Permit CITY TOG MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00501
e� DATE ISSUED: 8/12/2005
��'--=' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S134CC -02400
SITE ADDRESS: 12309 SW KATHERINE ST ZONING: R -4.5
SUBDIVISION: YE OLDE WINDMILL LOT: 004 JURISDICTION: TIG
Project Description: AC install.
CLASS OF WORK: OTR 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: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
NORTH CREEK HOMES Description Date Amount
PO BOX 231148 [MECH] Permit Fee 8/12/200f $72.50
TIGARD, OR 97223 [TAX] 8% State SurcharE 8/12/200: $5.80
Phone: 503 - 579 - 1698 Total $78.30
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265 REQUIRED ITEMS AND REPORTS
CANBY, OR 97013
Phone: 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: / L. Permittee Signature: 0 `( LeeLy`
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.
08/10/2005 14:19 15032632513 ROTH MECHANICAL PAGE 02
• ' .
Mechanical Permit Application 1,01( ()I pi( T ilsi.: t)N1 \
'City of Tigard Received r -- ) , ,
13125 SW Hall Blvd., Tigard, OR 97223 # / 3Pr '-A Datelly: br
Plan Review 111:=M....0,10
• Phone: 503.639.4171 Fax; 503.598.1960 /. le, l \ Date/By: Other Permit:
Inspect ,, . • : 03, 9 , 5 /C/C . .,,A4 1 Ni Date Ready/By: a r plp SI See rage 2 for
Intern r.. ik X4E Notified/Method: Sapp ring Inform anon
KEWIRto s 're4r4kr a cir ' EIOU'IYQ.4K t cRil. ;'4.01'410444!*0.4.00
0 New construction trAddition/alteration/replacement . Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
ORMintig6ktli.1.00140000001i0Ptii0:00filliMMENtMAilifiN Value: S
lal - and 2 dwelling 0 Cotnmercial/industrial 0 Accessory building
For special information wet checklist
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
i:2',,i.,itt ligaia.a1(141.:7 „!..:',. !.1 .'... :14g.i.it1ct '''':',' '. 1 44....61f i , , ,ligiNNWIMIVI Heathnecnullnk
Job site address: / 2. 30/ w 1 604t..6.../..*11/5/-- . Air conditioning or heat pump
(requires site plan showinulacernent) ( 14.00
City/State/ZIP: 7790/20( c5 ?7Z23 Furnace 100 000 BTU (ducal/vents)
J 14,00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: I project name:
. - Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydrcrnic hot water system 14.00
• Residential boiler (radiator or
, hydronic) 14.00 .
Unit heaters (fuel•type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: 1 Lot no.:
Other 10.00
Tax map/parcel no.: Other fuel appliances _
REMERS1' 1 f' V . ::::: 4,..k b Eift$51i,...'Yi',044.:,ii..i..1!;;TAZ'i:5i*i:::.: Water heatcr 10.00
Gas fireplace 10.00 , ,
Flue vent for water heater or gas
aui3OL fireplace 10.00
Log lighter (gas)
—
10.00
woocvpact stove 10.00
Wood fireplace/insert 10.00
... .,,, ,.,.... ;.: Chinmey/liner/flue/vent 10.00
', .$04.;' • ' '4. f'':01111 „. ,0 „, .., ' iiii.i■vi,; , „1 ,..i, „..
--IL , tr A .f- . :.,, 4., . . '1N . ...., 'ii•'•• ••••414,,,,t . '.. q&KI 11 .,•fi 717 N 1,1,, ....•:!r• . • oth 10,00
Name: L 4\71 4- k .. II * ' ..f. Environmental exhaust and ventilation
Address: f u Op-- ZR//zier Range hood/other kitchen
equipment 10.00
City/State/ZIP: -7-7 e. ,a ogcr 7 2A--:s Clothes dryer exhaust ..... 10.00 ,
---- Single-duct exhaust (bathrooms,
Phone: ( . ) 5 f) •• i — i0j. Fax: ( ) toilet compartments, utility rooms) 6,80
41040144ireAr: • - oliijoitit,4,,;:gi:, , j . .,1:;• ; ,; : ::: . ! ;; Ei 46: Attic/crawIspace fans 10.00
Other 10.00
Business name: Fuel piping
Contact nanac: SS.40 for first four; Si .00 for each additional
Address: . Furnace, etc. J .
Gan heat pump
City/State/ZIP: \.).//' WalVoispendeellimit heater
Phone: ( ) I Fax: : ( ) Water heater -
Fireplace
E-mail: Range
*el e, ,v, . :-..-':...- liwinpinviiriviixtfomptm Barbecue
Clothes dryer (g
r
as)
Other: _
Business name: 01* 4.,.0_,(1 /II
Address: 19D , /,12,...._. / 2,..6
_ _ lial3..'M :AMU
City/State/ZIP: eart i 0-/Z 9 70/3 Subtotal
Phone: (5a5) Zlato -4 2_LeI 1 Fax: (585) 26h _?l (/' Minimum permit fee ($72.50) -7 "Z, S7
Plan review (25% of • rtnit fee)
Cal lie,: / Z4 DO/ State surcharge (8% of permit fee) 5 RD
TOTAL PERMIT FEE - 7/t• 3 1)
..,
Tait permit surpnenimp =ns pi it a permit 11 not obtained within 180
Authorized signature: M9 ) TOTAL
alter It has been accepted as complete.
I Print name: 1 1'a e x,( /'}'141&. j Date: 4 — 1 • Pee methodology set by Tri-Cotmv Building lndustty Service Board
08/10/2005 14:19 15032632513 ROTH MECHANICAL PAGE 03
.- 3.
nos
Ai iTE p
• HDu,s 70'
UI RaG710).J
(0
RO - r J 20 •
1" ,
STREET
t 2 30 g s 1 16)A