Permit 64 CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2010 -00255
T 1 CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/04/2010
Parcel: 2S112BC11600
Jurisdiction: Tigard
Site address: 8137 SW MATTHEW PARK ST
Subdivision: MATTHEW PARK Lot: 11
Project: Alrick
Project Description: Replacing gas furnace and installing A/C.
Owner: FEES
ALRICK, DON Description Date Amount
8137 SW MATTHEW PARK ST
TIGARD, OR 97224 Air Conditioning 06/04/2010 $46.75
Furnaces < 100K BTU 06/04/2010 $46.75
PHONE: 503 - 624 -1186 12% State Surcharge - Mechanical 06/04/2010 $11.22
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 $104.72
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: � / Permittee Signature: "et
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CaII 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 -03 -2010 THU 03:38 PM ROTH HEATING FAX N0, 5032663478 P. 01
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City of Tigard
Mech anical Per mit A licl>ition M k ..: ; ; °
' i � IO /J Permit No.: �� ( v '(,1 - tZ -h
-
III
- ‘ 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 JUN 0 3 2011 Plan tteViow ether permit:
® ��: for
I I ,. : ,, t i 1 , Inspection Line: 503.639.4175 Supplemantal Information
Internet: wavw.tigard�r.gov ! r , `i : •' :,'
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.TYPE OF WORK COMMERCIAL FEE" :'SCHEDULE — USE'CHECKLIST ,.
Mechanical permit fees" are based ()lithe value of the work
E] New construction GE1 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dotter) of all
❑ pemolition
❑ Other mechanical materials. . i .m labor, overhead and rofit.
l V a tie'
CATEGORY OF CONSTRUCTION f iIESIDENTIAL ;EQUJPMENT / SYSTEMS FEES*
❑ 1- and 2 -family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. _
❑ Multi 0 Master builder CI Other: Description LQt F Ea. I Total
JOB SITE 'INFORMATION AND LOCATION . Heatina/rooliag
�j Air conditioning 46.75 1 4 7 IMI Job site address: 1 : SV�J M. G 1-- In.Q,LA) par K. Gi • (- .uirea rite don &Hawk': , leoom
ma
Furnace 100,000 BTU (duets/vents 46.75 4 • • • 5
City/State /ZIP: ~ ('j 4 (A I�Ci c ® q l/ Furnace 100 000+ BTU ducts/vents ME 54,
Project name: A L 2 1 C I � . Heat pump n 61.06
Suite/bldg./apt. no.:
_ Duct work 23.32
Cross street/directions to job silt: Hydronic hot water system 23
Residential boiler (radiator or 23.32
h +�dronic)
Unit heaters (fuel-type, not electric), 46.75
in-wall in -duct, sus ended etc.
FlucIven for a n of above 23.32
Lot no.: Other 23.32
Subdivision: _ Other fuel a dances —
Tax m /parcel no.: — Water heater _ 2332
DESCRIPTION OF: WORK _
Gas fireplace 33.39
--0— S ` .A.., C i • i (714..t (Q Flue vent ter water heater or gas 23.32
tiro fact
Lo_ liv ter . 23,32
Wood/pellet stove 33.39
— Wood fireplace/insert 23.32
Chimno�llincr /fluelvcnt 23.32
.3
Oth er: 23 2
'PROPERTY, O ❑TENANT. _
— Environmental exhaust and ventilation
Name: {� ! 04_ Range hood/other kitchen
equipment _ 33.39 _
Address: .e.._., — 33.39
— Clothes • er exhaust
City/State/ZIP: Single -duct exhaust (bathrooms, 2332
L0 Fax ( ) toilet compartments, utility rooms)
Phone: (503) W �.`I — � t �� Attirlcrawlspacc fans 23 32
APPLICANT ;C) .CONIACf.,Fr RSON:.: Other: _ 23.32
Business name: I _ — _ Foci : .1 :
514.15 for first four 54.0 for each additional
�l
Contact name: Furnace, etc. lia
Address: _ Gas halt • u
• WalUsuspended/unit heater
City /Sutte/ZIP: Water heater
Phone: ( ) — Fax:: ( ) - Piro face I
_ Rage marl Barbecue
MI
�CO NTRACfO& Clothes dryer (gas
Business name: . 1 °- e - Ck:1 , c ) di . til.,/ IT Other.
CHANICA} 'pEItMIT. FEES* , .
Addres C7, �" 210 Subtotal "6 • ...30 City /State L1V: �_al�, bt �� ` 7013 Minimum�atmit fcc ($90.00
C'' U/ • 1 ? LJ' Fax. (bail )c 10(!1 '"SL / .74 Plan review (25% of ermit fcc)
Phone: (50.3)
Stat surcharge (12 % of permit fee) 1 . 7_.�
CCB tic.: ) y Q G I g �— TOTAL PERMIT FEE 10 ,1 Z-
Tbis permit application it a permit b not ordained within 180
/ _ - , 1 L L " - days after it ham been accepted as complete.
Authorized signal �� ; 7 ' r 4 Fee methodology act by Tri- County Building Indurlry Service Board
Print name_ a dio {,I' ci 1 _,..c . ,_0 - 1 I f'.1'- Date: — II i 0
t J �44W6 IN2/CQM/WR8)
JUN-03-2010 THU 03:38 PI1 ROTH HEATING FAX NO. 5032663478 P. 02
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