Permit CITY OF TIGARD MECHANICAL PERMIT
& [» . COMMUNITY DEVELOPMENT Permit #: MEC2011 -00397
Date Issued: 09/08/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S111DC04500
Jurisdiction: Tigard
Site address: 9440 SW SUMMERFIELD DR
Project: Kremidas Subdivision: SUMMERFIELD NO.7 Lot: 360
Project Description: Gas line and vent for water heater
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: KREMIDAS, TOM
1005 INDUSTRIAL PARKWAY 9440 SW SUMMERFIELD DR.
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE: 503 - 538 -1950 PHONE: 503 - 968 -7137
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Flue Vent for Water Heater or Gas 09/08/2011 $23.32
Type of Use: SF Fireplace
Class of Work: ALT Type of Const: Fuel Piping 09/08/2011 $14.15
12% State Surcharge - Mechanical 09/08/2011 $10.80
Occupancy Grp:
Minimum Fee Adjustment - Mechanical 09/08/2011 $52.53
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: 04/ / � / J C` '/ 7d , V
Call 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.
09/07/2011 14:51 FAX 5035380165 {a a002/003
Mechanical Permit Application V ,,,, i i) is 0H-1( 1( 1- t ,- t 0\1.),
City of Ti and ' \\ R ived Q�� / `ie, Pe rmit No.: 00 9!
do r SW Hd' lvd Tigard. OR 99223 y' p Fhne: 503. 639.4171 Fax: 503-598 1960 (5 r /By: Other Aim. ': _
Inspection Line: 503.639.4175 Ins . 1 L r° , C lDaie RaQdylBy: kris: 95 tree Page 2 ibr
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Internet www.tigard- or.gov ; . -,.1 O' , �; "`�j \ - Z' Neafied/Mcthod: ' supplemental Information
(, ..� \h�.' J •
New construction Addition /alterationlr lacemeni
Mechanical permit fees* arc based on the value of the work
❑ performed. Indicate the value (rounded to the nearest dollar) of all
Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
<.:.
, ,. RESIDE1V77Ai',. E,QUfP'NLiNt l 9 41bS'a" . 0;PEES
)kL1 and 2-family dwelling 0 Commercial/industrial ❑ Accessory building l or special / n>znarion use checklist
0 Multi - family El Master builder ❑ Other Description Qty _- Ea. I Total _
kai grit it F( 1 N!;i - .1A04'4AC N Heating/cooling
Job site address: Air conditioning
r ...,•_.... SU i lA // _ _� fFalwros site p g p )
Ian showinlaceraL_ 46 - 75
City /State/ZIP: 41-41.% —. T LA Furnace 100,000 B L (ducts/vents) 46.75 ,
go Furnace 100,000+ BTU(ducts/vents) 54.91
Suite/bldg. /apt- no -: ' eject name: �--; heat pump . 61.06
Cross street/directions to job site: Duct work 23,32
"" lydronic hot water system 23.32
Residential boiler (radiator or
hydronic) - 23.32
Unit heaters (fuel - type, not electric).
in -wall, induct, suspended, etc. 46.75
--
Subdivision: . Lai no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other lhellippIiancea
Water heater 23.32
-- �---° Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 1 2332 _
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chi mny/liner/flue/vent 23.32
M :'>P ` /OW1! ;' !.? F ;"1 ` Other. 23,32
Name: f * Environmental exhaust and ventilation
�� j 1 4 ! + Range hood/other kitchen
Address: / Li. 0 Si 1-. s Y ' , Q,,1, � , e, ui , . ent 33.39
City /State/ZIP: \ 2., cuv ii , — ,g-, Clothes dryer exhaust 33.39
Single - duct exhaust (bathrooms,
I Phone: 6D ; 1 1 S' Fax ( ) toilet t • : , . utilit rooms 23.32
' °w' j , � ` R ',Ta '� . v 4 , : ' ;"+,,,('i, ,J Li, ii n¢ 4 ;, Atticccrawl pace fans 23.32 Other: I
- ; 23.32
' � ' ,
Business name: F pipiae
Contact name: SEASONS HEATING $14.15 for first four; $4.03 tb r each additional
1 II ,, e;11 .. Iv e . c I Furnace etc.
Address: Gas heat pump
City/StaterZIA 006 INDUSTRIAL RIAL1 Wan/suspended/unit heater
�i OR .1
Phone: ( ) N WaaP� l OR 971 `: f lax:: ( ) Water heater I III
Fire.lace
E - mail: R: :;
ax 3tt , y . '.! Barbecue
... .r •.. ; Er
Clothes r _as
Business name:
: , w .. - . w • • $ 1 C- •- Other: >
Address: r ME04i41(AL PEBWF „
City /State./ZIP:l 005 IN IAL PKWY - Subtotal
��11
�� ``!! ��tt,, 11!!�� Minimum permit flee ($90.00) y
' • : ( ) WBERG ' R 971' ' ( ) Plan review (2596 of permit fee) _
N
CCB lie.: i - State surcharge (12% of permit fee) 00
li
TOTAL PERMIT FEE
l 'Ibis permit application expires If a permit is gat obtained within 180
�
Authorized signal <, • I' days after it has been acacptcd as completes
Print name: - Date: 'a mum " Fee methodology set by Tri- County Building Industry Service Board
ea ► i •
r :1 uilstn wmlw1MeC- Pr+mitApp.doc 10/01109 44a.46171' (1I/021COM/Wg8)
09/07/2011 14:51 FAX 5035380165 11001 /003
s Sir,
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FOUR
SEASONS b 2
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FAX
DATE: I f TIME:_ 3 ',00
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TO: e- o Tr
ATTN: - m: i -
RE:
NUMBER OF PAGES (including cover):_ 3
FROM: Four Seasons Heating and Air Conditioning
1005 Industrial Pkwy
Newberg, OR 97132
Phone: 503 -538 -1950 ?MSC X o`
Fax: 503 -538 -0165 co N e„//
Sent By:
E -Mail: 14 CV) . @fourseasonsheatair.com N.\
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