Permit -, � CITY OF TIGARD MECHANICAL PERMIT
'''- COMMUNITY DEVELOPMENT Permit #: MEC2010 -00652
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.7182439 Date Issued: 12/14/2010
Parcel: 2S112CC04300
Jurisdiction: Tigard
Site address: 15855 SW 80TH AVE
Project: VANDERHEIDEN Subdivision: BOND PARK NO. 3 Lot: 71
Project Description: Gas furnace installation.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: VANDERHEIDEN, SEAN
1005 INDUSTRIAL PARKWAY 15855 SW 80TH AVE
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/14/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/14/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/14/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. e-
^
Issued By: •ermittee Signature: 6 A or i -
Call 503.63 by 7:00 a.m. for the next available inspection date.
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.
12/14/2010 14:04 FAX 5035380165 10002/003
Mechanical Permit Appl
_ lI)kri;l ,f . 1'NI (1vli ,
City Tigard R ecei ve d .
t3' g Datc�y: 1 1 0 �s
13125 SW Mall Blvd., Tigard, OR 97223. Plan Review
.._ Phone: 503.639.4171 Po: 503.5984 0 Date/By; Other Permit:
Inspection Line: 503.639.4175 O Date Ready/By, B7 sae Pa c x for
Internet: www.tiprd•or.gov `L 1 &
,�� Q Idatified/Method: Supplemental Information
l
d 1.
r�� : Mechanical Meohanl a
12 New construction Addition /alteratiolt6F . • - .D , J permit fees* arc b c value of tht work
,``\ performed Indicate the value (rounded to the nearest dollar) of all
El Demolition utter: �v mcchrmieal materials, equipment, labor, overhead, and profit.
and 2- family dwelling ❑ Commercial/industrial ❑ Accesso buildi Value; $
� ng � For apcCidl lr(lor»pprlort , ` -
lik SII '.i 'IAL 1'SYST im MS .
t h
■ Multi - family ❑ Master builder ❑ Other use checklist.
r:
Description ] Qty- ] Ea L Total
. JOS SUR 3INFOLOWPWThr P4VOVION: Heating/ceeling
I $ 5 W Air conditioning
Job site address: r1 Sreyuites site plan shoving placement) 46.75
City/State/ZIP: . et- _ Q f i ) Furnace 100,000 BTU (duets/veins) / 46.75 W 7.5
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name:
�� A 6. . 5 Heat pomp 61.06
Cross street/directions to job site: Duct work 23.32
_Hydronic hot water system 23.32
Residential boiler (radiator or
hydroni 23.32
Unit heaters (fatal -type, not electric),
in -wail, in -duet; suspended, etc. 46.75
Lot no.: Fluc/vent for any of above 23.32
Subdivision- Other: , 23 -32
Tax map/parcel no.: Other fuel appliances
',,,," , ;; r h; Water hcatcr . 23.32
:
Gas fireplace 33.39 ,
UMW 5 �
Flue vent for water heater or gus
fireplace 23.32
Log li (ltas 23.32
Wood/pe fct( stou t . 33.39
Wood firepiace/inseft 23.32
Chimncy/lincr/fluc/vcnt 23.32
11111111P .rigen3trY O t : , , ; a Other 23.32
"r �, • �i Environmental exhaust and ventilation
Address: Range hood/other kitchen
r,,� equipment 33.39
Clothes dryer exhaust 33.39
�tuct cxlttwst (bathrooms,
Phone: ( t toilet Sin$ic com� utility rooms) 23 -32
Q AiPmitios 0 R-Att; ' U1!T ,. Attic/crawlspace fans 23.32
Other: 23.32
Business name: _ ■ Purl r
Pit? >tC
Contact name: 514.15 for first four; 54.03 fbr each additional
Address: ! ! " e 1 • ' : • + , - Futnaca, etc.
Gas heat pump
cityfStatelZIP: j 0 �r TT
05 INDUSTR ' Wall/suspended/unit heater
Phone: ( ) k a BERG 11 Re7132) Water heater
Fireplace
E -mail: Range
Barbecue
Business name: - Clothes dryer (gas)
Other;
Address: . 11.ECLI#MCAL: PERMIT . INEW '..
City /State/ZIP: 1005 INDU" .." AL. P Subtotal
Minimum permit
Phone: ( ) NEWBER c I1 R 97932 fee ($90.00)
Plan review (25 /a of f permit mit fee
cc) TOTAL r � l
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State TOpermit
PERMITFEE j f`j
This permit application coins if s pertllit Is AO! obtahted within Igo
Authorized si a• : Nlw. . !� i��p : days after it bas been accepted as complete.
Paint name; � � , y ii Date: im • F. methodology- net by 1'6-County Building Indusay Service Board
1:1BwldiagwermitAMEC- PennitApp -Eon 10/01/09 440.461Tr COM/1 )
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