Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT
Permit #: MEC2009 -00613
Date Issued: 11/17/2009
T [ GARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S134BD08400
Jurisdiction: Tigard
Site address: 11003 SW 115TH AVE
Subdivision: PENN LAWN ESTATES Lot: 12
Project: Bickford
Project Description: Install gas furnace and air conditioner.
Owner: FEES
BICKFORD, DOROTHY J Description Date Amount
11003 SW 115TH AVE
TIGARD, OR 97223 Air Conditioning 11/17/2009 $46.75
Furnaces < 100K BTU 11/17/2009 $46.75
PHONE: 503 - 590 -1663 12% State Surcharge - Mechanical 11/17/2009 $11.22
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 $104.72
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 la • • k will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan -, or if work is sus. -nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Util• Notification Center. Th.s. • - s are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
o• direct questions to OUNC . callin. .246.6699 or 1.800.332.2344.
ssued By: I� Permittee
� ? y.
Call 503.639.4175 by 7:00 a.m. for an inspection that busi 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.
- Mechanical Permit Application . rOk (lll1(
'1 1 til ) N,1.,
N.... City of Tigard RECEIVE �, Permit No.: EL .. (7/l .
13125 SW Hall Blvd„ Tigard, OR 97223 plan )'review
O Phone: 503.639.4171 Fax: 503.598.1960 NOV 16 20 09 o„ trAy. Other Permit:
.. 4 ., Inspection Line: 503.6394175 Datc ReadyBy, geePa2for
Internet: www.tigard- or.gov Notifted/Metltod: , B ce
Supplemental Information
CITY OF TIGAR 1 •
1 1 1 1 6 ' .. CONMER CIAL. FEE, SCHEDULE — USE CHECKLIST
[] New construction 'I 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.
Y OF CON3!'R)<1
Value; S
T[{aN. RESIDENTI.AL,>GQUIPMFN I SYSTEMS FEES'
,�1 and 2-family dwellin g ❑ Commerciallindustnal D Accessory building
For special irybrrnation use checklist.
❑ Multi - family ❑ Master builder 0 Other: Description
Q tY Ea. 1 �l 1 Total
JOB SIFE FOUMATIOX'AdslI LOCAPO N .'. Hearing/cooling
Job site address: Air conditioning r - _.
L ~ ' I L. V ^ (requires site plan allowing placement) 1 46.75 `1(t+ 7 s
•
Cityy /State/ZIP: � (� v-C` ()k L? -7 )_ 3 Furnace 100,000 BTU (due(duets/vents) vents) ,/ 46.75 yb -7,-
_ � ! `' ' Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: 6 rck ---- U`4 Hcat Pump 61.06 _
Cross st-cet/direotions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
•
Unit heaters (thel -type, not electric),
in -wail, jn -duct, suspended, etc. _ 46.75
Subdivision: Lot no -:
Flue/vein for any of' above 23.32
Other: 23,32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION .9F Iv 3 C,,, . . Water heater 2332
,
Gas fireplace 33.39
I r,S -, ` C'{ t 4 "F _ Flue vent for water heater or gas
1 iiC47e r -
Log re lighter ... , 23.32 ,_,..
() 23.32
Wood/pellet stove 33.39
Wood fire, lacciinscrt 23.32
. Chimney/liner /flue/vent 23.32
. L 'OWNER .;. — • - Q' ::1:Ei4 -r . ' , Other: 23.32
Name: i • t • 81k ii ` ` 0 00' Environmental exhaust and ventilation —
Address: i �� J ��{ 6/lie— Range hood/other kitchen 39
I 33
City /State/ZIP: T 0._,,,k 9 - 1 ? I Clothes dryer exhaust 33.39 ,, / Single-duct exhaust (bathrooms,
Phone: (5G j) — I 4 6_3 Fax; ( ) toilet compartments, utility rooms) 23.32
ANT , Attic/crawls f ans 23.32
,1., C}.;k3Ql!A,CT - T 2332 1
Business name: FOUR SEASON : , i , Fuel piping
Contact name: ' v e • . Mt) I N ITIONING, INC. 514.15 for rust four; 54.03 for each additional
1005 INDUSTf IAL PKWY . etc.
Address: NEWBERG, OR 97132 Gas heat pump
City /State/ZIP: . Wall/suspcnded/unitheater
Phone: 663) 5, /3 j Fax: : (5 34 —iJ 6 Water heater
Fireplace
E-mail:
Range
_ ". wi�ri .., ni.����►�:� . rr,r..r. 13arbccue
Clothes dry
Business rtnrrre: AND AIR '()Nf]ITIONINfa t INC ()
Address: 1005 INDUSTRIA1. PKWY I ' MECHANICAL PERMIT F
NEWBERG, OR 97132 -
City /State/ZIP: Subtotal
Phone: Fax: Minimum permit fee (590.00 45 A 50
5G3) 3 ' I a $ b (5�3) 53 &'� Q 5 Plan review (25% of permit fee)
CCB lic.: ! 3 ( 5 a State surcharge (12% of paint fee) j 1 . •�
TOTAL PERMIT FEE /Q 4,1
Authorized signature: 1♦` 1>I
This permit application expires If a permit is not obtained within IRO
days after it has been accepted as complete„
Print name: l a Irk I"', Cs.l1V k Date: / .. / 6 ac? • Fur methodology set by - Ai-County Building industry Service Board
I: 1BuildiapiFam icalMEC-PennitAppdoc 10rttro9 440- 44I7T(tt /01/COMM'EB)
500 /50012 XVJ 6E :ll 600Z/9t/IL
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• PLEASEREFAX APIMLICAIION WITH SITE PLAN
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. - - - FOUR SEASONS HEATING ig
-; !I AND AIR CONDMON__ __ _ING INC.
1005 INDUSTRIAL PKWY c,)
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. . NEWBERG, DR 97132
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