Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012
Parcel: 2S102BB00816
Jurisdiction: Tigard
Site address: 10315 SW BROOKSIDE PL
Project: KONARZEWSKI Subdivision: BROOKSIDE PARK Lot: 1
Project Description: Heat pump installation. Unit must meet 5 ft. minimum rear and side yard setbacks.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: KONARZEWSKI, HILDEGARD
1005 INDUSTRIAL PARKWAY 10315 SW BROOKSIDE PL
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Heat Pump 01/27/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 01/27/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/27/2012 $28.94
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:
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.
01/25/2012 09:50 FAX 5035380165 2002/004
Mechanical Permit A • • i 6.. 14 /i■ (Yi I I( 1 I '-t i) \
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Phone: 503.639A171 11/417C 303.= 2 5 2012 Decay, `: •
lost:•ection Line: 503.639.4175 We lUaorlyakr. MillEEESE
Internet www.tigard-cLgov CITY OF TICIAFD Nentlediatedied.
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Mechanical permit fees' ate based on the value of the work
0 New consttuction Addition/alteratkm/replacemad patbmted. Indicate the value (rounded to the nearest dollar) of all
0 Demolition C3 Other: mechanical mown - qi labor. - - ' and . 'M.
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PISID*171"1"1"4121T / SMEMSIFSKS! - . -
g 1- and 2-ihmily dwelling 0 Conunercial/inctustriol 0 Accessory building For special information UN CheddiSt.
- Mulli-family 0 Master builder 0 Other. Qty nol Total
.1011 -Sag lttriat:4044 . - iy6i i i .
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City/State/ZIP: '' . ( Cry 41-2.i-i Putnam 100 000 ETU deernivcoa 111111IIIIMMIIII
Pomace 100 000+ RTU duciarvento IIII. 54.91 NM
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Address: NIL '1 0.1(6 8 - Ra_k. . MI 33.39
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Contact name 514.15 for that for S4113 for each additional
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This parmit application expires if a permit h set
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