Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 00229
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
Parcel: 1S 126DB05900
Jurisdiction: Tigard
Site address: 9169 SW MONTAGE LN
Project: Tobolski Subdivision: MONTAGE Lot: 30
Project Description: (1) A/C installation Building 6, new SFA Placement of NC unit must comply with manufacturers clearance
requirements
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: NW AREA INVESTMENTS LLC
1005 INDUSTRIAL PARKWAY 11150 SW RIVERWOOD RD
NEWBERG, OR 97132 PORTLAND, OR 97219
PHONE: 503 - 538 -1950 PHONE: 503 - 387 -3777
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Air Conditioning 04/29/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/29/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/29/2013 $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: Permittee Signature: brr II k A-PPU c 4 T (D4.1
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.
FROM Four Seasons Heating TO:603698196M2013 10:19:27 #1268 P.003/003
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Mechanical Permit Application I ( i k (il I ll 1 I ••1 I)\1 1
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2 9 20'3
City of Tigard Received
Date/lir Lfiaq I/ ; Cs1"- Klein No. IA c e.,30/3,D0a _ a ..
_:- • W Hall Blvd. 13125 S Plan Review
Il• Phone: 503.71132439 Fax: Tigard 'OR 503.5= °F TIGARD other mr,iiiip .-r apt 00(14S
,
I )aterlty:
Inspection Line: 503.639.4175 BUILDING D IVISION
u , [tale Ready/By: tufo WI See Page 2 for
Internet: www.tin,iird-orgov Norified/Mettxxl: en (,, I Stopplemental Information
............- ". ''''
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
------
- Mechanical permit lees' are based on the value ol the work
0 New construct ion LE1 Addition/alteration/replacement periOrtned Indicate the value (rounded to the nearest dollar) of all
o Demolition 0 Other: mechanical materials, eviement, labr. tiverhemd. and profit.
. Value: $
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT /SYSTEMS nose
N 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special infonnstion use checklist.
0 Multi-family 0 Master builder 0 Other: Description J Qty 1 Fa. I Total
. .-...........
3011 SITE INFORMATION AND LOCATION IleatieWcooliag:
- A ir conditioning _ I 46.73 46.75
lob site address: 9169 SW Montage Furnace 100,000 BTU (duets/vents) 46.75
, ..
C'ity/StateilP: Tigard, OR 97223 Furnace 100,000+ H111 tisietsf“,ia,9 54.91 ,
Ilea' pump 61 06
Suite/bldg/apt, no.: I Project name: Tnholski
Duct work 23.32 _,...... _
Cross street/directions to job site: I lydronic hot water system 23. .
. .._. ___ .. _______.... . ....
------- - Kesidentiai boiler (radiahm or
hydmniq 23.32
Unit hollers (fuel-type, not electric).
in-wall, in•duct. suspended. etc 46.75
Flue/vent for any of above ... 23.32 ,.
-
• --- i . .
23.32
Subdivision: - '' -- Lot no.:
Other fuel appliance!:
1 ax map/parcel no.: Water heater 23.32 __.....
DEM:RirTION OF WORK (.125 lireplace/insert 33.39
Flue vent for water heater or gas
Install Air Conditioner fireplace 23.32
log lighter was) 23.32
Wood/pellet stove 33.39 ...
wood fireplace/insst , 23.32
Chimney/liner/flue/vent , 23.32
Other: ,
IS PROPERTY owNER U TENANT 23.32
EnvIronmeital exhaust and ventilation:
Name: Aline Tobolaki Range hood/other kitchen
: "" - - " emaipment 33.39
Address: 9169 SW Montage
Clothes dryer exhaust 33.39
......_._
City/State/ZIP: Tigard, OR 97223 Single-duet exhaust (bathrooms,
toilet com2artments, utility rooms) 2132
Phone: (503)699-3957 l ax: ( ) Atticicrawispacc fans a „.„.„............. 23.32
- .
Ca APPLICANT 0 conrrAc.-r PERSON Other: 2332
,...!'"m.S
Business name: - "'
p our _s oavzals _H ea t in ' g ....__ $14.15 fur Wirt fuur;$4.03 for adnitional
Contact name: & Air Conditioning, Inc Furnace, etc.
Address 1005 Industrial Pkwy (ias heat pump
: •
Newberg, OR-g7132 Wall/suspended/unit healer
( '. iiy/Stal&Z I l' : Water healer . _....
phone: (503) S38-I95.0 Fax: : (503) 538-0165 I- ireplace
, . 1,2:_gin e
E-mail: debnraliCrillourseasonshea to ir.eum ttarbeux
CONTRACTOR , Clothes dryer (gas)
---- - Fear Scarsorts-Hestint---......... .
op.: -
Business name: _....,
_Ai cnriditinning 1nC MECHANICAL PERMIT FEES*
Address: 1005 Industrial Pkwy Subtotal 46.75
(7ity/StateJZIP:
NEAKiffell, VDR9D132 - - - Minimum permit 1 1$90.00) • • WOO
.... .
I'lan review (25% of permit fee)
Phone: (503) 538-1950 Fax (503) 530-0165 State su t charge ( 12% of permit fix) 10.80
C.C14 lie.: 97152 . 11Yrn I. PERMIT FEE 100.110
This permit application tapirs% it • permit is let obtained within 110
days after it tun been accepted as eosisplele_
Authorized signature: /11) h 46_00 • Fee metlexlelari ye hy Tri lieildelp letliedry Service Hoard
Print mune: Deborah Salo I Date: 4/26/13 I
I ■14„,i,i.iie,iniiiii:\ tai•u 1 111111 / 3 du, 4411.4617r (II rovconewius)
FROM:Four Seasons Heating TO:5035981960 04/26/2013 10:19:14 #1259 P.001/003
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'1 FOUR P
SEASONS
% 4 AIR cow\
FAX
DATE: L I - :?-(o - 13 TIME: 10 :_t 9 a,,--
TO: City of Tigard
ATI'N: Permits
RE: Please issue and fax copy of Permit as soon as possible.
NUMBER OF PAGES (including cover): 3
FROM: Four Seasons Heating & Air Conditioning
1 005 Industrial Parkway
U!1 Newberg, OR 97132
G
v■ Phone: 503 -538 -1950
t '
ti; Fax: 503 -538 -0165
O
Sent By: Deborah
E -Mail: deborah@fourseasonsbeatair.com