Permit CITY TIGARD MECHANICAL PERMIT
I � DEVELOPMENT SERVICES PERMIT #: MEC2006
DATE ISSUED: 3/29/2006
:-..a 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 111 DC - 14700
SITE ADDRESS: 15993 SW KREICK PL ZONING: R -
SUBDIVISION: KREICK MEADOWS LOT: 001 JURISDICTION: TIG
Project Description: DUCTWORK INSTALL
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
TOM CHAMPLEON Description Date Amount
15993 SW KREICK RD.
TIGARD, OR 97224 [MECH] Permit Fee 4/6/2006 $72.50
[TAX] 8% State Surcha 4/6/2006 $5.80
Total $78.30
Phone: 503- 407 -5630
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503- 266 -3478
PRI 503- 266 -1249
Reg #: LIC 14008
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: dor, Permittee Signature: % - // ��
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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.
AI ` 03 /28/2006 09:06 15032632513 ROTH MECHANICAL PAGE 02
Mechanical Permit I - -. ,
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City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 ri r iVi % Date/By; ,>' / —G h. Permit No.' �, .0,, /0,0 50
Phone: 503,639.4171 Fax: 503.598.1960 t ?� l s ' , Plan Review
�" '�'.'x�,t "'1} '�` • Date/By: Other Permit
Inspection Line; 503.639.4175 '!'
Internet: Line; 503.6 9. 17 , , - g l i J Date Ready/By; ® See Page 2 for
iJ ficd/Mct1t Information
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Supplemental
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Addltion/ / rc la. A ' X� GOMME�t omit fecs*aro on ! w value of the wor based ❑ New construction k
❑ Demolition [] Other: p f El, p mechanical rmed• Indicate the value (rounded to the nearest dollar) of all
( : :tU „ a< "�f :�.i�.,k� .I , .. .
, - ���� , materials, 9wpmentLbor, overhead, and profit.
. . O G ON C't'I "7
1 - and 2 falnil dwelling C ; n i x ` RESIDE Value:
Multi -family � Accessory building ' � - 1 special information we checklist �� !' 1i';
Y g ❑ ommcrci alhndustna l g +� EQ[1IP1f 3V'l;"- 'SL'ST .
Y ❑Master builder 0 Other: !
i 1 E�� t; r i O on J Qty I Ea-
Total
Dcacepli
: �; :� ; lt ,� t .t :... :. :dOB'9r1'E`�(1RMA'CIUN ANA;LOCAfiIFi �:
Job sett address: 51 '� r Air conditioning or heat pump •
� � � 0'1 C'\(.. Ni” k (iequiros site plan showing placerhent ) 14.00
City/State/ZIP: r 1 �a r U? g 1 2 Z L Furnace 100,000 T3TIJ (ducts/vents) _ 14.00
Suite/bldg./apt. no.: -----1 Furnace 100,0004- BTU (duets/vents) 17,90
Project name:
Cross street/directions to job site: Gas heat pump 14.00
( 14.00 0 Iy.be.
Hydronic hot water system 14.00
-- ,. Residential boiler (radiator or
hydrontc) 14.00
Unit heaters (fuel -type, not electric),
in- wnil -duet, suspended, etc, 10.00
Subdivision; Lot no -: Flue/vent for any of above 10
Tax map /parcel no -: Other- _ 10.00
Other flue! ,,: Bib.: r.:f;;itvr,f.ir,iAi,R`G. :; :;'; Dl� appliances
; �,; : :
f,.. r .�.,..� -,;� :, :':, . •:: ;,...., .,, , , 8?Ck�IPTIOH •Ok' :�1!OR� : :;�i :. Water hinter _ 1000
Gas fireplace 10,00
l,__L� k t;,Y L Flue vent for water hatter or gas
f srlace 10.00
Log l ghter (gas) _ 10.00
Wood/pellet stove 10.00
Wood fireplace/ingot
, PROBER Y.''OVYNTR 2s: Chimney/liner /flue/ven • 1000
.,
Name: Other- _ 10.00
` ' '"'" • a Environmental exhaust and ventilation ,_
Address: Range hood/other kitchen -
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00 -
— Phone: (c� - Single-duet
h ; ^„ . - .'N�.SS :'�i f -
� � � p F exhaust (bathrooms
)L�07 103
Fax:
,;; ....'3;rr .` ,44p4. .'r''='... , `t. > , ° "'' . q , .. Attic /cmwispac
,
.. -:a = CONT.f, Brits utility
., '..,..,... . , .,.,... .. ,. a ce fans _
rooms) 6.80
CT; :ICERSON : :.� :` 10.00
Business name: Other, 10.00
Fuel piping
Contact name: • _ $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
•
..]
City/State/ZIP: Gas heat pump
,N\i' ,._______
�N1/ heater
I Fax:: ( ) Wat • heater
Phone: ( )
E -mail: Fireplace
p.
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,('..,� .., I I ::; ?, : Y.i :i: ;tlf': i riTfiA lr lit, i 'h:, , :: Baiheeue
Business name. l� Clothes l er as
Address: �I /� (# g n rOuter
City /State /ZIP: � / / 0� '' a .` i1h, , d�4')<'`p } ":' '
" 1 Subtotal 1 L1. o t7
Phone: (5a j) Z,(v (a ^ Z 9 Fax: (5 j) 2 4 — ( 7 Minimum permit fcc ($72.50) c, o
/ Plan review (25% of permit fee)
CCI3 lie.: ' �. ci Q State strreha t a 89� 01
g ( peratit fee) O
K _ TOTAL PERMIT FEE "1 Q� ?U
Authorized signature: { This permit application expires If a permit Is not obtained within 180
" days after 11 has been accepted as eumptete.
Print Warne:
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