Permit CITY OF TIGARD MECHANICAL PERMIT
It • COMMUNITY DEVELOPMENT Permit #: MEC2013 -00132
T [ GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 03/11/2013
Parcel: 2S110DD90521
Jurisdiction: Tigard
Site address: 10920 SW MEADOWBROOK DR 52
Project: Fisher Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 52
Project Description: (1) heat pump installation
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: FISHER, PAMELA
1005 INDUSTRIAL PARKWAY 10920 SW MEADOWBROOK DR #52
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE 503 - 538 -1950 PHONE: 503 - 670 -4955
FAX 503 - 538 -0165
FEES
Specifics: Description Date Amount
Heat Pump 03/11/2013 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 03/11/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/11/2013 $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: AiltAie,i( due Permittee Signature: 00 e 4 -r pd
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.
03/08/2013 08:11 FAX 5035380165 0003/004
Mechanical Permit A ication lH () l: t i r l l e I 1,1 t t• l
Received p No.: L'
City of Tigard �D 3r 1 [ r' / 3 NE av 13 -[wr 33-
I N . - Date/By: 1 3125 SW Halt Blvd., Z igard, OR 97223 Plan Review Other;
• 't . phone: 5017181439 Farr 503.591 MAR 1 1 2013 DatelBy
— inspection Line: 503.639.4175 Date Ready /By; huts. El See Paps 2 for
Internet: www.tigurd-er.gov Notified/Method (l (, Bappkauntal lnformation •
:' .at.r r: - `. •.r ':. , T�lr( Mechanical permit fees* are based on the value of the work
❑ New construction liji Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor. overhead, and profit •
;14,71 - --• , • i '. fat,; 4 V, r .. F .a s;+ \o;a.�'0,.?4,,4 AII.,'t�,t'Pr. a^r.v.vvv ; . ,, , • • . Value:
7tA.CJ
art- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Foespedal dtjonraadan use d*ec*1&
❑ Multi- family ❑ Master builder ❑ Other. Dm:iipt I QtY- I Ea I Total
k; , . �t,,� Heating/tooling:
`� ; ;P :' �`.' .;:;::':i 4i : , , Il 'tglIZ ' .' +I •' Air conditioning —
Job site address: 1 pc) AO 5 ,v4 m eo_a t, w1 b rb tr 4. by sa (requites site Plan showing placement) 46.75
Furnace 100,000 BTU (dticta■vents) 46.75
City/State/ZIP: 1,Ar Cl o P. Oil 7 tat t Furnace 100.000+ BTU (ducts/vents) 54,91
Suite/bldg/apt. no.: et G I Project nano: 1 S H E R. Heat pump
_teairires sire plan showing placement) i 61.06 (Y 1.0 to
Cross street/directions to job site Duet work 23.32 .
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 2332
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 46.75
Subdivision: J Lot no.: Flue/vein for any of above 23.32
Other: 1 1 23.32 .
Tax map/parcel no.: Other fuel appliances:
1...fit'.4.i. r. a,,..- cx• wrwr ". ,S -- - Water heats � 23.32
" . ;f Gas fireplace/insert . 3339
ii.- IL y.; e4k-ot evt vr-. r Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) , 2332
Wood/pellet stove 33.39
Wood fireplauc/insert 23.32
+7rw.c ?SF rti� `,•1.. :,o : ". ',112 i chimney/liner/flue/vent 23.32
`.. .\ °•. • •, 1 i ~ ° d • :• ,. 4 ;' . 23.32
Other:
Name: t'gn e.l a k c..ln Environmental exhaust and ventitetion:
Range hoed/other kitchen
Address:
04 AO C w % Mc,ad ot+4j oo 1(. 5 equipment 33.39
City/State/ZIP: ft G�OY"d 0 ( — 91 x «2.4 — Clothes dryer exhaust 33.39
P ) ' Single-duct exhaust (bathrooms,
I� ( 1 Fax: ( ) toilet compartments, utility roams) 2332
Sr • err , i y@'
P) . '.. ,I. y age +^ k t ~ - • i11 2 T : Attidcrawlspaace fans 23.32
Other 23.32
Business name: Fuel pipin1F_
Contact titan: & Air Conditioning, Inc S14.15 for first titer; 54.03 for each additional
Addr 1005 Industrial Pkwy Furnace, etc.
• • lslowbcrg, OR 07132 Gas hentemp
y /State./Z(P: Wall/suspeodeN+mit heater
Male: ( 6 603) 53$ Fax :: ( , . ) +S _. 0 ass Water heater ,
Fireplace
. E -mail: s • . -rah a ;ot.w • • < .• C . Q IV • �vw Ran e
d - '.iii' ,` ..I: .... ',1 -1"- ,gyA :.U: -- . ;s ,..`'I ^1T,' Barbecue .
Business name: Four Seasons Heating Clothes dryer (gas)
Address: If 4f.d� Pkwy Other. �' 1 f AP'1IGtX' , $ l!,,F. '� •q 't"NS S
15 Subtotal /
City/StateJZ1P: Newberg, OR 97132 Minimum permit the ($90.00) aim
Phone: (. ) 53 r 1 X15 Fa ( 'e3 S Ig — 01 t oy
Plan review (25 %of permit tie)
CCB lie.: 9 1 15 SA
State surcharge (12% of permit fee) 10 . O _
TOTAL PERMIT FEE 100.111:I
/� , �`"� \ O /{ _ This permit application expires if a permit is not reined within Ito
Authorized signature: ,( -J .6 J 244 7 days after it butt been acceptecept ed as complete.
f Print rams: 1)<A r4 p 1 Dane: 3.-g .. 1 3 • Fee methodology set by Tri -Crnmry Building Industry Service Baud
t doe 03!07/17 • 440J61 - TO 1101/coMnvFe1 .
03/08/2013 08 11 FAX 5035380165 Z001/004
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FAX
DATE: TIME: S• a ,,Y■
TO: a;11.40, ac 1 rEA
--�11 f7
ATTN: fe elvXT -.) ; (9 C & m S
RE: t\\ d P-e,e IryN PI era
NUMBER OF PAGES (including cover):
FROM: Four Seasons Heating & Air Conditioning
1005 Industrial Parkway
Newberg, OR 97132
Phone: 503 -538 -1950
Pax: 503- 538 -0165
Sent By: e.1=0 coqn
E -Mail: a€ @fourscasonsheatair.com • ‘0
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• 03/08/2013 08.11 FAX 5035380165 Z004/004
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