Permit CITY OF TIGARD MECHANICAL PERMIT
/1 1 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00291
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/17/2009
Parcel: 2S 111 DCO5000
Jurisdiction: Tigard
Site address: 15671 SW SUMMERFIELD LN
Subdivision: Lot: 0
Project: Nelson
Project Description: Install gas furnace and heat pump.
Owner: FEES
NELSON, GARY & Description Date Amount
SANDRA M, 15671 SUMMERFIELD LN Air Conditioning or Heat Pump 06/17/2009 $14.00
TIGARD, OR 97224
Furnaces < 100K BTU 06/17/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 06/17/2009 $8.70
Minimum Fee Adjustment - Mechanical 06/17/2009 $44.50
Contractor:
FOUR SEASONS HEATING & A/C INC.
1005 INDUSTRIAL PARKWAY
NEWBERG, OR 97132
PHONE: 503 - 538 -1950
FAX: 503- 538 -0165
Type of Use: SF
Class of Work: ALT Type of Const: •
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct scions to NC by Iling 5 .246.6699 or 1.800.332.2344.
Issue By: Permittee Signatur �1� • ,` � • � to.'_,le •
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Apalica CEIVED rOu OIli( r I ..0. (i\l.N
City of Tigard No.: c /_ 9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revview 0 ,
• Phone: 503.639.4171 Fax: 503.598.19 N 1 6 2009 Datc/Sy. Other Permit
1 11 , ,. I , 1 , Inspection Line: 503.639.4175 Date Ready/By. Judi: 63 See Page 2 for
Internet www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemwtai wornutioa
1
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` ".--�/' '.'..�10 %/ !�!�, 1 + :. .r • 2.!s:'J: A1L`, ill.'.. M� J* . A. ..��_.• ..... , . ,APE -00. l
❑ New construction \1 • ddition/altcration/replacement Mechanical permit fees* are bred on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ■ • , er mechanical materia equipment labor overhead and profit_
,.,.: a :;jv;:.A "t..' k "H`(- , . . - ..n. - •:`�„ ; ,_ v ,.,« .. :::c::• Value: $
.::.': -. . .... K:r1 •.:/ . . ,,. :1,'.. /' �-' lYrt:"'.."'. P.-,�'y�1' -'.^`• I � �K� I n�n:: - :' ., .:. ... ..'. ,. (. x.•r:' � .�4✓•4
. t .. . ,
I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
El Multi-family ❑Master builder El Other For special lnformallon use checklist.
Description I Qty. I Ea- I Total
. :;... , :.::4:: , ...;;,.4;n;!0.•.•; - . ' :: : •,4 : Sgtf • ' Oh3 :. ° . ,� _ . ;: .y ..._Ira ^;•; Ileating/eooling
Job site address: /� ( ( Air heat punt _•.
/5(21 I N SGT SS.lMNA Q.Y` 1,I Lo , it (req uirca conditioning cite pint� t) 14.00 1
City /State/Z1P: L ` 3 v.< ( t ) 1 , - -2-k4 Furnace 100,000 BTU (ducts/vents) 14.00 1 q
1 Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project nam So ktk Gas heat _
pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall. in -duct, suspended, etc. 14.00
Subdivision: I Lot no.: Flue/vent for any of above 6.80
Other. 10.00
Tax map/parcel no.: Other fad appliances
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; % <( �:.i ^� 'U :� °.' "w:a °i "�� ..„.:.”,i;....',.. r, . 0' ' a.'/:.: .A�..'ri+' ✓r'e:�d_, :.
H• .,. ;6.l • , : � ., rter. . l ' t a''{: 5 a ti ., . ,.-r "ktioya'1.'u' .:i ,� Z:5'.:1 ?, . t ..7 " i.7t. Water heater 10.00
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E r S k 1-4,20A-- e u NT 16- Fl 10.00
Flue vent for water heater or gas •
fireplace 10.00
A • dL I ` Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
T. Chimney/liner/9ue/vcnt 10.00
i i•I_.r '... :a'� -,. ' : = \':- i3�ii ti ∎a ' ..4 .?:1 lit Other: 10.00
Name: (:-AU-..,1 f e . Se yk ( + Environmental exhaust and ventilation ge Address: / S O 1 1 �vl) Slew.. t�A.'QIF (� Yt e 1 a L �Jc 1/% `e- eg qu uippmenn otherkitchen 10.00
City/State/HP: - 1 - % q q, y .GQ Q A. 1 � � (,
Clothes dryer exhaust 10.00
J 1 ' Single -duct exhaust (bathrooms,
Phone: (5 (p ~ # 5 Fax: ( ) toilet compartments. utility rooms) 6.80
; +c > _ �!,1/� " . � Attic/crawls ace fans 10.00
= i'��H�d � 't+�":.)7i�, ' �•� ..,,, q�'u '� L1: 0 �;�ty a! P
Other. 10.00
Business name: 81 : - , • i , - . . I . , , t Fud in
PIP E
Contact name: AND AIR CONDITIONING, INC. $5.40 for first four; $1.00 for each additional
1005 INDUSTRIAL PKWY Furnace, etc. -
Address: NEWRCBG, OR 97132
Gas heat pump
City /State/ZIP: Walllsuspendedhmit heater
Phone: (,505 5 p S� Fax: : (56 S' 2"'m ( 6 Water heater oft / Fireplace
E -mail: Range
. } • N . / • G I i�: i'�' liGIY " " ,Y .. \ r •QI ':7MT T �' I . .:f: l� 1�t'h �I.C..:' i:.yr.- !A.JrI Barbecue
Business name: FOUR SEASONS HEATING Clothes dryer (gas)
Address:
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INDUSTRIAL RIAL .,r.•.rw.a�.•..4n .�. i. ..?..
City /State/ZIP: NEWBERG, OR 97132 Subtotal
Minimum permit fee (572.50) 7 2,
Fhotre: ( ) I Fax: ( ) Plan review (25% of permit fee)
CCB tic.: ct 7 I s' State surcharge (12% of permit fee) 1 70
TOTAL PERMIT FEE J ?..e)
lea p ermit application expires If a permit la not obtained within lase
Authorized signature: dna.fler it has been accepted as complete.
Print name: v�, a?.._ , 6.,,L, Date: :' j , / S� a * Fee methodology set by Tri -Cowry Building Industry Service Board
1: le 7ald6110.PermanuMic- PPtmIApp.doo 01/tOro7 440.4617T (i1/07/ O Nam)
000 /00021 X1id b1:Zl 600Z/91/90
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A/C-HEAT PINIP---UNIT arrE PLAN
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- PLEASE REFAX APPLICATIpN 711311 S.ffE PLAN
FOUR SEASONS HEATING
, . • AND AIR CONDMONING INC.
O - 1005 INDUSTRIAL PKVN
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NEWBERG, OR 97132 f g
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