Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00493
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/27/2012
Parcel: 1 S 134CC04500
Jurisdiction: Tigard
Site address: 12405 SW WINTER LAKE DR
Project: Sample Subdivision: CAPSTONE Lot: 12
Project Description: (1) gas furnace installation
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: SAMPLE, KATHLEEN A
1005 INDUSTRIAL PARKWAY 12405 SW WINTERLAKE DR
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503 - 538 -1950 PHONE: 503 - 524 -9139
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/27/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/27/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/27/2012 $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. /�
Issued By: C4�t.CJ�`� Permittee Signature: nil 4 p UCieb�} I ( a
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.
09/26/2012 11:50 FAX 5035380165
la002/003
` Meehk eal Permit Ayaion RECEIVE
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City of Tigar d P ''' ...,,1/4. 7 >�312ssW >31„a.Tigard, ox 97223 SEP 26 2012 I , „ /a' (e z� 1a -i 44_
Phonec 500.639.4171 Fax 303.598.1960 Other Pin "•
Inspamkai Unix hums: www.�6md'or•gri'� OE Y OF' IGARD: 17 1t.-1 im., ` la Sea Pam a mr ■
- I up Elennenturrid ratermaiton
k, I MING DIVISION
T I O OIL W( K CO9fittitaAt 3W $COLE.= > `,
❑ New construction 14Add ioniatteraadtcplttcement McCbarncal permit Bes• we based on the value of the work
❑ Demolition El Other: pt l the value (rounded to the neatest dollar) of all
is ai nintedals, equ� meat, labor, ovaheed, and Welk
GTEGO . : 069 RtFCTfOIIi , • value: $ _
7 1- and 2- family dwelling El Commercialfindustrial ❑ y bu: int.�tiv[ r»L�SR
❑ Master builder ❑ Other: ' For apaeml iwJBanmdw use ■ ; ! ` L QJ Ea. 1 Total
. JOB SIFE n '; ia) WC T1ON f Heating/ _
Job site address: a r (A.-) - COrl I frewires ataoemao0 4673
Ole Z 3 Fun= 100,000 BTU Notai w ) O _ 46.75
Furnace S OF
no.: , Pro, name: ' f 100 000+ 8TU (=heats) 61.06
Gross sneerr/idireottarts to job site MCI work r 23.37 •
1 11C lot water system 2332
Residual boiler (raft= or
I iy�dronic) 2332
Unit heaters (fuel-type, net electric),
• iu woa8, ®-duet, ansperded, etc. 4675
Sobirivision: L Lot no.: Flue/vent ha tray of above r.32
Other. 2332
Tax map/parcel no.: Odter feet amillantes
• nascaalker oF`.WORK. Water heater 2332
Crew f eplaae 33.39
Floe vent fir wider haamar or gas
' I fireplace 23.32
r + Log lighter (ms) 2332
WooSitaium stove 33.39
Wood fireplacereisert 23.32
ChintneWlinerffluehrent 2332
O 2332
Name: ■ - - ` `1"14 � Environmental e bauat and wmilladon
405 SM3 W , 111r La.,ft4, Drr . r Range hooeVother kitchen 3339
aty/9tatatry:'j za ,,,, o L 9-12Z3 5 3339
Pleome:0 5) -9 I Fax' ■ ) , toilet canpartmems, utility roams) 23.3E
.•:...:....' •• ' ' :C'1°. APPE,tiLorr • :. :0, t` d':Acr PB Hl Attidctaarltinoe fans 2332
eth
8rrONO er , 23.32
Gong name: FOUR SEASONS H4 ,u - 1 St4.15 for >c !liar, 84.93 for ends additional
AN D AIR COND INQ INC. _ Furnace, etc-
Gas hero
1005 IND PKWY we heap
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Adder: AND AIR CONDITIONING, INC. orbe
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Plan wviea► C2596 of permit 6eer)l �
TOTAL 1 i CO YO
i e ' iliaAsmft_dw engine Va waft b obtatoar vriedn VA
Authmized ': ii i►
" i 'AI logs alter is !leer been maimed as
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09/26/2012 11:50 FAX 5035380165 21001/003
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FAX
DATE: C ifia II TimE;j2. : 06 pity)
TO: ck.r
ATTN:
RE:
NUMBER OF PAGES (including cover): 3
FROM: Four Seasons Heating and Air Conditioning
1005 Industrial Pkwy
Newberg, OR 97132
Vetore) 0
Phone: 503-538-1950
Fax: 503-5384165 z...----tg\e9--A • • CP
Sent By: • e,
E-Mail: rtArt n e ®fourseasonsheatairecom •
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