Permit 1 114 q CITY OF TIGARD MECHANICAL PERMIT
o . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00579
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07/2012
Parcel: 25111 DC14000
Jurisdiction: Tigard
Site address: 15785 SW OAK MEADOW LN
Project: Jacober Subdivision: SUMMERFIELD NO.11 Lot: 636
Project Description: (1) gas furnace installation
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: JACOBER, JOAN M
1005 INDUSTRIAL PARKWAY 15785 SW OAK MEADOW LN
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/07/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/07/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/07/2012 $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: Oki . D./ j �1 i �
n )O
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 1 C-
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.
11/06/2012 11:24 FAX 5035380165 a 002 /00 •
Mechanical Permit A p plicati oRECEIVE I I t,,; (l l 1. I .l. t I N I ,
City of Tigard Received
A ' c Date/By: ii l 7 ?— S'f Permit No.: 6 . „ cosy/
•
. r. SW Hall Blvd.,
503.718.2439 Fax: Tigard, 503_598.1960 _ ' 0 v Z012 D� Review Other Permit:
lrrapec tl on Line; 303.639 �/ �(� Date Rcady /By: Sufis: el See Page 2 for
• Internet www- tigatd- or_gov C 1 I OF TIjig Notified/Method 1' G supplemental Information
❑ N ew construction ddllioNSlteration/re lac4micnt Mechanical permit fees' are based on the value of the wor
p performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other. mechanical materials. equipment, labor, overhead, and profit
Value: S
*f;
.. . " . ' i - taiFdDYNT1lLL SQi;Ii*PAlY1''/ SY81tM8 F3wB*;. ..
11
1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building For special information use checklist.
Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. - I Total
. : JOB SITE ' 4 14 ilc '.: Ti<Qta i • " Heatingkoolihhlt:
. `Si -Do cJW � Air conditi plan Job site address: ij pin
(requires site an shuwrog placement) � '' \ 46.75
C /l �J Furnace 100,000 BTU (d ct
City /StatealP: ) M.91
C !J�— Furnace 100,000+ BTU (ducts/vents) 4J 54.91
Suitelbldg. /apt. no I Project name , ' Heat pump
'3 (requires site plan showing placement) 61.06
Cross street/diretx to job site: Duct work 23.32 _
Hydronic hot water system , 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
_ _ in-wall, in-duct, suspended, etc. 46.75
Subdivision: l Lot no.: Flue/vent for any of above 23.32 •
Other. 23.32
Tax map/pa el no.: Other fuel appliances -
' r n., ./ J .v i lY .. il:•
.,� } ei •,w`-' r Water heater 2332
GAS . ✓hQ � Fl
Gas ue vent for water heater or gas 3339
fireplace 23.32 ,
Log lighter (P) 23.32
Wood/pellet stove 3339
Wood fireplace/insert _ _ 2332
,� '... r „ �: �
,. �''•-:,%.' ;;; � 4$ , ; . ' Chimney/liner/flue/vent 23.32 T
r r Other. 23.32
Name- VCC) X' enviroameatal exhaust and ventilation: _
Address; i S'l $5 c °out. µ,,eaciati, Range hood /other kitchen
equipment 33.39
City /Stntca Pf 39,1A ' Z_ 22,1 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
IA . : : : • f OLA l'T
>t!P�:�eANT ' .- � . � :-LJ�' . io Attic/etewlspace fins 2332
Business name: Other — 23.32
FOUR SEASONS HEATING- 'fuel piping:
Contact name: $ 14.15 for fast four, Sdr03 for each additional
Address:
AND AIR CONDm ONING, INC Furnace, etc. W
heat pump
City/State/ZIP: 1005 INDUSTRIAL PKWY Gas s ende .
��n� l WalUsuspended/tmit header
^ Phone: ( ) NEWRERG GA197482 ) Water heater
Fireplace
Business name: Clothes dryer (gas) -
Address: AND AIR CONDITIONING, INC. per j,5,V4 ,
City/State/ZIP: 1005 INDUSTRIAL PKWY Subtotal .
Minimum permit fee ($90.00)
Phone: ( ) NEWBERG, Od 674%2 ) Plan review (25% of permit fee)
CCB lie -: C !, i i - '� * State surcharge (12% of permit the 1. � "N.,
TOTAL PERMIT co .10
Atrthorivad signs. 4 • � 77�ix permit da ft bae bum acceptedpermit is not o
com teed within f
Y am.. � I t► �. pkte.
2,„," Date: I I M • Fee methodology set by Tri- County Building Industry Service Board
1: tOuitdingTeimitaiBcParmrtApp .doc 09107(12 440 (11/nlJCOMtWL:H) 1
11/06/2012 11:24 FAX 5035380165 0001/003
‘1M-OE 'SA7,
ti , 1 f 4
T om •
ci o
m�
I e
C .
$ AIR GO
FAX
DATE: :_ I I '. L �
ATTN: Te.
RE: _
NUMBER OF ' PAGES (including cover):
FROM: Fhur Seasons Heating and Air Conditioning
1005 Industrial Pkwy
Newberg, OR 97132
Phone: 503 -53$ -1950 ��
Fax: 503•'538 -0165. '.\ X
V
Sent By: .
E - Mail: cttc l,e_, @fourseasonsheatair.com
''
/\\\P-*'