Permit a.a
'� ��d "; CITY OF TIGARD MECHANICAL PERMIT
n
B COMMUNITY DEVELOPMENT Permit #: MEC2010 -00249
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2010
,, , _ ;_ Parcel: 2S112CD13100
Jurisdiction: Tigard
Site address: 7736 SW CYPRESS LN
Subdivision: HAMBACH GROVE Lot: 29
Project: Vanderheiden
Project Description: Installing A/C.
Owner: FEES
VANDERHEIDEN, MARITA A Description Date Amount
2167 NW TWILIGHT DR
BEND, OR 97701 Air Conditioning 06/02/2010 $46.75
12% State Surcharge - Mechanical 06/02/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/02/2010 $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. ��2
Issued By: ` r Permittee Signature: / 1; ^
i � 1
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.
JUN -01 -2010 TUE 09:23 AM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit A lie FIV/FD
2 I,f)It (II,I,I('1.;ti,SI.: ON1.1
CI yam, of Tigard ' Received
N,.._. 13125 SW Hall Blvd., Tigard, OR 97223 J J U N 0 1 2010 Dam* l ?
' fl ' Phone: 50 3.6394171 Fax: 503,598,19 0
, ila Permit No,: u Fc. p ,41
Plan Review
i 1i ; A V i
Date/By: Line: 5 03,639,4175
Other Permit:
Internet: www.ti and -or. v CITY OF 1n
8 So CI I t OF DIVISION
t. DateReady/By:
,--.- BUILDING DIVISION N otiQod/Iyethod: Suppleme ntal ® Bee otii for
1 ntalleformaden
TYIL OF WORK ` '.COMMERCIAL FEER''SC
® Addition/alteration/re lacement - 1 sed on the - USE th e CHECKLIST
0 New construction
p Mechanical permit foss arc based on the valu of th work
1
Demolition El Other: performed. indicate the value (rounded to the nearest dollar) of all
mechanical materials, leg meta Tabor, overhead, and profit
CATEGORY OF CONS RUCTION
-.. < Value: $
Eli 1- and 2- family dwelling ❑ CommereiaVindustrial ❑Accessory building RESIDENTIAL jQUIPMENT/ *. • ;
0 Multi- family 0 Master builder For era!
Worrrlarlon
[] Other al use elterk!lst,
JOB. SITE INFORMATION. AND LOCATION Description I Q. Ea I Total
IIeatlnR/cttolirrc
Job site address: '77&J (0 s c mpr _ e4s Air conditioning
City /State /ZIP' '"� �1 — „axle ee r site plan showing placement) 1 46,75 � y.15
a • d ' U 7 Z Furnace 100,000 BTU (duets/west__ 46.75
Suite/bldg, /apt. no.: Project name i_ t? Furnace 100,000 BTU (euc19/venta) 54.91
Cross street/directions to job site: Heat pump 61,06
Duct work _ 23.32
Hydrenic hot water system 23.32
Residential boiler (radiator or
moronic) 23.32
Unit heaters (fact -type, not electric),
in -wall, in- duct etc. 46,75 _
Subdivision: Lot no : — _ Flue/vent form of above 23.32
Tax mop /parcel no,: Other. 23.32 L
Other fuel appliances
iances _
DESCRIPTION OF WORK :
Water heater 23.32
• (� Gas fire lace 33.39
Flue vent for water heater or gas
plae 23.32
LIB lighter (gas) 23.32
WooJlellet stove 33.39
Wood fire lace/insert 23.32
® PROPERTY, OWNER Chimney /liner /flue /vent 23,32
1, ':' 0 TENANT. Name: G( ri f V ail G� e)' / . f (�r �1 R Other: r__ 23.32
Environmental exhaust and ventilation
—
Address: (S`a m (/ Range hood/other kitchen
City /State/ZIP: _ equipment 33.39
Clothes dryer exhaust 33.39
Phone (Sti f o q77-- (0q (pg Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments utility rooms) 23.32
-
' a APPLICANT , „ ' AD. CONTACT PERSON _ Attic/crawlspace fans 23.32
Business name: Other: _ 23.32
_Fuel piping
_ Dl A
Contact name:
$14.15 for first four; $4.03 for each additional
Address: Furnace. etc, I
City/State2lP: Gas heat panto _
_ Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
> -mail: Fireplace
Rannse
CONThACTO
Barbecue
Business name Otte I'- ft'Gl, -hI'lri �, ��7 l Clothes dryer (Ras)
Address: f D. 6 1 2,( s Other; T
•,MECHA.NICAI PERM FEES'
City/State/ZIP: @ it E? G12, 770 v
Subtotal L.-Lip • 7 5
(603)
Phone: (5��) a (j) ( Z I Fax, Minimum permit fee (590.00) 90- 00
�77� i
Plan review
CCB lie,: 14-100F
(25% of permit fee)
State surcharge (12% of permit fee) 10- ID
A TOTAL PERMIT FEE
14A---
TI h permit application esp.ra per mit is sot ot><aloed within 180
Authorized signatu _
low
1 days after it has been accepted as compete.
Print name: lc Date:
--I --I 0 • Fee methodology set by Tri- County Building Industry Service Board
1: nuildinnV'ermig \Msc.p - itApp.dac 10/01/09
4404617T(1l/c 1coMwr )
JUN-01-2010 TUE 09:23 AM ROTH HEATING FAX NO. 5032663478 P. 02
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