Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2013 -00328
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2013
Parcel: 2S110DD90152
Jurisdiction: Tigard
Site address: 10955 SW MEADOWBROOK DR 15
Project: WOLFE Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 15
Project Description: Heat pump installation. Placement of heat pump unit must comply with manufacturer's clearance requirements.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: WOLFE, SANDRA
1005 INDUSTRIAL PARKWAY 10955 SW MEADOWBROOK DR #15
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Heat Pump 06/13/2013 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 06/13/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/13/2013 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure: High
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:
v
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:Four Seasons Heating TO:6036981960 06/13/2013 12:30:28 #4257 P.003/003
Mechanical Permit Application
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City of Tigard
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- ,3,2,sw Hall Filvd., Tigard, OR 972 : i .., , ...\`'.13 Plan Review
Phone: 503.718.2439 Fax: 503.5' '11,:.4711 Other Pamit
Oa 6- 0 Dately:
ii Inspection Line: 503.639.4175
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Internet: www.tigard-orgov
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TYPE OF WO
Rit4SC;4*" COMMERCIAL FEE SCHEDULE - USE CHECKLIS1'
Mechanical permit tees` are based on the value of the work
0 New construction pdAddition/altcrationed6ment performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead. and profit.
Value: $
CATEGORY OF CONSTRUCTION ,...
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
ig
I' and 2-family dwelling 1:1 Commercial/industrial 12 Accessory building For special Infonnailon use dreallst
0 Multi 0 Master builder 0 Other: lkscription I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION . Heating/cooling:
- -
Air conditioning 46.75
Job site address: I oci..5 s me 1,, i* 15 Fi, TRW i mono up iiihed9
City/State/LIP: --r
e 0 c-11.3--`1 Furnace 100,0004-1-9 ..... ,........._51.91 . __ ..._
Ilmt pump ( 61.06 6 1.3go
Suite/bldg./apt. no.: (5 Project name:
i)uut work 23.32
Cross street/diredions to job site: I lydrunic but water system 23.32
•• - ---- _._........ _ . . ... -- - ---. --- Residential boiler (radiator or
hydronie) 23.32
linit heaters (hid-type, not electric),
41.mill:in-duet. suspended. etc. 46.75
Flue/vent lie any yf above ___ ...........,..... 23 : 32 .. ,..... ...........,.._
Other. 23.32
Subdivision: lot no.:
__ . .... Other fuel appliances: _
Tax map/parcel no.: Water heater 23.32 •
__
DESCRIPTION OF WORK thus fincylace/insert 33.39
Flue vent for water heater or gas
- Ine.- 2 i 6,±.Ak, --.‘eth_A Pt.krr. ............_.__ lirolitce 23.32
1 og lighter WO 23.32
Wood/pellet stove 33.39
Wood fiiplacc/inser1 23.32
Chimney/liner/flue/vent 23.32
' k PROPERTY OWNER -1- 0 TENANT (Vier:
Environmental exhaust and ventilation:
-
Name: Sc v.\ (3 1 ( e.... Range hood/other kitchen
. equipment 33,39
Address. ss: 1 cdasS k p ,.. _ ‘‘.... ..., .,., i.._ 1..,„, ../ , . ,,i
---, s . --...rev..se.xef_tm: .1...• • t• ,--,' IC Clothes drysaxhaust ...._.... 33.39
(Ity/State/LIP: 1 L A 0 R q 1 .12,..1.4 Single-dud exhau (bathrooms,
toilet companmcnts. utility moms) 23.32
Phone: ( (0) -1 Pax: ( ) .._Attic/crawlspace funs 23.32
14 APPLICANT 1::1 CONTACT PERSON Other: 23.32
Fuel p .
Business name:
Four Seasons Heating $14.15 for first four; 54.03 for titch additional
Contact mina:: & Air Conditioning, Int: Fumat: etc.
Address: 101)5 Industrial Pkwy ()as hem pump
cp -ENR-4•1491.± Wall/suspended/unit heater
Ci ty/StateTZ I P: Water heater
.. -
...-
2•5
Phone: ( 5k )5 5 _. (cia _14ace
-, Fax: : ( 54 5 33-011:d <
11 :: - ma i l : CA ei-" rf•-i"C“ -c ':,. CA k.uo-s5-ine-re-i a ir - . C 4.3 y - f - % . Barbecue
, - -
f:ON1'11ACTOR Clothes dryer (gas) _......... . ...__
- -.
Business name: Fou Other: r . Seasons Heating
MECHANICAL PERMr1 PEW'
Address: & Air Conditioning. Inc
Subtotal 4.) I. Olp
1005 Industrial Pkwy-
City/State/ZIP: Newberg, OR 97132 Minimum permit fee ($90.00) q o , 0‘)
Plan review (25% olpermit fee)
Phone: ( 5(..)3 ) C 3•6 - tic.-, Fax: ( - 9 ' 11) S IS t)„t65 _
State surcharge (12% of permit fee) ,..._ 0 .S.P,.........../'
CCM lic.: C y e-3 x ,7'" TOTAL PERMIT FEE
- .,. . ----•-•••• Thks permit application expires if. permit Is not obtained within 180
Authorized signature; AliAthi. Xt,,c) days after it has been accepted sr complete.
• Fee mesh Net by *MA:manly Budding Intim/Ey Service Board
Print name: 7;k3VA S.C.-1 c.. 'Date: ( 01...3 , k :21 I
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