Permit CITY OF TIGARD MECHANICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: MEC2010 00481
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/01/2010
Parcel: 2S 101 AB01100
Jurisdiction: Tigard
Site address: 12335 SW 72ND AVE
Subdivision: HERMOSO PARK Lot: 1
Project: Bauer
Project Description: Gas Furnace replacement.
Owner: FEES
BAUER, DANIEL E & Description Date Amount
BAUER, BARBARA G, 12335 SW 72ND AVE Furnaces < 100K BTU 10/01/2010 $46.75
PORTLAND, OR 97223 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.
Issued By. Permittee Signature: e
■ AIWA _ _ _ ■-
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.
09/29/2010 15:12 FAX 5035380165 1 003/003
Mechanical Permit Application � VO i i r 1; i) l 1 i t l I 1 r i 1 "1 t, N. I
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City of Tigard X Received r• ° t ! s Formic No.: air � v —
13125 SW Hall Blvd, Tigard, OR 972 �Re Review
I' '� _ Pho 503.639.4171 Fax: 503.598.1 .4175 C 9 ^ .1 Date /By: Other Permit.
t i „ i inspection Line: 503.639 �+ Ready/By; SS See Page y for
Internet: www.tigaM•or.gov 5 r.NR 1 Notified/Method: S, Supp��lnformatiee
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.� Mechanical permit fees* ere based on the value of the work
New constructionAdditiaNalterati laccmcnt
performed. Indicate the value (rounded to the nearest dollar) of all
❑ ��
❑ Demolition mechanical materials, equipment, labor, overhead, and profit
. ;::. ;; ::r.: Value
,.. utiau.a . .
.. . �' . peep.. ��; "'
1- and 2-family dwelling Commercial/industrial - -. .
stn •.,•. ..
p eep. . ....,.,
y g ❑ - al ❑ Accessory building �'
414' For special information use checklist.
Multi- family ID Master builder ❑Other.
Description I Qty. Ea 1 Total
3o$' ,. ate ' ::. r t��i, m . Ber Has Mutine
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Job site address: 12335 3 t -- Z
�1/`er Air conditioning or heat pump
re . e loo oho ' Placement) �
`#
City/State/ZIP: -t� OR 91 2.'2 3
F 00.000 BTU owns/vents) s/vents)
Furnace 100,000+ BTU (ducta/vents) 17.90
Suite/bldgJapt. no.: Project name :Uete
Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 14.00
Flue/vent for any of above 6.80
Subdivision: I Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliance
1000
^ Gas fireplace 10.00
Eil ) Q J Flue vent for water heater or gas
fireplace 10.00
Log lighter (Ras) 10.00
Wood/pellet stove 10.00
Wood flit placcfinsert 10.00
x °y p n� v: is r ,ov RS Chimney/liner/flue/vent 10.00
I,7;x ii,i f �i Y i y �Y' : r er r':. . ry Q u µfxr�., :,
cf��:5 \ +: Y��!.!!!! �,', ��`�' 7m:....T���' `f. e � ''� r : . ,� -nee. ?'. Other. ' 10.00
Name: k]n Jr-C.A.— ta ie...4 Environmental exhaust and ventilation
W '7 Z Pdf e_ c�mem other kitchen
Address: t Z 3 3 S .5 10.00
: City /Stata/Z>P- C J 4 e. t-ii 'k.Z , Clothes dryer exhaust , 10.00
Single -duct exhaust (bathrooms,
Phone: ... ) (p .. ('2_0-1 Fax: ( ) toilet compartmems, utility rooms) , 6.80
' t. • at F • F :: '!! ai.'.1 '"•� Y;acr� ,. . : Attic/efawlspacc fans 10.00
",`.: .• .. • ,. • ,' !'
Business name: _ h Other: 10.00
A ND AIR Cp,�,ornoNWNG. INC. Fuel trig
Contact name: $S 40 for first four: 51.00 for each additional
: Address: 1005 INDUSTRIAL PKWY Furnace, etc.
Gas heat pump
City/State/ZIP: NEWBERG. OR 97132 i Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
Fireplace
E -mail: Ramie
Clothes
_peep.
Business name: AND AIR QammoNINci P INC_ dryer ( gas)
peep
•
. Address: 1005 INDUSTRIAL PKWY ,, .
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..�.: prp. FN. ts(�C ��
City /State/ZIP: Subtotal ry
NWBERG r1 Minimum permit fee (S72.50) - _ - Q tl (f -w
Phone: ( ) r" a ( Plan review (25% of permit fee)
CCB lie.: 417/ 6.1 State surcharge (12% of permit feet' �0t
TOTAL PERMIT FEE $ l . 7 6
This permit application expires if a permit le not obtained within 180
Authorized signature {�.. 1(1T/��
/ � days after it has been accepted as complete.
Print dame: N I fi /}ma /J /) • Pee methodology set by TO -County Belding Industry Service Board
1 I: �C. eraiitApp.doc OI /1Q07 , 440.617T (14/02/ s COMIWnE))
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