Permit CITY OF TIGARD MECHANICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: MEC2010 00476
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 2S114BA04000
Jurisdiction: Tigard
Site address: 9635 SW SERENA WAY
Subdivision: PICKS LANDING NO. 2 Lot: 100
Project: George
Project Description: Gas furnace replacement.
Owner: FEES
GEORGE, DEANNE R Description Date Amount
9635 SW SERENA WAY
TIGARD, OR 97224 Furnaces < 100K BTU 09/30/2010 $46.75
12% State Surcharge - Mechanical 09/30/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 09/30/2010 $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 calling 503.246.6699 or 1.800.332.2344.
Issued By: — , = Permittee Signature:
JEW.' j or
Call 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 -28 -2010 TUE 08:50 AM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application I.tII 111•1•1('1.:IltiI.(' I.\
City of Tigard '� � � `'( , )g / v (377-- permit 14°.: pi 9c, to - c5 LE (2
a 13125 SW Melt Blvd., Tigard, OR 97223 C� plan Review
Phone: 503.639.4171 Fax: 503.59E1960 V bmeBy: alp Permit
i 1 , . •, „ ; Inspection Line: 503.639.4175 9 I - Date Ready/By: ® See Page a or
Internet www.tigard or.gov I if IMeIhod: 77,6 Supplemental Information
— .TYPE OF .WORK 1vGb1 ..... , ,'COIi�RCIIaiV:.rt��: SCHEDULE .�;LiI�cl�ecKi,Lar
C, - k . Mechanical permit fees* aro based on the value of the work
ID New construction 121 Addition/alteration/rep �D" " ptsformed. Indicate rho value (rounded to the nearest dollar) of all
CI Demolition 1:1 Other: � mechanical materials, cq pa ment, labor. ovcnceadd and profit. • ' . '.: • CATEGORY..OF CONSTRUCTION. :'' ' .
.. 'AT91DFNTIALEQUIPMENI! ISTEMS FEW....
IS 1- and 2- family dwelling Q Commercial/industrial I] Accessory building For special hfortnatian use checklist
❑ Multi - family ❑ Master builder ❑ Other: Drip LQty. ) Ea. l Total
' :JOB arts INFORMATION ANA LOCATION •'' -i:. : : ILeatlnvlwaliig
Air conditioning
Job site address: `p 3 ` , .� f� a W c _ site ton ehowi tacernon 4 6.75
City /Statc/ZIP: 179 &r d 0 i [ _ 1 v, 7 2 z.y _ Furnace 100,000 BTU ( ducts/veto) ) 46.75 (n • le •
y J Furnace 100,000+ BTU (duola/veate) 54.91
Suite/bldg./apt. no.: Project name: >Irr Heat pump _ 61.06
Cross street/directions to job site: Duct work _ 23.32
HYdronie hot water systom 23.32
Residential boiler (radiator or
—
li droni 2 3.32
Unit heaters (fuel -type, not electric),
in -wall. in -dud, suspended, etc. 46.75
Flue/vent for ., of above 23.32
Subdivision: I Lot no.:
— Other 23.32
Tax map/parcel no.: Other fuel a liaaeee
' • Wamr hula 2332 AFRCRIPY ION OFr WORK Gas fireplace 33.39
TiG S fu,nifti,e. Ch ill. ad- Flue Flue vent for water beater or gas
fire . Lace 23.32
Log lighter (Ras) 23.32
Wuod stove 33.39
Wood fireplace/insert 23.32
Chitaney/liner /fitte/vcnt 1 23.32
:[$ ',PROPERTY OWNER' .. . . I . 0 TENANT .•, '. ff
O: 1 23.32
Name: r , j1 Cl r ,p ■ . Environmental exhaust and ventilation -
Range hood/other kitchen
Addtssa Sa L i equipment 33.39
Ci /State/ZIP: T ' Q. 17 2,2..?-1 Cl rver exhaust 33.39
tY 1 j f'�l Single—duct exhaust (bathrooms.
Phone: (5°3) Cp 10 - 1;00 Fax: ( ) toilet corvmonents. utility rooms) 23.32
2332
• ti.1APPWCANI'• . i; : ,❑. CONTAeti3O1 00N . :i:�:: f ans , 23.32
Other: Business name: Fad piping
Contact rage: $14.15 for first four) $4.03 for each additional
Fumacy, etc.
Address: _ Gas heat pjnw
City/State/ZIP: Woluauspendcd/rmit heater
Fax : ( ) Water heater
x
Phone: ( ) F' -. la
E -mail: Ran -
CONTRACTOR : Barbecue
' Clothed dryer (gest
Easiness name: ROilel 11-eacti P) `r` er7)01Alan other: •
Address' p U. 150)( 12,ti S . •.ME PERMIT FeEs":.:.. :..... .
Subtotal II lP •'1
CitylStatc/ZTP: C -u�� E7 t� LO/2.. 4f' 7 0 M inimum permit foci ($90.00) - 0. l) 0
Phone: (6603) Q (L p •) . 4 : % Fax: (6(�) (p -ai- 7 e Plan review (25% of , , it fee)
) .L7
CCB hie.: . r C 0 d State surcharge (12% of permit fee) p , Ca
TOTAL PERMIT FEE Mr
)
This permh application capital if a permit is not obtained within 184
Authorized sign :. ■ : ALA J . 1 4 .6^.-- days after it has been accepted as complete.
Print name: 0 { "1 -e: , P _ ' ..pJ1 f ",r- Data: C71
• Fee methodology set by Tri- Cougty &ANDS rndastr rd
y service Boa
•
I:1BmldInalPamitahlEC•Par PP
Adae 10/01/09 440.46 In (It f e/CoMnieB)