Permit a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013 00502
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/04/2013
Parcel: 2S102BB00822
Jurisdiction: Tigard
Site address: 10405 SW JOHNSON ST
Project: JACKSON Subdivision: BROOKSIDE PARK NO.2 Lot: 1
Project Description: Gas furnace installation.
Contractor: FOUR SEASONS HEATING&NC INC. Owner: JACKSON, ROBERT M&
1005 INDUSTRIAL PARKWAY NITA J TRS
NEWBERG, OR 97132 9547 SW ELROSE ST
TIGARD,OR 97224
PHONE: 503-538-1950 PHONE:
FAX: 503-538-0165
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 09/04/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 09/04/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/04/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: 411101110_ Permittee Signature:
._..c2. �r2 ,
11111.211■
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM:Four Seasons Heating TO:5035981960 08/30/2013 14:41:48#9912 P.003/003
Mechanical Permit Apoli . . , . • I,,I:,■)1 i li I 1 ,-
• City of .
SW 111111 Trd CEIVEC) Received
Datenly 4 # ;3
1377--- IZEMENIPPINI
Tigard Blvd..Tigard.Olt Plan Reviow
' II:'' Phone: 503.718.2439 Fax: 503.598.1960 a 2013 1,/ateilly. )urintmm=IMIIIIIIIIIII
Inspection Line: 503,639.4175 SEP 3 mt.Itcadylay: El See Page 2 for
Internet: www.tigard-orgrw Notifted/Meittod: Supplemental lorommtnen
CP OF TIGARD IIF7A
TYPE OF
BujiPtNG DIVISIOI\I COMMERCIAL FEE' SCIIEDULE- USE CIIECKLI-ST---
-- Mechanical pcsmit fees arc bused on the value of the work
0 Now construction Lgl Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition D Other: mechanical materials.Equipment,labor,overhead,and profit.
._...... ...... Value;$
CATEGORY OF CONSTRUCTION .....-._
RESIDENTIAL EQUIPMENT/SYSTEM.%FEES*
.._. _.......
M 1-and 2-family dwelling 0 CommorciaVindustrial 0 Accessory building leor special Information use cheridlst.
0 Multi-family 0 Master builder 0 Other. I)escription ....._,,.... ..., ...,........... T (- . T JUL I- Tutill_
,. ....___
JOB SITE INFORMATION AND LOCATION Ileadrsg/coulIng: —
Air conditioning 46,75
Sub site address: I(st4 as- s .5 o v\y. --- Furnacul900(1 13111 ulucia/vants) ' f 46.75 ...4(. 1_5_
city/statci111): --r; 0)a r 4 0 g, 9 1 D_.).(-1 Furnapc 199poof B.riii4y.h.bi... 54.91 . .. .....
Ileat pwnp
SuitabldgJapL no.: I Project name: -Tv,c_4(__co r_i
• _ 1 xict work 23.32
_
Cross street/directions to job site: .1 lidronic hot water system 23.32
....._____. . . .... ' - "• ------- " '•----------- litmidential boiler(radiator or
hydrunic) 23.32
.
Unit litters(fuel-type.not electric),
in-wall,in-duct,suspended,etc. 46.75
...._.,.
.ylue../.vmd for any of above ,., 23.32
--" ()dm: , 23,32
SubdiviSion: I Lot Ito,:
____. . ........_ ..._____. ...._. . Other hod appliances:
Tax map/parcel no.: _W.OcilicON __ 23.32
— ____....... ... ..
_...-
DESC:RIPTION OF WORK Gas tircelace/inscrt 33.39
_ ..,...... ._
_ .. .
Flue vent for water filmier or gas
/-
23.32
1-.-.Y1 S 41,1,- ..‘. t--ICA _.......t-.U.(lick c e_., .._.... _ fireplace ... ...
Loll lighter(84) 23.32._
._._...... Wood/pellet stove 33.39
Wood fireplace/limed 23.32
..„ .,_______, _______ . ________.... -r-
Chimney/liner/hue/vent 23.32
pid PROPERTY OWNER I — U,...,
TENANT Other.
F:nviroomental cabanas and vendlation: 23.32
Name: ( 12)2(-4 ), A-61, 7:310±(,*---_Cly ., Range hoNvotticr kitchai
,_equipment 33.39
3339 ---
_,—...---. Till
City/State/ZIP (.1.1
..-(1 o & ci 1 .,7)--,. ,Lt Single-duet exhaust(bathrooms.
1 toilet compartments.utility rooms) _ 23.32
_......_
Phone:( ) (...,c c„A.._ ot. sa . ---. [.ax:( ) Atlic./cr.bv...4. 2332__...,.. .
APPLICANT 0 CONTACT PERSON „_t niter:
1-
I twin MSS name:
-------- ------Four-Seaseos-Heating-- $14.15 for first four;$4.03 for each andIttotuil
Contact name: 8,___.. Air Conditicning, Inc ________ ,__ Furnace,et_c::. . , .
.....____.___
Address: 1005 Industrial Pkwy Gas heat.pum
.. ... . Nwt.R.:11);-()R--9-7132 Wall/suspended/unit heater
C ity/State/ZIP: .WitunLhetuer _ _ ....
. ._. . .. . . .
Phone:(5,6 3) t.;2-> -- ICI 5-(....) i Fax::(li:X):51 s-13<g- — 0 i 44 c.; Fireplace _.
l''-niu"!__L..1 P 1,74;k,(..cj•E' ("; u,r SR sk-su-l'\s.tiNsLG,±0.\.%_r,_u4zn,.. Barbs:we
...
CONTRACTOR Clothes drysrAgas).._
__...... .,
13usiness name: Four Seasons Heating Other: ... .. . . ......
&Ali--c-darstiturrirrgHrte — MEalANICAL PERMTT FEES*
Address: • Subtotal" ---(,-,:ic,-;"...
—1-0054cidua1riaLP .W.Y.. . ...._______________
City/State/Zit': Minimum permit fee
_._
1 .....
-- ____ _ . . ......N.._e.wbefg, OR 97132
_...... • Plan review(25%of permit fee)
Phone:( () 1>eg- tI'lc3t. I Fax:(So'..}) 5 3 . s.) , tor
_..,_, —_...._... . Slate surcharge(12%of permit fee)
____
7t.14 lie.: (.1/ g.5- -,..-a__ 'TOTAL PERMIT FEE I 1:2•CI .5,„-(.1
_________n_az____ ._ . ... .
• --iiii;ormit appiliatian-aitiTties it a perudi k notOiiained;1112fis ISO —
day"after it ham been accepted as complete.
Authorized signature: Z12,..0 -Q-I6 /6
/ILA • ice mailialblopy WI by Tri-Coonly nuiWing Induslry&uvula limed
..- ... . .. . ...._.
[Print 11/111l.l:: ...> to 0_1_44N S.c,...V.Ls. 1)ate: C-1
Is - 3r 2 i
1,111. oitig1PormitAMEC Nilo App 040113 doe +11/..0 171(11/1/2./COMtvilijti
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