Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: MEC2010 -00498
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/13/2010
Parcel: 1S133DC12900
Jurisdiction: Tigard
Site address: 13290 SW SHORE DR
Subdivision: ARI GREEN Lot: 20
Project: Padilla
Project Description: Gas furnace replacement
Owner: FEES
PADILLA, MELISSA & Description Date Amount
BLOOM, JASON, 13290 SW SHORE DR Furnaces < 100K BTU 10/13/2010 $46.75
PORTLAND, OR 97223 12% State Surcharge - Mechanical 10/13/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/13/2010 $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 OU by calling 503.246.6699 or 1.800.332.2344.
Issued B - / Permittee Signature:
AMP
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.
OCT -12 -2010 TUE 09:25 AM ROTH HE
RIKEIVED FAX NO. 5032663478 P. 01/02
Mechanical Permit Application oc T i - i FOR O1∎I 1CF.. USE ONLY City of Tigard Received CITY OF TIGARD
i �
IN
q 13125 SW Hull Blvd., Tigard, OR 97223 Date/By: ti I 1 1 'I
Phone: 503.639,4171 Fax; 503.598.19
Inspectionl.inc:503,G39.4175 -BUILDING DIVISIO►a Oilier Permit
T 1(i A R D Dote Ra1dy /By:
Internet; www.tigard- or.gav g 6d See Page for
(.4 1 I 1 1 Cl NatiScd/Mettwd; Supplemental i Information
..t "to-:5N.. g'.i l'e ° I:I i',:li i:7i *ti+; ,^T t,e. 0:q,.l..
❑ Ncw construction Addition /alteration/replacement Mechanical perrrtic fees' are based on the value of the work
❑ Demolition ❑ Outer: performed, Indicate the value (rounded to the nearest dollar) of ell
�,, }� mechanical materials. equipment, Tabor, overhead, and profit.
❑ Accessory building
,, `' .
1- and2- familydwelling ❑ Comm •••••• -- • tri •• c ? 4•NT g9XPME1s'l;s.',IFS A.1.sX;F.1GS,,,
ry ilding �
❑ Multi family _ For spacial lnformarinn f e e checklist:
❑ Master builder ❑ Other: r
V , yS Description 1 Qty. 1 Ea. 1 Total
.A;i . .. !..CCl t E�?11 r ij0. :, D4, y.r ;: ;'
',.y,
::.r. :.�,:, .ro::� �7".1:� °� „�..y��...,�.,.,�,..Lj� , �+ o�:! �' AQl�: a, 1'. �. �; , ,.. , .; I.i•!j.'aii; ?PI, P. Heating/cooling
' Job site address: 1 Z six) � C� /ti �� Dr; Air conditioning
5� V �� (requires aitc plan showing piecemeal) 46.75
City/State/Zip: 'T` cti. (� l og 9 7 23 Furnace 100,000 BTU (ducts/vents) I 46.75 1 414.7S
Suite /bldg. /3111 no.: Project name: /; '/ /�, Furnace 100,000+ BTU (dueis/veen) 54.91
"`�' f Heat pump 61.06
Cross street/directions to job site: Duct work 2332
Hydronic hot water system 23.32
Residential boiler (radiator or
hvdranic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, induct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
-
Tax map /parcel no.: Other fuel appliances
'.'; I :' . .. , • L .1 1 _ :,ii.' ..... .....•.i. :
Q _L ...Ir r..j .•n.'' Water
';bESCl�I�Tyb1y, 1{,` h, .� ,r r heater 2332
- OS -rj f)lr r' �, I „ ►„ � f J O4 � Ga s f vent tor water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood firepluce/inscn 23.32
.'' ;:•r:.(]'.PRU .O . ' Chimney/liner/flue/vent Other:
3 2
, ... , is � ,
,.. , T�.i4�11� .,... ir .. ., Other:
p 23.32
Name: in e/14 SS u� r 1..(G(, Environmental exhaust and ventilation
Address: S 1� Range hood /other kitchen
equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
() Sin le
? - duckcxhaust
Fax g (bathrooms, (bathrooms, r(bathrooms, Ph
toilet comp calms) 23.32
r --��� �I 3 Fax: ( ) 1 „ � compartments, utili�! r
:;i ''' ':I'l :,i�^'�. � .. . , , .i:ciio."d',,I' ";�)�';i'� ��r� °�l::�.Ti� :i ��� a' .r i. �:c -
. ,., .'ri!!i' h' rf Pj L Nr :;r•:P�: nl'. ti':,d�.r,ial'4.L,,�,ii +R 1. 5 ,� P j' , 1, } t 4, � Attic/crawlspacis fans _ 23.32
Other
i.. C � ,,4YC((! '.Ey1i3 . ,'F.y��' fa
Business name: = 23.32
Fuel piping
Contact name: $14.15 for first four; $4,03 for each additional
Address: Furnace, etc.
Gas heat pump
•
Ctty /Statc/ZIP. WalVsuspended /trait heater
Phone: ( ) Fax: : ( ) tauter heater
E -mail:
Fireplace
u ... Range
..... ) {,'� '; :r;" c,i., N,l'cS' ;'.;I'1 r > '� ?' •..�:.;.' ii,�iJ;:,:i�• ..nr .. I:. q
�.i.��' ii11 r { �.� . ;'.'.I' '.�V� :�li:u.111 77 ��, �G.<lti ..1�. .. i(',• 'I`I'i11 .gig. N� I r:l
.Y:,... ,..�l:,l'� ..,..r...,. eSi�1',',�i'];.X .. . ib'. tiS ,, iph�� ^il: °. d. ��FY` .t�La�Tl,lnli.illnLerli DarileCUC
Business name: / 14, ii L� f �I ool.t.n Clothes diver (r as)
Address: > e t ? - 5 Other:
city can el-1015 •,;;�. to .•,�:`:�,:,,;:::,.
/statezip: b , _ S ubtotal ( x , i 5
Phone: (� 1'?) I I .f Fax; n Q Minimum permit fee ($90.00) D, () 0
I Z ( 3) 2 'J�� a Plan review (25% of Detroit tee)
C'CI3 lie.: 14.f 00 - State surcharge (12% of permit fee) LO • ,'0
TOTAL PERMIT FEE 100. O
Authorized signature: �■ ii A, . « _toji 1 _ This permit application empires ire permit Is net obtained within too
■ v`+ l�r days after It has been accepted as complete.
Print name: ' J ir 0 16 e ,i t 1 ` Date: - 7 " Fee methodology by Tri-County Building Industry Service t9aard
I:\Buildiigt mite) (NEC- PetalltApp.d°° 10/01 /09 L 440_4617T /02CCM/W6B)