Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2010 -00335
Date Issued: 07/15/2010
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S133DA02400
Jurisdiction: Tigard
Site address: 12935 SW GLACIER LILY CIR
Subdivision: Lot: 0
Project: Arroyo
Project Description: Replacing gas furnace and NC. A/C unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
ARROYO, JAMES W /CAROL L Description Date Amount
12935 SW GLACIER LILLY CRL
TIGARD, OR 97223 Air Conditioning 07/15/2010 $46.75
Furnaces < 100K BTU 07/15/2010 $46.75
PHONE: 12% State Surcharge - Mechanical 07/15/2010 $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 1.801 . - . .
Issued By: / - Permittee Signature:
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.
JUL -14 -2010 WED 07:38 AM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit A' r , al la; =,+� i ( /I( ui:i.i (•►' ntil, (),NIA
City of Tigard j l I' ! 1" r ]teeeivrd A
Permit No,. h L
n 13125 SW Hall Blvd_, Tigard, OR 97223 P Review
. 11
'' • Phone: 503.639.4171 Fax 503.5) J 1964 4 205
Dale/By: Other Permit:
i inspection Line: 503.639.4175
Internet: www.tigard-or.gov , , . Date Reedy/By; % Sec Page Z for
_: a i ' 1i - - NotifiedlMethod: Supplemental larormadoa
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. TYPE OF w Rl , " :: COMMERCIA P ! ,:SCHEDULE - USE CHECKLIST:
Mechanical permit fees* arc on the vitro of the work
❑ New construction IJ Addition /alteration/replacement
performed. indicate the value (rounded to the nearest dollar) of all
12 Demolition ❑ Other:
mechanical materials, equipment, labor, overhead, and profit,
CATECORY;OE CONSTRUCTION,
Value: S
®1- and 2- family dwelling q Commercial /industrial RRSIDICIVTtAI: EQ M>♦NT / S YS1EM9 F S ::
❑ Accessory building Far special hiformaiion use checklist,
❑ Multi - family ❑ Master builder ❑ Other: Description 1 (ty J ll Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
!oh site addre l � l 5 SU) `(L L W.� $ � Air conditioning
l -t + C� C� ,A (requires site Plan showing placement) I 46.75 iiti 1r'7
City/State/Z1P: r OR '12_2 Furnace 100,000 BTU (ducts/vents) i 46,75 iii, p115
Furnace 100,000+ BTUSducts /venom) 54.91
Suite/bldgJapt.no.: Project name: 4 Irir6 Beatpurnp 61
Cross street/directions to jab site: Duct work 23.32
Hvdronic hot water system 23.32
Residential boiler (radiator or
hLrdronic) 23.32
Unit heaters (fuel -type, not electric),
inwall -ducd, suspended, etc. 46.75
Subdivision: Flue/vent for any of above 23,32
Lot no.: Other: 23.32
Tax map /parcel no Other fuel appliances
. DESCRIPTION OF WORK Water heater 2132
J
�S Gas fireplac 33.39
�v J � rt (A 0 a 1. o, Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
:, , PROPERTY ,OWNER' I :0 TENANT..
Chimney/liner/flue/vent lmney/Ii 23 32
l �7 S Other: 23.32
Name: j a ryl out)
Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment _ 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: CM 1) 50 le — gLi (.4 C Fax: ( ) toilet o act rtme nts (bathrooms,
rooms) ,
toilet' campartments utility roo 2332 _
la: APPLICANT [] CONTACT "P1±RSON Attic /crawlspacefang 2332
Business name: .
Other: 23.32
Fuel piping
Contact name: 514.15 for first fauj3 $4.03 for each additional
Address: Furnace, etc.
- n
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone. ( ) I Fax:: ( ) Water heater
E -mail: v Fireplace
Range
: , CONTRACTOR . .. :' Barbecue
Business sierra: n Clothes dryer (pas) —
`fi'l' 1 ( a71 H i I . ..no 1A:ni other:
Address: p. ( box 1 au) : MECIIANICnL PERMIT FEE •
City /State/ZIP: &U L33 I Q '770/3, Subtotal 1 ,50
(r�0) , �/ j I ) Minimum permit fee (590.00)
i /rime Fax: (� e LP -& - -it Plan review (25% of permit fee)
CCB lie.: ) f p D F t - State surcharge (12% of permit fee) 11 ,
TOTAL PERMIT FEE 10 +L
r / Thi pormk application e xpires it a permit Is not obtained within ISO
Authorized signatu : A r' r te- � �"- days Amer it has bear accepted as complete
Print name: L�r �� e � ' C � Y� . G eii r �r p 11 L+ .
1: • Fee methodology set by Tri- County Building Industry Service Board
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JUL -14 -2010 WED 07:38 All ROTH HEATING FAX NO 5032663478 P. 02
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