Permit a CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2010 00550
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 2S104BD05400
Jurisdiction: Tigard
Site address: 13724 SW WALNUT LN
Subdivision: Lot: 0
Project: Marvin
Project Description: Gas furnace and A/C replacement.
Owner: FEES
MARVIN, RANDALL A & Description Date Amount
KERSTIENS - MARVIN, HELEN A, 13724 SW
WALNUT LN Air Conditioning 11/02/2010 $46.75
Furnaces < 100K BTU 11/02/2010 $46.75
PHONE: 12% State Surcharge - Mechanical 11/02/2010 $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: Natural Gas
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 1.800.332.2344.
Issued By: - Permittee Signature: - / 4
4 02
Call 5 1 - . • 39.4175 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.
P. 01
FAX NO. 5032663478
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NOV-01-2010 MON 01 : 46P1 ft FIETlli
City of Tigard . . , . .'. t Realiyed
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Data/By: 1 Perm No.:
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312a Bld,, gard, OR 23
Phone: 503.639,4171 Fax 140103.1961 201676 Plan Review
Date/By:
Other Parma:
Tic;ARD Insr&ction Line: 503.639.417
D4le Reedy/33y:
Internet: WWW.tignrcl-ongolk
WY OF TIGARD Notiacd4.401
ell 2„ri. t
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0 New construction NI Addition/alteration/replacement • Mechanical permit fees* are basecl on the value of the work
perfonned. Indicate the value (round LO the nearest dollar) of'
0 Demolition
0 Other:
mechanical materials, ,tii.men labor, overhead. and .rotit.
• l: " .Y ;':;i.' : 1::;':.::::YeAr!*00...*i.S1414).01.0!VO,!':::.;,;:':::';':;::::it.::':;''t: .. . Vai $ ,
'i:::::;';:ji411i
4 1- and 2-family dwelling 0 COmmercial/industrial 0 Accessory building . '
For special information use
• if*OgSgii.4 checklist.
0 multi.thinily 0 Master builder 0 Other;
Description
(NY. 1113111 Tow
;::::::.,•!.:-,:::,::i:::.)ok..*3.:41.)i.iiiyiii0,0'.**0]*0.!:::, Wank coolin_
Job site address: 131 2
I n u, • n e., Air conditioning
fret larva site Ian showin :Bement) 11111111 •:
• • a■ Furnace 100.000 BTU (duatsAfenis) inn 46.75
Furn (duets/yam) Ili. 54.91
Suite/bldg./apt, no.: Project name: ace 100,000+ BTU
I 11111 6 1 . 0 6
Cross street/dircelions to job site: Duct work 111111111M1
H dronic hot watcr system 111111M111111111
Residential boiler (radiator or 11.1111111111
hydronic
Unit heaters (fuel-type, not electric).
in-wall. in-duct, sus:ended. etc. 1111P111111111
Flue/vent for an of above IIIIIIMMIIII
Subdivision: Lot no.:
Other:
1111111 M.1111
TM map/parcel no.:
Other fuel a . :fiances
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rimmeemsmir 33.39 ....
L 4 krna u arkc c r •/CL( t d4 LIA,1-- plut vent for water heater or gas 1111111111111
fire: lace
Le = li hter ( as) rommennee.
resamm
Wood fire . lacc/insen
a
,..;;,,;t';,;:',ig,.:,.:.,,., 6122insizzomoltrallane'■■••=1
Other:
..r 1 Environmental exhaust and ventilation
Range hood/other kitchen
miesal
Address:
.4i.rnent
City/State/ZIP:
Clothes dryer exhaust IIIIIMMI
Single-duct exhaust (bathrooms,
Phone: ( SiG 2
— 0 DSO coact corn .• ents, utility rooms IIIIMIIII
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:tisuicU nuuLaMMIIIIIII ___..m.....mmommumulo lirtrle
Contact name:
$14.15 for first four; S4.03 for each additional
Address:
Giis hcaraitl-14111111.111111111
emin..___Wall/susod/o,,it 1-77MMIIIIIIIIIII11111111111111
E-mail:
111111M1111111111111111111 121"111111111111111111- cataicn."111111111111111111111111.=
C;KOlt*„,t400*g;...WN:`.4g;.:.6'!;;1,:if:v,';`;;!%t.,A;ik:. Barbe,„
111.11111 .111.1111
Clothes d cr , us) 11•111._____IIIMIIMIE
Business mune: P i . ' C01• 11 1,. e_.0(-, J') c
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Address: 0 2_1 4 s
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city/statemP: 0, en 0 1 s
Subtotal .5
Minimum permit fee ($ MIN
Phone: 6 03) 24 10 . 1 L ci Fax: ( 503) 2 lt)(0_ 5L/7E
Plan review (25% of pemtit fee) mmoni
State surcharge (12% of permit fco) nil@Ri
TOTAL I:WM.11T FEE prime
This permit application expires if 11 permit is not obtained within tmo
,uthorized signature:411 AI,. la.,..kr i te...,..-
days after it hoe been accepted as complete.
riot name: . , ■ Dote: f f la . • Pee methodology bet by Tri-Couoty Building Industry Service Board
todiao.PernatstmEc-is tApp doc in ung
440 • 1 71' (I I/ONCOM/WI3)
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