Permit 1111 �� CITY OF TIG ARD MECHANICAL PERMIT
COMMUNITY DEVELOP Permit #: MEC2013 00416
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2013
Parcel: 1S126DB05600
Jurisdiction: Tigard
Site address: 9456 SW 92ND AVE
Project: Epstein Subdivision: MONTAGE Lot: 27
Project Description: Install a /c. Placement of a/c unit must comply with manufacturer's clearance requirements.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: EPSTEIN, DANIEL & BREANNA
1005 INDUSTRIAL PARKWAY 9456 SW 92ND AVE
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503 - 538 -1950 PHONE: 541 - 521 -7890
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Air Conditioning 07/24/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/24/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/24/2013 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: Permittee Signature:
Air
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:5035981960 07/23/2013 15:53:15 #6966 P.003/003
Mechanical Permit Annlicatio,RECEIVE
City of Tigard Received •
JUL 2 3 2013 RR IelliY: 7/ 3 CZ Permit N°.' geoloig-ev
, _-- 13125 SW Ilan Blvd., Tigard, OR 97223 / Gi?)
li
Phone: 503.7182439 Fax: 503.598.1960 Plan Review
1 Oilier Penna.
Inspection line: 503,639.4175 CITY OF TIGARD .
, , Dn. R.dytny: , luriv RI See Prom 2 for
Internet: www.ligard-or.gov BIJILDtNG DIVISIOlpiwir-umw-i su,„1......1 infor.,...a
........,......._ ............. __
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----- " , " " - ....... _
. ...._
TYPE OF WORK COMMEJRCIA 1. FEE* SCHEDULE - USE CHECKLIST
_ .-.,_.
- 1 ; VrCettanical permit fees* arti based on the value of thc work
0 New construction XAdditionhilterali .. .—
on/rcplaccment performed. Indicate the value (munded to the nearest dollar) of ell
0 Demolition 0 Other: mechanical materials, equipmenklabor, overhead. and proly..__
.... ,. . Valu: $
CA'TEGORY OF CONSTRUCTION . .—_ ._
- ItESIDENTIAL EQUIPMENT /SYNTF.MS FEES'
. . ,
I - and 2 dwelling 0 Commercial/industrial 0 Accessory building ForrFedal lifforntallort we cheddlat
Multi family 0 Master builder El Other: Description • 7 Qt; i lia7 1
__...,-... _._.
- ----
Ileathipicoollna: :.
Jou sfll INFORMATION AND LOC:ATION
. . . . ,.. _ Air conditioning ( 475
6.
on site address: CI Li 3G, .,.. GI -,) A c .. r
I' urnucc WO 000 WU (duos/maw 46.75
City/State/ZIP: Lsi)c ,, . __ .. _ fill ,--) A (..- I FIIIMISZ I 00 000+ WU (ductevcuts) 54Ni
--- •••-• ---- ••• • -
61.06
v.
SuiteibidgJapt. no Project numc: (:.• 1 . i (..-.` . - .-----
.'"-A-.,...2-. r.)
• Dud work i--- 23.32 .. . .
Cross street/directions to job site: I lydronic hot water system __.. _ . 23.32
hydronic) 23.32
__
Unit heaters (fuel-type, not electric).
.. in-wall, in-duct suspended, etc. 46.75
Flue/vent Ibr tiny dr shove _______. 23.12 _...
. . ......... . _............ ......... . . . . . ..
- • • .. . 23.32 . .........
Subdivision: I no..
. . • • Other fud appliances: ....... _
Tax map/parcel no.: Water healer ' 23.32
.. .. _._ .._... _ , ------ •
DESC:RIPTION OF WORK Oes fireptacc/inser
33.39 . .._. ...
— , ------- -- Flue van Ihr water hcecr or gas
23.32
I A) 8. l ie t qcPs9 j- 23.32 •
• • • - • Wood/pellet 81.0VC ; 33:49
,...
Wood fireplace/1min 2312
—
Chimney/liner/fluOvent 23.32. .......
Other:
• 2.132
PIH/PERTY OWNER 0 TENANT '
..
___ Environmenta_114aust and ventilation: ..______ ____
_
..1■1Lime: .... n t.e _i_ c.,-,,.... In Itangc hood/othcr tOtchcn
equip_ment '.; 33.39
— _._.......,
Address: t LAC, L., C C A_ '') 4- " d PV e•Y■Ax- ..::1.1...- .47.9 .,.....tillm _ ._..._..___...._
(2 ity/StaldZIP:1 ■ r)(..\,.e cj . .. 0 C. CJI 1 :),.. 3_ Singie-euct Ciontusi (bathrooms,
toilet com_partit____L utility nit .. ____ 23.32
-----
Phone: (9..1 1 ) F 1.1 - 1 .... S 4:1 CI Fax: ( ) Attic/crawlsptux fins 23.32
. . ....—
APPLICANT ED CONTACT PERSON Other: . . __ 23.32 ___
.,F9$ • ._..i
Business mue: FOLIE_Seasons Heating
$14.15 tar first four; $4.0.3 for each additional .
.._ . ,
Contact name: & Air Conditioning, Inc !: 1: • "
.....
1c)(15 inbuStrIatf*vvY — .
Gas heat pump : .... ...
Address:
Newberg. oR 97132 Wall/suspended/in* heater
I :4/Slate/ZIP: Water healer ,
.
. . ..
1 el <cc • Fux:: ( c-07 C - 6 ..... ..F.jr10. ',
_ Rattle •
. _._ ..... . .
I 4 :1 .p _te .•'1' (') f ir ((A (14.,A It i r , k-4 h. Ilarbecue .
• . ., . ___
:
CONTRACTOR .. Clothes dryer (my: _ ......,,. -
_ . _. _ ___._ . __.. ........_
liminess name: Four Seasons Heating Other. _____,...,
MEL PILRIVIIIT FEES*
..., .... .
Address:
Subtotal I-4 G . 7 s
Ci tyiStatell11 Newberg, OR 97132 :minimum pcnnit 0) ..•'t 4,7 L ,4, - ,,,,
. ... ... ..... ...
lia mview (25% of permit fce )
Phone: f 663 is ) 3 .... i 0 1 C,, • Fax: (' ic?;6'-- rs.rs-i.- ..... •
Stale:Surcharge (12% of perrnit
•••
CCH tic.: 1 '.--1 1 1. -,...?.___ L . AZ _ , .. TOTA PERMIT FEE
, . ..... . . . . .
- - 'fhb. perm, appliea4ion espires it's' permit te oot °endued withiiitati
. \'• ; (', ..
dar■ sittr it has been mcccptett as complete.
AuLitorinxi signaturc: ( I L. ) ki A 4-...._1„,...a.) . Prea methodology sin by In-County Building iudisary Service mead
. .. 1 Onto; -- /.......:) -7 ,_ _ ..1 .. 3 . ....i
.
I \ IiiiildingUNAms1.11VIliC romtilApp fl-j)1 /MA( I II (I I 1137KOWIViill) •
FROM:Four Seasons Heating TO:5035981960 07/23/2013 15:52:58 #6966 P.001 /003
54;4
9
Xn
FAX
TO: City of Tigard
ATTN : Permits
RE: Please issue and fax copy of Permit as soon as ilossible.
NUMBER OF PAGES (including cover):
FROM: Four Seasons fleeing & Air Conditioning.
1005 Industrial Parkway
Newberg„ OR 97132
Phone: 503-538-1950
Fax: 503-538-0165
Sent By: Deborah
E -Mail: deborah(i fourseasonsheatair.com