Permit CITY OF TIGARD MECHANICAL PERMIT
1111 •' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00508
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2009
Parcel: 2S103CB02500
Jurisdiction: Tigard
Site address: 13235 SW 121ST AVE
Subdivision: WILLAMETTE NO.2 Lot: 28
Project: Molatore
Project Description: Replace gas furnace.
Owner: FEES
MALATORE, ANGELIA Description Date Amount
13235 SW 121ST AVE
TIGARD, OR 97223 Furnaces < 100K BTU 09/29/2009 $14.00
12% State Surcharge - Mechanical 09/29/2009 $8.70
PHONE: 503- 290 -6442 Minimum Fee Adjustment - Mechanical 09/29/2009 $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 $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ( CFI Q Q n Permittee Signature: CAW
Vl v r `/ � Call 503.639.4 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
'Mechanical Permit Application 1 (t•1(0 r a 1(1 1,1 (1 \ 1 1
City of Tigard 5E F 2 9 2009 Date/Hy. Received _ � i 2do9 �C
N......
g tsatd$y: Permit No Q
13125 SW Hall Blvd., Tigard, O 9 , `'e"
Phone: 503.634.4171 Fax: 50 TIGARD
9 tkau,/sy. Other Permit:
i 1 , Inspection line: 503 . 639 . 417 RUILDING DIVISION pato Reidy/Hy, E S Page 3 for
.
Internet; www.tigard- or.gov Notified/Mathod: Supplemental Information
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El Ntw construction Additl0n /ttlteration/replacetrment Mechanical permit fees* are based on the value of the work
❑ New onstr ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materiels, equipment, labor, overhead, and profit,
aZ..v.'�.., Is ,.,, :.. ° : .z 1B ,' I y �, � ,,,* , t K� 1
Value $
� ' . x+ „iuAdhh :.ukwtb(i� Y " 4 a1.'laf � w .rw.o J i ' r . :%4 , ' , � i ... ,,
V 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building A " " "'01" ' ORP
1:1 Multi - family ❑ Master builder For special Injnrntolton use checklist.
' Description I Qty. Ea. i Total
'', . ;.y . :. 1 'A Y ; `, ;'Z.t Mi u -�u >. *ag.!,Er, o �; �.w ?.„„ is ` ' _ :,. ;
:4 ',!' Heathig/cooling
Job site address: 3 A S 5 1 S a v Air conditioning or heat pump
(requires site plan showing placement) 14.00
City / State/ZIP: 0-6-a ( q , L Furnace 100.000 BTU (ducts/vents) 1 14.00 1 L4 r o-e -
1 � l Furnace 100,000+ BTU (ducts/vents) 11.90
r w t
Suite/bldg. /apt. no l Project name: r r) 1 a r Css 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: 1 Lot no.:
Flue/vent for any of above 6,80
Other: , 1 0.00
Tax map/parcel no.: Other fuel appliances
!
h ) ^ • p " S4i_ ___ _ a � a9 2,l JP ,., 4∎ b s Water eater
L.. ' ) s , � v 1 , 1 ' ^i 0 a ti ly d+_'a {�.' e� t� � 1 , i .. r O . .. N .. "' Wt heater 1�10.00 �i. •••+ � . .. FN, ' 9 � ( ,.,. ' ./:. J0. ,_.i. i, 1i.a. yNF�. n � n ,LL';',.; .,. ..Q; — °
A p /� Gas fireplace 10,00
f)LC ` F' l 1AJ1/` 1f 10. Flue vent for water heater or pa
fireplace _ 10.00 _
.- " Log lighter (pas) 10.00
Wood/pellet stove 10 -00
Wood fireplace/insert 10.00 ,
h 1 r "'v'eas
4 e'" yr , f0;' ). fir, ' ," ,, rp";,1 µ n .°0; ' . Chimne iner/flue/vent 10.00
4/, my '_ y :..,J.d/,,, cc.. . .Oise+) k''.. .:, ......G. , 1' v,, 10 4iiiGdL....,r ∎k�9x 7NA M ..s
Other: ]0.(10
Name: a (A. Il _ Cj l Ct. (0 �(` Environmental exbaupt and ventilation
Address: -13 2.. J _5 t 1 °'-fi- A V Range hood/other kitchen
equipment , 10.00
City/State/ZIP: �� � v v ` 0 `� D__:._.3 S ngladua exhaust (bathrooms, 10.00
Phone: (5 ) Gi 6 - Co 4 2, Fax; ( ) toilet compartments, utility rooms) 6.80_
/, ` .��`r '� 4 t • ° I' , .P Attic/crawls ace fans L0.00
/ a)" rt�h , .w M'U(uf!� .ieX� u..x..W V"�AP''� �.
Business name: /� � � +�a� der: 10.00 piping
Contact nam e: r A D AIR CON IO NING, e � Fuel
55.40 for first four; 51.00 for each additional
1005 INDUSTRIAL PKWY Furnace, etc.
Address: NEWBERG, OR 97132
Gas heat _p_
City /State/ZIP: Wall /suspended/unit heater
Phone: (j ) • ..'"r.) ..'"r.) — • Fax: (50 ) 6 g - O (/v - Water heater T .
rj
Fireplace
E-mail: r Range
' s . x -1 hi' : 1 `. . q . ` ° F� Barbecue
euraar'Gr'I,. .rte. r . v Y ,,, i' : ,P,..,;,,:441,14 .Y4,: )/q ,o � l µ
S OUR SEASONS HEATING Business Hama Clothes dryer (gas) Other
Address: AND AIR CIDIT�. ;
1005 iNnUSTRIAL POD( ;,, „ i ? 4 1 ` > ;/ , ,
City/State/ZIP: NEWBERG, OR 97132 - Subtotal
Minimum permit foe ($72.50) '7 a ILTO
Phone. ( ) I Fax. ( ) Plan review (25% of permit fee)
CCB lie.: q 7 (,5 State surcharge (12% of permnit fee) 3 , "1 O
TOTAL PERMIT FEE ( .
Authorized signature: c.,p' - rah permit sppileatiea expires if a permit it eat obtained within 1110
'..%.' a ,9_ `„ - rah days after It has been accepted as complete.
Print name: ” ym - tiQ k Date: R - ,a 8 0 l" • Fee methodology set by TA- County Building industry Service Board
m: W1ntReselatkEGpennlWpp.doe ol/1W7 440 9617T(1UO2/COtd/WM)
800 /Z002 XVJ ZL :81. 8002/8Z/8o