Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00310
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2011
Parcel: 2S114AB05900
Jurisdiction: Tigard
Site address: 9325 SW MILLEN DR
Project: WILCOX Subdivision: KNEELAND ESTATES Lot: 46
Project Description: A/C installation. Unit must meet 3 ft. minimum rear and side yard setbacks.
•
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: WILCOX, DALE G /NANCY A
1005 INDUSTRIAL PARKWAY REVOCABLE LIVING TRUST
NEWBERG, OR 97132 BY DALE G /NANCY A WILCOX TRS
TIGARD, OR 97224
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Air Conditioning 07/01/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/01/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/01/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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.
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Issued By: - Permittee Signature: _
503.639.4175 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.
06/30/2011 13:55 FAX 5035380165 Z002/004
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City of Received
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35 Blvd., Tigard, 503 639B 03.595-9C,f71 3 0 201 ¢ y ' / , r
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Inspection Line: 503.639.4175 Data RIB
Internet: www,tigard- or.gov CITY OF TIGARID D Rcadnerbo: FILMEEtiEEM
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- 1 ► , 'VISION
no) .'ft., a .. . , i t } c N A 1 i 1 ?: ,f. ''•�� .y
Mechanical " are based on the value of the work
El New construction ► � Addit /a]ttrationJrep(acelnrnt permit fees
P
0 Demolition per; performed. Indicate the value (rounded to the nearest dollar) of all
mechanical mater overhead. and profit.
'` ,.,•_. .'.0; V' >':'4 Value:
1- and 2-family dwellin ACCessary building RESID T* EQUIP/t1CNT /:S.. :
Y g 0 CommerciaUindustr,al
Fur sPecial formation use checklist
I Multi - family 0 Master builder 0 Other:
Description Qty
_l .:. I Ca_ I Total
' .JO* Silt ' 1.; i ; r : .
***Ciril4/: '.Lii0ll;.: ' ' HeadnP/coal[ng
Job site address: • • 4 , , D / Y.e.._, Air conditioning
• (requires site plan showing placement) I 46.75
City /State/ZIP: I • g d • IZ — 7 2 zff Furnace 100,000 BTU (ducta/vents� 46 -75
SuitrJbld / / - Furnace 100,000+ BTU (ducts/vents) 54.91 -
€,apt- no.: Project. name:
Iicat_pump 61.06
Cross street/directions to job site: Duct work 23,32
Uvdronic hot water system 23.32
Residential boiler (radiator or
hydmnic) 23.32
Unit hewers (fuel -type, not electric), _
in-wall, in- duet,,suspended, etc, 46,75
Subdivision: Lot no -: Flue/vent for any of above - 23.32
-- Other: 23.32
Tax map/parcel no._ Other fuel appliances
'� :v, ,a ... t • .' .: Water heater 4 ,3z ,
z.
A 4 [6 ` Ali Gas fi 33.39
+ ... 1t I Flue vent for water heater or gas
fireplace _ 23.32
Log lighter (gay)__ 23.32
, Wood/pellet stove �� 33.39 ..�
Wood lecc/insert 23.32
�` .' : :''::':'`,'; ": > ' #d r' � '.�, : '.�::. 23.32
Chimney/liner/flue/vent 23.32
v ,......
Name: � Other;
r` t.Il ► ‘` � Environmental exhaust and ventilation
Address: -- Range hood/other kitchen
. .L VQ__., equipment 33,39
City/State/ZIP? r CZ 9 --� ea. L/ Clothes dryer exhaust 33.39
Phone: J / Single -duct exhaust (bathrooms,
Ph • f > corn sattments, utility rows) lity ro 23.32
P ax: ( ) toilet
4i . ° . _ yv S t � w r x ! i .. r ' A 5.534 ? � w hY i ;�� t @ Attic/era pace fans ._ 23.E
Business name: other 23.32
■ _ :. 11 I, ■ 1 '■ c Fuel piping
Contact name: $14.15 for first four; $4.03 fbr each additional
Address: ' Furnace, etc.
/TEL ,. ',
h ; i r , • Gas beat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) NEWBERG 7(1 e.2) Water heater -
Fireplace
E -mail:
Range
1 ,;"b; •„ . ' Barbecue
Business name:
' - s N HFATINO Clothes dryer (gas)
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Address: DI7 Other: ..,
. M*H1#i!IIeAI. PTFRMF6'100 : :; :: - ... ,
City/State/ZIP: 1005 INDUSTRIAL PKWY Subtotal
Minimum permit fee ($90.00) % Q D • to
Phone: ( ) ■ 4 :; -. . ,. • i» . . Plan review (25% of permit flee)
CCB lie.: '' - State surcharge (12% of permit fee) /D. `i6
a � ` � / TOTAL PEAlt s d FEE I ) AdIQO /6
Authorized sign '� �?�'�}J Tbis permit a teirca 1f a is dot obtained thin
days ys e after aft r it has been accepted as complete.
Prin attle: to _ h' 1 Date L J/ • Pee methodology set by Tri -County Building Industry Service Board
t :lBuildingTarznitsVdrC.P eitAco,tee 19/01/o9 4404617T 12/02/COA OM/WEB)
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