Permit CITY OF TIGARD MECHANICAL PERMIT
: s COMMUNITY DEVELOPMENT Permit*: MEC2021-00720
Date Issued: 9/20/2021
TT i;A R i5 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110AA91531
Jurisdiction: Tigard
Site address: 10783 SW CANTERBURY LN 103
Project: Rubin Subdivision:TONDO SUPPLEMENTAL PLAT NO.5:/ Lot: 15-3
Project Description: Replace gas furnace and NC.
Contractor: ROTH HEATING&COOLING Owner: RUBIN, MARTIN&NAOMI
PO BOX 1265 10783 SW CANTERBURY LN#103
CANBY,OR 97013 TIGARD,OR 97224
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Specifics: Description Date Amount
Type of Use: MF Air Conditioning 09/16/2021 $46.75
Class of Work: ALT Type of Const: Furnaces<100K BTU 09/16/2021 $46.75
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 09/16/2021 $11.22
Stories:
Project Valuation: $11,000.00
Fuel Air Handlers
Fuel Types: Units< 10000 cfm:
Gas Pressure: Units> 10000 cfm:
Furnaces Boilers&Compressors
Furnaces< 100K BTU: 1 0-3 HP:
Furnaces>= 100K BTU: 3-15 HP:
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning: 1
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $104.72
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
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
Issued By:Hotly VGuv We .e Permittee Signature: 0YUApp14.CtLOTI
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.
RECEIVED E - 917 2
Mechanical Permit Application
City of Tigard EP U 7 2021 Received
;�. • 33125 SW Hall Blvd.,Tigard,OR 9722 Date/By: q/((p I'Z/ At 1() Permit No`7EL ,Z,. 74726
CITY OF I IGARD Plan Review
Phone: 503.718.2439 Other Permit:
Inspection Line: 503.639.4175 BUILDING DIVISION DaterBy:
l I t;A v.t) Date Ready/Byre ludr ® See Page 2 for
Internet: www.tigard-or.gov Notitied/MWrodf ./L4 4 O .-r-j/'_. Supplemental Information
i7t7
• : - -r , t -° TYPE,z 0 r r¢.� �x -- ^ R a r�t . _. -..._ .. ,
.�._ ,� �...�.,. .... ,,...� �a�.A��.. ..E-7�'SCHSDU6T417� CrKL1SP�::: .
❑New construction PAddition/alteration/replacement Mechanical permit fees'are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overheard,and profit.
' :. . �fiU,flr 1COlati 'tt .I.'y 1 values I I/ 00,QO 66/
❑ I-and 2-family dwelling `ja'Commercial/industrial ❑Accessory building
Multi family D Master builder 0 Other: Fo special information �yrecl sr.
r ec-1 in or use checklist.
�- _a-� .., . . _ _ _ Description Ea. Total
gy P
.'�' m;?+ 7d-� iT;'�+B.II. ..UA'Y'!'TI�� D _ U '1'l.- 1 ''?> z .
>,_� _, �, , _ >i� HeatinFlcooiing:
Job site address: 1 5 1 Tba.,1,,,/ it Air conditioning 5/ 46.75
�` �� J�� �� I,/D� Furnace 100,000 BTU(ducts/vents) / 46,75
City/State/ZIP: T i 7•-IL_ 9 Z { Furnace 100,000+BTU(ducts/vents) 54,91
Suite/bldg./apt.no.: to,) Project name: P t1 b h.,/IQ 11 '7 i Heat pump 61.06
J Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.:
w� F Water heater 2332
a. ii
T ,�., ;: F, .�' � 4<FDESCRIP!�'IO10$x'�ORK,`,�,�'��h tf n;�;��" zlrAp Gas fireplace/insert 33.39
Flue vent for water heater or gas
y� �/ fireplace 23.32
RQ�lane.. ,',/ c t-�n=f'laCrt.. f idh (Cf.fsf/O,C Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
r ROPERTY O ER: M ti n t i i ;` D TE A Z `s ' K Other: 23.32
Name: v1/I����' k��I y/ Environmental/othexhaust and ventilation:
/ r r Range hood/other kitchen
Address: j �i _ equipment 33.39
City/State/ZIP: c��f(J�`,I/ (�� Clothes dryer exhaust 33,39
Single-duct exhaust(batlrroonts,
).7�_ c/ Fax ( )
3 toilet compartments,utility rooms) 23.32
Phone )
Attic/crawlspace fans 23.32
`� RPLIGANT ❑ NT COACT PE O ,, '
•.'� � ly._, i Other. 23.32
Business name: �/O7/` �/I,,,�7 C, 1!/' Fuel piping:
Contact name: O/ ,r,!. ��i:'�r/ �r'y��,�/yam J 514.15 for first four;$4.03 for each additional
`^ �L i Q r�'/"' Furnace,etc.
Address: P4 b( 2-&G Gas heat pump
City/State/ZIP: ,'1 ( r 7 Qi Wall/suspended/unit healer
Water heater
Phone:(%P 2_2 �}. j ^ Fax!:/( ) 40(p- 3 (7(.'7J) Fireplace
E-mail: 1/kS CSCt"1Aa 3 —.Ca./..'.C401 ✓ Range
Barbecue
CONTRACTOR Clothes dryer(gas) _
Business name: Other:
Address: Sit ' , 1 :11iECHANICAL PERMIT FEES > -: ',..•,`-
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
1q (� Slate surcharge(12%of permit fee)
CCBIie.:
7[74.66() TOTAL PERMIT FEE Mt/r 7..`�..
This permit application expires if a permit is not obtained within I5a
Authorized signature: ( -II2j it.,-, days after it has been accepted as complete.
• Fee methodology set by Tn-County Building Industry Service Board
Print name: �r�i r rl1 . Date/�{///�'i 1�J
I lauiIding\Pcnni. AEC Prnni;App_a1t2S2a dot 44-4617'TU(1'I N2,COM/WE01