Permit h ` " `;� CITY OF TIGARD MECHANICAL PERMIT
' $ ,,e, COMMUNITY DEVELOPMENT Permit #: MEC2010 -00181
ANIIKai 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/22/2010
TIGARD 9 Parcel: 2S111DD09400
Jurisdiction: Tigard
Site address: 15955 SW 87TH AVE
Subdivision: CHESSMAN DOWNS Lot: 20
Project: Kelly
Project Description: A/C add Must maintain 3' rear and side yasrd setback
Owner: FEES
KELLY, JASON Description Date Amount
15955 87TH AVE Air Conditioning 04/22/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 04/22/2010 $10.80
PHONE: 503- 403 -8614 Minimum Fee Adjustment - Mechanical 04/22/2010 $43.25
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503- 266 -3478
Type of Use: SF
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 OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ' ' / i ,d't-, Permittee Signature: (4,-.) C( ('&L'
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 -21 -2010 WED 11 15 Ahl ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application 1 99 6C 1 (►It Ol 111 i' l +sI: (► i,,
City of Tigard CJ nT Cr Permit No.:L eC gar 0 -0081
13125 SW Hall Blvd., Tigard, OR 97223 pl an R
1 ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
I 1 ■1 r\ 11 I I Inspection I ins: 503.639.4175 APR 21 2010 Date RCodyIBy: luny: li7 See Page 2 for
Internet: www.tigard•or.gov Notified/Method: supplemental Information
. CITY OF TIGARD COMMERCIAL .l;r� :'scHEn - USE CHECKLIST .
TYPE OF
Mechanical pettnit fees' are based on the value of the work
❑ New construction [I Addition/alteration/replacement performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY. OF CONSTRUCTION .
Vsluc'
RESIOENTIAL EQUIPMENT 1 SYSTEMS.FRES'
tg1 1- and 2- family dwelling ❑ Commercial /industrial [] Accessory building For use checklist.
❑ Multi - family 0 Master builder ❑ Other: Description Qty. 1_ Ea. l Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
i 5 GJ 55 s \A) g,7 —
Air conditioning ++ 11
Jab site address: � �(e (requires sit� K
fam showing placement) � 46.75 1 . - .)‘!P: 1 6
City /State/ZIP: ', ai d t () Q 9 - I 2,2-14 Furnace 100,000 B'PIJ (ducta/vents) 46.75
Furnace 100 000+ BTU ducts/vents 54.91
Suite/bldg./R:4. no.: Project name. Heat pump 61.06 _ _ _
Cross street/directions to job site: _ Duct work 23.32
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
Tax map/parcol no.: Other fuel appliances
Water heater 23.32
DESCRIPTION OF, WORK 33.39_
Gas fireplace
G C Flue vent for water heater or gas
fire . lace 2332
Log Tighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner/flue/vent 23.32
'1(g PROPERTY. OWNER I :. , . 0 TENANT , Other: 23.32
Name: C,tS \C p ( Environmental exhaust and ventilation
�� Range hood /other kitchen
Address: , ui.mcnt 33.39
Clothes d exhaust 33.39
City/State /ZIP: - Single -duct exhaust (bathrooms,
Phone: ( �50 Fax' ( ) toilet compartments, utility rooms) 23.32
i CONTACT`. PERSON Attic/crawlpacefans
2
APPhIC , p' Other. 23.32
Business naive: Fuel piping
Contact name: 514.15 for first four; 54.03 for each additional
Furnac etc.
Address: - Gas heat pump
City /State /ZIP: Wall/sus .cnded/unitheater
- Water heater
Phone: ( ) Fax: : ( )
— . Fi lace
E -mail: Ran
,'CQNTItACfOR Barbecue •
Clothes cr as
Business name: �1 � j -e(,`- t . i - (o . Other;
Address: p 0. f I'Z,,(/,r
Subtotal i41.12 • 15
City /State /Z1P: i Q12.. '7701
Phone: (5Q3) o Lip. (p • ) '11`2 Fax: (5Q3 )c;2 CG ( —( le permit
CCB lie.: J'—/OD permit 10. -
TOTAL PERMIT FEE 100.
T his pe rmit application expires If a permit is not obtained Within 18(1
Authorized slgnatuta: , , ,� , Gt ,0- - p .,4 \L "- J da Mtkr It bas been accepted as complete.
• Fee methodology set by Tri- Ceonty Building Industry Service Board
Print name: l�.l�►� -i'.•r ci (;� {'1l I j' r . I Date: ;� I -- I,C)
Metilldleg\Perm enMEC•Pcr n Aep,doc 10 /01/09 440.4617T (11/02/COM/WF9)
APR -21 -2010 WED 11 15 AM ROTH HEATING FAX NO 5032663478 P. 02
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