Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00438
Date Issued: 10/04/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S111CC17900
Jurisdiction: Tigard
Site address: 10380 SW HIGHLAND DR
Project: Graves Subdivision: SUMMERFIELD NO.4 Lot: 230
Project Description: Replace gas furnace.
Contractor: FOUR SEASONS HEATING & A/C INC Owner: GRAVES, DONALD E & AVIS G
1005 INDUSTRIAL PARKWAY 10380 SW HIGHLAND DR
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE. 503 - 538 -1950 PHONE. 503 - 716 -6232
FAX. 503 - 538 -0165
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/04/2011 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 10/04/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/04/2011 $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: -p • 4 �
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.
Mechanical Permit Application REcEiv
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City of Tigard
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13125 SW Hall Blvd., Tigard, Oft 97223
Phone: 503.639.4171 Fax: 503.598.1960
Internet: www.tigard-or.gov DaBy
Inspection Line: 503.639.4175 l
—
OCT 0 3 2O 1p7.. ,,, / i // EC,
CITY OF TI i:t e
itioaRtatYliro:d2 Permit No.: fr./We/A-eV 5,
Oiler Pers.':
j Ea See Par 2 for
Supplemental Inform at
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BUILDING DIV , m i
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... . , popfgg' X!4:-111+4P'.0.114E4 0p04/..
Mechanical permit fees* are based on thc value of the work
0 New construction PP: - idition/altcration/replacement
porton Indicate the value (rounded to the nearest dollar) of all
0 Demolition • it ther: mechanical materials, equipment, labor, overhead, and profit
CATEGORrOgrCONgfil$1064.0.. ' ' ' • . Value: $
. .
1- and 2-family dwelling El Commercial/industrial 0 Accessory building
4 .....Th
Master builder 0 O
u. ti-family 0 Other: 1014/0104FFV.EgitrIVIKINTI,SYTIVIligliaelft
Far special information use checklist. M
Description I Qty. I Ea. I TOW
JOB SITE lit4Ft*Op4****** 14904ot • , Hentittglcoolide
Air conditioning- . - - .
Job site address: 1032'C) 4 ji/ s b, (1).... -. ' . Nita 'km sbowia :. . : ,... , — , t 46.75
City/State/ZIP: q )'
ci-A-0Q —---).-(1' Furnace 100,000 BTU (ducts/writs) 46.75
Furnace 100,000+ BTU (doets/vatits1
54.91
Suite/bld,g,Japt_ no.: Project name: Heat pump 61.06
—
Cross street/directions to job site: Duct work _ 23.32
„ .
— Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
— — Unit heaters (fuel not electric),
in-wall, in-duct, sti3:iended, etc. 46.75
Flue/vent for . t of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map/parcel no.: Other fuel appliances
—
' , , i 1 F4SO4 4 1 1 9 4 'efF P * 1 !1 '• . ' .. Water heater 23.32
Gas fireplace 33.39
A, • „, , ,,,,,,..,,,_..... _...,...,. 4,..,_. - Flue vent for water hcatti et gas
0 fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
•
Wood fireplace/insert 23.32 .
. , Chimney/liner/flue/vent 23.32_
r., ..inganitrY owook, ,, ..- '. • ' , , - , ' ra TtitiAlfr . •
- Other; 23.32
Name: Ali alp i ■ 0 4 EiivIronmental exhaust and ventilation
— Range hood/other kitchen 1
Address: C i 3 : a 1 ' Lita... C.--vC)t7 equipment 3139
City/State/ZIP: - 1 - 1 a li ke) ,
it ti - qk 7 3-7—. Clothes dryer exhaust
Single-duct exhaust (bathrooms. 33.39
Phone: ( To - .. '3 Fax: ( ) toilet compartments, utility rooms) 23.32
e4r ' ',.,., •■,;'.}p' l t i:k...fl I . 4 ' ;■' ' er ' : !••:' LI P4 , ' , ' Atticicrawls_pace fans 23 32
Other _ 23.32
Business name: IP : '; ." = . • ., .•- . i '. . Fuel , . in.
Contact name: AND AIR CONDITIONING, INC. s14,13 for first !bar; $4-03 lbr each additional
;•; , 8/ • - • Furnace. ctc.
Address! NEWBERG,OR 7i3 _ Gas hcat
City/State/ZIP: Wail/sus . - &Minh heater Min NM
Phone: ( np — a— dip Fax: - .E5 g32 -of& s7- Water heater Mill
1 FireplaCe
E-mail: Range
- - 0010itki*Re •' ": ,:".. : :: ''':' r
• Barbecue lal
Business name: FOUR SEASONS H .. - ' A .
Clothes' - .: t - MOM
Other: _ or
' . 1 ' • r el , D 9' ' '' .
Address: tiilitAL PltictigiimaiI*
Li. : l ' ti it
Subtotal
City/State/ZIP: NEWBERG, OR 97132 —
Minimum permit Inc (S90.00) M07.211
Phone: ( ) Fax: ( ) Plan review (25% of Pernik fee) 1.1111111111
CCE lie.: q I "--... Starisurchinge (12% of . — 't tee) litIMMI
TOTAL PERMIT FEE imam W
This permit application moires Ira motif is not obtained within 180
Authorized signaturc, ,. , 11111 111.. i iii days after it bat been am:0W as complete.
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Print name: Date: / a (/ . fee methodology set by Tri-County Building Industry Scrvice Board
till #
MuildiotParthita4DC-PenzatA4p doe 10t01/09 440-441 (11/02JCOMAVER) . .
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NUMBER OF PAGES (including cover):_ 3
FROM: Four Seasons Heating and Air Conditioning
1005 Industrial Pkwy
Newberg, OR 97132
Phone: 503-538-1950
Fax: 503-538-01
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Sent By:
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E-Mail: ___ILailf....---@ fourseasonsheatair.com
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