Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: MEC2010 00449
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 1S134BD09900
Jurisdiction: Tigard
Site address: 11608 SW SPRINGWOOD DR
Subdivision: PENN LAWN ESTATES NO. 2 Lot: 27
Project: Budai
Project Description: Gas furnace replacement
Owner: FEES
BUDAI, CHRISTINE Description Date Amount
11608 SW SPRINGWOOD DR Furnaces < 100K BTU 09/09/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 09/09/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 09/09/2010 $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: Natural Gas
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by callin 503.246.6699 or 1.800.332.2344.
Issued By: (// Permittee Signature: Q y ,
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
SEP -08 -2010 WED 02:46 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application ��, 1?ato/aY: I•'c ti: ( )I. I.lc is i itil', ()NO
IN ._ City of Tigard r `t. Received U ! e C rI�
• 13125 SW Hall Blvd., Tigard, OR 97223 11 - Q
Y .ri
Phone: 503.639.4171 Fax: 503.598.1960 O g �Q\ mat Ma Permit:
i i : , „ , , Inspection Line: 503.639.4175 0 . T, , lurk
Internet: www.tigard- or.gov CI FIEMEM
TYPE OF WORK Or NG,S
.: COMMERCIIA111EP!: SCHEDULE. - ,USE`CHECKLI T :,
ID New construction ® Addition/alteration/repl end Mechanical permit fees* are based on the value of the work
per. Indicate the value (rounded to the neatest dollar) of all
❑ Demolition
❑ Other: mechanical materials, equipment. labor, overhead. and profit
.
. CATEGO • *Y: DE CO NSTRUCTION
i f 1- and 2-family dwelling ❑ Comtnercial/industria) ❑ Accessory I:QUiPMENT /;�iY$TF.M6 FEES' : , :.
Ccssory building For special biJarmth:a use checklist.
O Multi family ❑ Master builder 0 Other Description
Qty. I Ea. I Total
.:.JOB , STTE.INFORMATION AND LOCATION Heating/cootlug
p 1,1 � ` Air conditioning
Iob site address: 11 (D D 4 ^' 5 4&) .a Spr I I�1 L1) onol r 1 '/'Q -' (reaches site elm showiest alinement) 46.75
City/State/ZIP: T1 a 1rd i D l�- q -I -E. Z?j Furnace 100,000 BTU (ducts/vents) 1 46.75 14 to h7G
Suite/bldg./apt. J Furnace 100.000+ BTU (dud s /vents) 54.91
klg /apt no.: Prgject mesas c�� Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hvdronic hot water system 23.32
Residential toiler (radiator or
hydi nic) 23.32
- Unit heaters (fuel -type. not electric),
in -wall. in -duct. suspended. etc. 46.75
Flue/vent for any of above 23.32
Subdivision I Lot no.: Other. , 23.32
Tax map/parcel no.: Other fuel appliances
: • : DESCRIPTION OF,, WORK Water heater 23.32
A ,, // 11 Gas fucplacc 33.39
uS a.Y n (..C•�. v 0. (Q fl1L \ Flue vent for water heater or gas
fireplace 23,32
Lop lighter ((tax) 23,32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
. Chimney/liner/flue/vent 23.32
, fa PROPERTY, .OWNER - 1,. . . 0 TENANT, • Other. 23.32
Name: 0, VI r i S 15 u d fAA Environmental etrbauat and ventila1lon
'Range hood /other kitchen
Address:
S Gl,n —' equipment 33.39 ,
City /State/ZIP: Clothes dryer exhaust 33.39
� ) 59 D _ 1 Lot t comp radiants (u tility or
Phone: Fax: ( ) Wild compartments, utility teams) 2132 .
:1 APPLICANT ':.I, :;:. ' ,. CONTACT': PERSOhi'' ° '' ":• Attiderewlspace 2132 •
Other: 23.32
Business name:
. _ Fuel pining
Contact name: 514.15 for first four, $4.03 for each additional
Furnace. etc.
Gas heat pump
City/State/ZIP: Wallsuspended/unit heater
Water header
Fireplace
Phone: ( ) Fax:: ( )
F. -mail: ap
•`. . . • CONTRACTOR . .. Btubccue
Business name: g t-y1 1 - t'�Gl l < 0..n
n� o Lu)e) Clothes dryer (sera)
,p J Uthar:
Address. - ? O , box 12l, s .MECHANICAL: :PERMIT FEES!
City/Statc/ZIP: e_Ll.(i , Oa. 170 3 Subtotal LIU .1S
ne: (� . .� {Fa (5C') Minimum permit fix ($90.003 ' q 0 r O 9
Pho
a0) a (.0 Ln • / D y 7 e7 [el - Z e Plan review (25% of permit fee)
CCB Tic.: )1-) o G State surcharge (12% of permit fee) 101Z?
TOTAL PERMIT FEE 100 -
Authorized aignatu : r1 J/L� Thu permit application expires if a permit is oot obtained within 180
_ ti 'L days after it boa burn accepted as complete.
Print name: / !"i • -e.. , ' .{} -'f') le Dato: • Fee methodology set by Trl -Cemty Building todnemy service tad
t:laoildingWermitsVHPGP• . dace toroVes 4404617x(11/0214 0M/WEB)
q i I (...e_ 6 c e,, ' `