Permit CITY OF TIGARD MECHANICAL PERMIT
1111
• COMMUNITY DEVELOPMENT Permit #: MEC201300189
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/09/2013
Parcel: 2S104BA08600
Jurisdiction: Tigard
Site address: 13811 SW LIDEN DR
Project: Khawaja Subdivision: CASTLE HILL NO.2 Lot: 121
Project Description: Install air conditioner. Placement of a/c unit must comply with manufacturer's clearance requirments.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: KHAWAJA, IRFAN U
1005 INDUSTRIAL PARKWAY IRFAN, GHAZAL I
NEWBERG, OR 97132 13811 SW LIDEN DR
TIGARD, OR 97223
PHONE: 503 -538 -1950 PHONE: 503 - 704 -3304
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Air Conditioning 04/09 /2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /09/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /09/2013 $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 que ' • s to • C by calling 503.232.1987 or 1.800.332.2344.
Issued B /� ., / Permittee Signature: "ALAI/. /.
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.
FROM:Fou sons Heating T0:5035981960 Q 22:46:37 #103 P 003/004
RECEIV
Mechanical Permit Application 0 8 2013
City of Tigard K RietW;ed L' Q g
y 7 8 �3 pertnn Nn r A0li/ 49e v�/
11 - • 13125 SW Hall Hlvd.,'Tigard, OR 92 OF ARD Plan Review
Phone: 503.71/.2439 Fax: 503.5 O �� Data /tly Oilier Permit.
1 i , . I , inspection Line: 503.639.4175 BUILDING DIVISION
Date Ready/Br. Inn, a See Page 2 for
Internet: www.tigard- or.gnv Notified/Method. I Su Supplemental I
_ ._.. -- .._.,.__,......._._...... 111 pa ._. . _ 1
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work .
❑ New construction ® Addition /ultertuion /rcplaWment performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit '
,,,,,— Value; S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
I- and 2- family dwelling ❑ Commercial/industrial ❑ Aet:essory building For special Information usecheckllst.
❑ 'Multi- family ❑ Master builder ❑ Other: Description Qty. i La. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
`' Air conditioning
Job site address: 1350 % .5‘..1 t � L-+ d e.,,, pr"1 we. / v placement (require <te plan shoving placecutl 1 46.75 I
- -- Furnace lUU,INS) lull (ducts/vents) 46.75
City /StatePLll : t ok� d C3 - /3 - i Furnace 100.0001- BTU Iducts/venls) 54,91
Suite/bldg./apt. rut.: Project name: K hu >,c�1 * .J,t�+c I leaf pump
(madam site plan showing placement) 61,06
Crass street/directions to joh site: Duct work _ 23.32
I lydrunic hot water system 23.32 '.
Residential boiler (radiator or
hydronic) 23 32
— Unit heaters (fuel-type. not electric).
in -wall• induct, suspended. etc. 46.75
Subdivision: 1 „ 1 ,,,_ Flue /vent tilr any of shov 23
_ Other: 23.32
p pa Other fuel appliances:
- m
Tax lira / rce{ no.: pplfanres:
W ater h eater 23.32
DESCRIPTION OF WORK
_ . .._
Gas fircplacc,hnscrt 33.39
� n� i I A „t r (1 l 1 I- t fl'O rl_e,r Floc sent for water healer or gas
fireplace 23.32
— Log lighter (gas) 23.32
Wo od/pellet stove 33.39
Wood fireplace/insert -. 23.32
C'himney /litter flueb t:nt 23,32
PROPERTY OWNER ( ❑TENANT
IZ _........_. .. - - - t.>fher: 23.32
Name: _r. r f of v> K 11e4 i,°1 1 -
m e..i _ _ Environmental exhaust and ventilation:
-"° Range hood/other kitchen
Address: 34, () S,rJ L r F" l V tYJ -.-...... equipment , 33.39
— City/State/71P: -- 2,r_d 0 47 1 1 2-Z-3 Clothes dryer exhaust 33.39
Jingle -duct exhaust (bathrooms,
Phone: ( ,3) l oti - 13 pt-4 Fax: ( I toilet compartments. utility rooms) 23.32
Rf APPLICANT ❑ CONTACT PERSON Attideriwlspace fans 2132
Business name: Other L 23.32
_ . .Eour Seasons Heating Fuel piping:
Contact name; & Air Conditioning. Inc 514,15 for rirnl room 54.03 for each additional
_-
v Furnace. etc.
Address: phyyhprg OR 97132 —.... ._.. .......__ . .
__.. —.. _..., (s heat �llnlp
City /State/ZIP: Wall/suspended/unit heater
Phone: (kio S) 5 3 $�� i `1 So) Fax :: (1;b1 ) +5 3 'is-- V f , 57" Water heater .... _-._�.,_.,.._r,.- - --
—
„„., Fireplace
E-mail; ci I +r C 41)ur S1 atsyn lie oN.1 a 1r , (--YY• Range
CONTRACTOR llarbecue _
Business name: Clothes dryer (gas) I
...- e Per Conditioning. Inc ^ Other:
Address: 1005 Industrial Pkwy MECHANICAL PERMIT FEES"
City/State/ZIP: Newberg, OR 97132 — Subtotal y 4, . 5
Minimum permit fee 1590.00) `7 o . r,G
Phone: ( 503 ) 1 531 ■ 1 u — 11" :(50 3 ) t 3 l - U 10 5
_, Plsn review (25% of permit fee)
('('B lie,: 11 i I.5 2 , State surcharge (12% of permit fee) to , go
,) — TOTAL PERMIT FEE fvo , c:
Authorised signature: Thi', permit application expires it n permit is not obtained within 11111
days alter it has been accepted as complete.
Print name: pe bo v Yc h / 0
Date: y.. 8...1 .3 • tee methodology •N by Tri- ('eunly Building Industry Service Board
Ittiwkting , Perrosla/MEC• Patina Apr, day 01,07/I'_ 444144171 anvoI
FROM:Four Seasons Heating TO:5035981960 04/07/2013 22:46:52 #103 P.004/004
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FROM:Four Seasons Heating TO:5035081060 04/07/2013 22:46:22 #103 P.001/004
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FAX
DATE:
1: 77 TIME: I U
TO: City of Tigard
ATTN: Permits
RE: Please issue and fax copy of Permit as soon as possible.
NUMBER OF PAGES (including cover): 1
FROM: Four Seasons Heating & Air Conditioning
1005 Industrial Parkway
Newberg, OR 97132 cit'S
Phone: 503 - 538 -1950 tObilto
Fax: 503 -538 -0165
W •
Sent By: Deborah \r
•
E -Mail: deborah),fourseasonsheatair.com 141141t4