Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/26/2009
Parcel: 2S103BD00800
Jurisdiction: Tigard
Site address: 12070 SW WALNUT ST
Subdivision: Lot: 0
Project: Woods
Project Description: Replace gas furnace.
Owner: FEES
WOOD, ROLAND R Description Date Amount
12070 SW WALNUT Furnaces < 100K BTU 05/26/2009 $14.00
TIGARD, OR 97223
PHONE 12% State Surcharge - Mechanical 05/26/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/26/2009 $58.50
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: Natural Gas
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 N• ''cation Ce _ . Thos- rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir-ct questions to OU •y c -fling 503 246 6699 or 1.800.332.2344
Iss ed By: - , I f ` Permittee Signat re:
Call 503.639.4175 by 7:00 a.m. for an inspection that bush- s 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.
RECEIVED
r
r Mechanical Permit Application a, ( t I I i I t i ,,,
MAY 2 2 2009 Received
IN City of Tigard Dare/Sy. 7 R.", D y BA Pemilt N °-: M e C,..1049-0,0„z55
13125 sw Hall Blvd., Tigard, OR 97223 CITY OF TIGAR
_V Phone: 503.639.4171 Fax: 503 598.19 0 Permit
Inspection Line: 503.639.4175 598.1960_ CITY
1 • ,,.,,� . _ s.e ram a for f > Internet www.tigard- or.gov Cf!• :. i„ ,'. f Supplemental information
TYPE OR WORK „ ., . , . Yom* SCHEDULE - USE CHECKLIST
❑ New construction Addition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials equipment, labor, overhead, and profit.
CATEGORY, OF C01HS'�F} i, , ,.' Value: $
lipapENTIAL $otapr nrr /SYSTEMS FRES*
1 - and 2- family dwelling ❑ Commercial/industrial D Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. r Ea Total
JOB SHE irIFORMAiDii A ''E:G 1 : ,� Heating/cooling
Job site address: / conditioning or heat pump
t / 17 1 1.aJ (requires site ttlaa showing placement) 14,00 1
City/State/ZIP: T U a , to � R q 7 1 _ 100.000 BTU (dacniveols) t 14.00 1 �1
T Furnace 100.000+ BTU (duota/Venrs) 17.90
Suite/bldgJapt. no.: [ Project name: c 0 01 S - Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
-- }lvdronic hot water system 14.00
Residential boiler (radiator or
MMCNI " hvdronic) 14.1)0
C E _ t L Unit heaters (fuel -type, not electric),
in -wall, in -duct. suspended, etc. 14.00
T Flue/vent for any of above 6.80
Subdivision: 1 Lot no.: Other: 10.00
Tax map/parcel no.: Other fuel appliances
9ESOOPTION 'OF 'f , , a .. , Water heater — 10.00
Gas fireplac 10.00
G -.-`i L U` n / C. -e- fireplace vent for water heater or gas 10.00
L.og Iiy(htcr (gas) 10.00
Wood/ stove 10.00
Wood fireplace/insert 10.00
- - Chimney/liner /flue 10.00
. I. ,' ,STY OW1Edi • ' - . �tf '!E'F. # • , . O t h er 10.00
Name: E il 1 /1 - ♦ IM1 Environmental exhaust and ventilation
Vi, Range hood/other kitchen
Address; ��! y • U equipment 10.00
C `a - - Clothes dryer exhaust 10.00
ity /State/z1P: , `I
Single -duct exhaust (bathrooms,
Phone: (6 . e r _ Fax: ( ) toilet comparunents utility rooms) 6.110
' "Q '0 ;, ,, l Attlo/ctawlspace fans 1000
Other
Business name: Fuel piping
Contact name: AND AIR CONDITIONING, INC. $5.40 for fret four; SLOB for each additional
i ;• . - a - _ . - : . T ' Furnace, etc.
Address: NEWBFRr, OR 97132 eras heat pump
City/State/ZIP: Wall/sus nded/unit heater
Phone: ( j) 5 'lSC : ( c5 8-`01 p 67 c Fire lace heater 1111
E -mail: � $ ~ r Fax: �
C70NTRA'. r0R:'', . , .. Barbecue �
Clothes d
Business name. Other:
Address: AND AIR CONDITIONING, INC. MECHANICALPERMIT SEES*
—
t INDUS I NIAL PKWY Subtotal ( q r r
City/State/ZIP: k • _ A t' . ! Minimum permit fee ($72.50) 7,Z' 5
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
State surcharge (1294 of permit fee) t ? C)
CCB lie.: C ~I S �- TOTAL PERMIT FEE 5( a o
Thu permit application a:pitss it a permit is not obtaiaod within 580
Authorized signature: ---‘. • „ days alter it has been accepted as complete
` � Dat • . • • • fee metbodolopy' set by Tri-County Building industry Service Board
Print name:
Bairaioacre otnt+rm '
.17T011. a. �:)
E00 /E001A XV 6C'80 6002 /ZZ /90