Permit CITY OF TIGARD MECHANICAL PERMIT
Et • Permit*: MEC2010 00167
COMMUNITY DEVELOPMENT Date Issued: 04/15/2010
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
TIGARD: Parcel: 2S110AC01000
Jurisdiction: Tigard
Site address: 11545 SW BEEF BEND RD 33
Subdivision: WELLINGTON ESTATES APARTMENTS Lot: 0
Project: Wellington Estates
Project Description: Replace gas furnace.
Owner: FEES
FERN VALLEY PROPERTIES LLC Description Date Amount
BY CAMBRIDGE REAL ESTATE SERVICES, PO Furnaces < 100K BTU 04/15/2010 $46.75
BOX 2968 12% State Surcharge - Mechanical 04/15/2010 $10.80
PHONE: 503 - 901 -9435 Minimum Fee Adjustment - Mechanical 04/15/2010 $43.25
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503 - 266 -3478
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue: -
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 -0100. You may obtain a copy of the rules
or direct questions to calling 503.246.6699 or 1.800.332.2344.
Cb
Issued By: �,� f ' j , • � Permittee Signature: e �D G / e 4 0
KO' Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
APR -13 -2010 TUE 09:38 AM ROTH HEAT ►mac CEIVE • FAX NO. 5032663478 P. 01
Mechanical Permit A lication I )I< t /1.1..14' F. I LSI', ONI.ti•
City of Tigard 1 3 2 010 ReceiveY `' d ,(
M 13125 SW ] DatdB : y/�i0 - Permit No" / EC O/ / W 7 Hall Blvd., Tigard, OR 97223 sir / �D . I'
1 ' Phone: 503.639.4171 Fax: 503.598.1960 CI IG' ' II
ins action Lino: 503,639.4175 ' Other Permit:
I I' i A �, t p BUILDI DIVISI Ir
Internet: www.ligard- or.gov li! sec Page 1 far
supplemental information
,TYPE OF WORK .
- - T COMMERCIAL `.REE .'9Q1EDUtE,- USE:CHECKI,IST•
Mechanical permit fees* are based on the value of the work
❑ New construction �AdditioNrtlteration /rcplelcement
ID Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials e • ui , men labor overhead, and ,refit
' CATEGORY OF CONSTRUCTION .
1 •
al Valuo:5
, // ❑ Accessory r ' I �r - and 2-family dwelling buildin
B RESIDENTIAL scI UII� information u , e checklist
FEES*.
` y g ❑Commercial /industr
PI s ulti family ❑ Master builder ❑ Other: Fa► specie! information usr thecldisr.
Descri ion Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION
' Hestia. coma:
Job site address: 1 SI--1 e-p SV,) _ t {Z ,� , _ _ `` "Alf Air con ditioning -
�..� v uJl � _ re wires site Inn ehowin , Wement
CityJStote/ZIP: " I � D C� 2_ Furtin e 100 000 BTU ducts /vents 46. EPSEI
Suite/bldg. /apt. no.: Project name; Furnace 100 000+ BTU ducts/vents 54.91
Heat • um • 61.06 MS
Cross Street/directions to job site: Duct work 23.32
H dronic hot water s stem 23.32 MIN
Residential boiler (radiator or
h dronic - 23.32
Unit healers s not electric),
in -wall in -due c sus us . ended, etc, 46.75
Subdivision: Lot no : O ent for an of above Other: � 2
Other: 2332
Tax map /parcel no Other heel a lianeea
' DESCRIPTION OF. WORK . - Water heater 23.32
G a& Gas fire • lace �M�
��" , A • . mow`-" Flue vent for water heater or gas
7'NC 1\-\() [- ri_CA- k fire • lace 23.32
Lo_ hitter :as 23.32
Wood/ • ellet stove 33.39
23 -32
Gs. PROPERTY OWNER ❑ TENANT .. /liner/flue/vent �
Chim e
Name; \Al
Other 23.32
[. Environmental exhaust and ventilation
Address: Salmi -Ry Range hood/other kitchen
/�'� e•ui mcnt 33.39
t/1,
City/Slate/ZIP: . ' Kr i S- 11 Clothes d r exhaust r 33.39 MU
Phone: ( 1) f \ ^ 9 [, ax ( ) Single -duct exhaust (bathrooms,
TI t toilet eom armtents utili moms El 23.32
0 `APPLICANT ..: _ 0 CONTACT' PERSON , Attic/crawls •ace fans 23.32
Business name: Other. 23 32
Fuel , i , in ,
Contact name: 514.15 for first four 54.03 for each additional
Address: Furnace etc,
Gas heat • um MIIMII
City/Slalc /ZIP:
Wall/sus , ended/unit heater
Phone: ( ) I Fax: : ( ) water heater
E -mail: � �_�
, CONTRACTOR : ' ' ' , . l arbecue 11111111=
Business name: l H I i f Clothes d cr ■ as IIIMIIIIIIII
' Other MI
Address: p 0 ejcfs , 1 2.(P 5 111111121111111111111
City /State /Z1P: e_ bu 1 O' ` 7717 Subtotal e�
P�} one: (J0 ) G LP • 1 D 4,/ 1 pax: (51 - 1 ,3 ( ) lo T t f p. Minimum permit fee (590.00) mgr • Q
7 a Plan review (25°10 of • rrnit fee)
I " CCB lie.: i Li p o ' i/ State surcharge (12% of permit fee) • 0 . ID
TOTAL PERMIT FEE p , , ,/
Authorized signet This permit application expires if a permit is not obtained within 180
gar IAA ,L,',%_, t '� �`' days after it has been accepted as complete.
Print namo: J _ -i C1 f c. .Ct) I� �
r D 4 - t * Fee methodotoay set by Tri•County Building Industry Service Board
Lla � - f` t — a l uildinaTermiteV�C -Per mApp.eoe to /m /oo 44e-46171'(11/07JCOMfWEa)