Permit ,.,i CITY OF TIGARD MECHANICAL PERMIT
° - 8 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/05/2011
Parcel: 1 S134AD09100
Jurisdiction: Tigard
Site address: 10793 SW 106TH AVE
Project: VITALI Subdivision: WINDSOR PLACE Lot: 28
Project Description: Gas furnace replacement.
Contractor: FOUR SEASONS HEATING & NC INC. Owner: VITALI, MICHELE B
1005 INDUSTRIAL PARKWAY 10793 SW 106TH AVE
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/05/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/05/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/05/2011 $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.
/
Issued By: �,'��, Permittee Signature: ■
Call 503.6 •..175 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.
05/04/2011 09:36 FAX 5035380165 Z002/003
Mechanical Permit Application N R C I l 1( i. t' 1
�
j Deto : • `
City of Tigard ^ C� v naco/l .>/� I� -
13125 SW Hall Blvd., NEW, °R 9722
Phone: 503.639.4171 Far. 503398.I9 )
PbnItcriew
l"1"11 MI liaititEll .
Inspection Line 503.639.4175 `1011 Date icy:
Internet. www.figenl-or.gov 'V New construction ‘06,44ddition/alterattecAtient Mechanical permit fees" arc based cc the value of the work
perfiemed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, rabx ad, and pr fit
t AT?bl*W+1� �.; . .. . - . Value: S .
kT 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building For hurt use cheddar
Multi-filrr111y [] Master builder lder ❑ Other: 1 Qty. l Ea. I Total
J S!.. * M i AND heart cool Air conditioning
Job site address: I 67 7. a i ot p
necLesee site r elawias 1t...c) 44+ 75
City/State/LIP: ct Q Z Of - 1 22_7 Fumacc 100,000 BTU (dam 46.75 ■
Furnace 100 000+ BTU duetelveote) 54.91
Suitr/bldglapt- no. :.. I Project neme: V I a.i _[ Heat pump 61.06. . _
Cross street/directions to job Site: Ductwork _ 23.32
Hydrattiahot water system 2332
Residential boiler (radiator or
hyinaic) 23.32
Unit heaters (fuel-type, not electric).
in -wall, in-duct, su,peaded etc. 46.75
Flue/vent for any of the 2332
Subdivision: La no.:
Other 23.32
Tax map/parcel n0.: , Other fuel appliances
--. . . Water heater 23.32
ng j, O, *ORR • (lets tinplate 3339
td 6 E f trine veer for water heater or gas
fireplace _ 2332
- li 23.32
Weed/pellet stove 3339
Wood fireplaodiasest 2332
;, -;_„ ;,r.f ,�y.;�; Chimney/Hoer/flue/vent
� «IR!w!V 1eN' .'.� ; . y 3: ` 4 1• �'r:... �7.7F r
r 1( ;'. Other: 23.32
Name: IA , o' L Ln ' ,.p ` l i_ f A Environments] e=haast sad ventilation
Address: /� � 514.) � " `� n J ` Range hood/other kitchen
[ )� ��p /�V - atulpment 3339
City/State/ZIP: rii en 7 . Z . ---‹) Clothes ern exhaust 33.39
She -duct exhaust (bathrooms,
Phone: ( ) Pilot: ( ) toilet compatriots, utility rooms) 23.32
-- . , .
fans 2 32 • _.. ... �.�-- APPhICAIYT ... _ � Attic/c[awlstapc _
Other - -- - -- -
Business name: _ FOUR RFA SONS HEATING , Fuel piping
Contact name: r ` r ■ ■ a $14.13 fur Best filar; $4.031hr each additional
Address: - - a ' - Fume', hoc 1
Oas heat pump •
City/State/ZIP: r d - •1 - h , WaWsassaded/uaithealer
Phone: ( ) NEWRERCI, 1 (971 ;2 water heater
Fireplace
E•1111U:
,• .,, . . r +++ . '+++ `✓' + +.2j'+Vd••4""+,M ' i Barbecue
c Business name: - 11 $ Cl r (gas)
Other.
Address: AND AIR
CCNDMONING, INC. meciWacu. ,
City/State/ZIP: 1005 INDUSTRIAL PKWY ltiimimumparrmritfee else )oa p f • " C •
Phone: ( ) - NEWBERG ) Plan review (25% of permit the)
CCB lie.: . State sum gt (12% of permit fee)
TOTAL PERMIT FEE
718, pe=ak app0eatiow emirs It a penait beet oblaolod witini 1
Authorized signature— -in OJ'i -S a -, A days anew it has bias accepted es ebwpteee.
Print a nne: d. ..r • day Ire A .•
Date: 4. 4211,1 • Fax methodology set by qty Budding Indwell Servix Boat
rA)1.74 .1Akm.p,haYd..- PafnhAendoe tonaiA19 440- 4417r (II inzt]Jsonat1
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