieri placement) 14.00
Furnace 100.000 BTU (docts/venta) f 14.00 I / • DO
City/State/ZIP: 710aki tt ox 9-77_23 .-
/_ Fur.= 100,000+ BTU (duets/vents) 17.90
i2te/
bIdg./apt. no.: PIRioa name: . Cias heat pump 14,00
Cross street/directions to job site: Duct wott 10.00
--- Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) i 14.00
Unit heaters (fuel-type. not electric),
in-wall. in-duct, suomided, etc. 14.00 ._
- Flue/vent for any of above 6.80
Subdivision: I Lot no.:
Other: 10.00
Tax map/parcel no.: Other Nei appliances
Pt View Wittig 10.00
A - TOKria.ne . . ,. Gas fireplace 10.00 .,
Flue vent for water heater or gas
, fireplace 10.00
Log lighter (tgis) 10.00
.. Woosi/pcIlet stove 10.00
Wood fireplace/insert 10.00
,
"--14.",trrtgrgn,..y.AgoviTt Chimney/liner/flue/vent 10.00
.
other , 10.00
Name: .1 p In rex_ _ .?-41<iC,e_dv." Environmental exhaust and ventilation
" Range hood/other ltitehen
AddrcsS; 1 ° 0 Sl.4 Jok"son cquipment 10.00
,
cit 6a. Clothes dryer exhaust 10.00
Singlo-duct exhaust (bathrooms,
Phone: ( ) FOUR SEAS° ,, z 'INEATINO toilet compartments, utility rooms) 6.80
44 . „,:: ;', , '.;'.. .'t: ', .: : q, : ;• i lilloi l ft - ':::17'i'' . :; : , ..; -.„ : , ,,,,-.. Attic/crawlspace fariS 1000
- ' - - • Other: 10.00
,.. Business name:
1005 INDUSYRIAL PKWY Fuel piping
Contact name: 55.40 for first four; 51.00 for each additional
Address: NEWBERG, OR w132 Furnace. etc.
! Gas heat pump
, City/StatetZiP: Wall/susvendedhmit heater
Phone )5 39 - / 1 -e::• I Fax: : ( ) Water heater
i: - Fireplace ..
E-mail:
&mac
: '• .' : .. • :: ' :•. YRXMIIIM ,... _ IMONThier, . Barbecue
Business name: AND AIR CONDnioNit iNct Clothes dryer (as)
Other:
Address: ..,r- , .4 ,. Y'. :.'e'-' , ,
1005 INDUSTRIAL plkWy 4: !'ff . AP4 .'' I ' ......4k•
; • City/State/ZIP: Subtotal
Minimum permit fte ($72.50)
Phone: (
Plan review (25% of permit fee)
•
CCB lic.: cri (€.5 a . State surcharge (12% of permit the)
1 TOTAL PERMIT FEE 1 , P
. i
is permit mikados expire' if a permit is not withI
Th
Authorized signature: .14tA2te_ :' days after it has bean accepted es complete. i
1 I Print name: IM: r. t-kpa,,,, v•. : I Date: Cy/Z 'I/ 0 • pee methodology set by Tre•C-onmy Building Industry Sella. Board
i 1:Vatilia0PermitsNMEC-ParmitA.9400 OVIg/07 440.4617T (lima/commas)