Permit n CITY OF TIGARD MECHANICAL PERMIT
1111 a COMMUNITY DEVELOPMENT Permit #: MEC2010 00568
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/09/2010
Parcel: 1 S 135CC00600
Jurisdiction: Tigard
Site address: 11730 SW TIEDEMAN AVE
Subdivision: Lot: 0
Project: Chaney
Project Description: Gas furnace replacement.
Owner: FEES
CHANEY, CORALYN A Description Date Amount
11730 SW TIEDEMAN
TIGARD, OR 97223 Furnaces < 100K BTU 11/09/2010 $46.75
12% State Surcharge - Mechanical 11/09/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/09/2010 $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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800. 4.
-
Issued eye - �_ E % ?
Permittee Signature: P
i
Call 51 . • . by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV -05 -2010 FRI 11;29 AM ROTH HEATING FAX NO, 5032663478 P, 01
Mechanical Permit A lication FOR OFFICE IISE °NIA'
City of Tigard CEIVED n te;By; (' �/o jy -
" 13125 S W Hall Blvd., OR 97223 / Plan Revie
r 1j Date/By; Other Permit;
• m Ph one: 503,639,4171 Fax: 503,59$.t960 1
I' I CI A } D Inspection Line: 503.639 Date Reudy/By:
ha' ' F21 Si e Page 2 for
Internet: www,tigard Notifind/Mcthad: i Supplemental Information
CITY OF ' ' i
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Mechanical permit fees* arc based on the value of the work
❑ New construction ® Addition /alteration/replaCement performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
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1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building • For special inforrnarion use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty, 1' Ea. I Total • . a
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.......... ..: . 1 „ < >'. �. IOC � , ! f:'ia:`.; : I; : ling /cooling
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1 1130 S / ` A ir conditioning
Job site address: W .•uire>, site .Inn showin Iacement 46.75
City /Stulo/ZIP: , 6 ,, j I Q L gill! Furnace 100,000 BTU (ducts/ventsl 46.75 466
Furnace 100,000+ BTU (duets/vents) 54,91
Suite/bldg. /apt, no.: Project name: arAVl/C, / Heat pump 61.06
Cross street/directions to job vile: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 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: Lot no.: — Other: _ 23.32
Tax map /parcel no.: appliances Water heater 23,32
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I ..tia I. , 1 .4 &_ : 01 M Flue vent for water heater or gas
fire, lace 23.32
. Log lighter (gas) 23.32
Wood/pellct stove 33.39
- Wood firepluce/inscn 23.32
/liner /flue/vent
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Name: CO r1 C12_,.. Environmental exhaust and ventilation
Range hood /other kitchen
Address: SCA. e ui.ment 33.39
- City/Stine/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (boa • $ ci -- Log M Fax: ( ) toilet com_p_arintcnts, utility rooms) 23.32
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, r 7 , <,p I„ gl`PI , a,. ` Other: 23.32
Business name: l+ucl piping
Contact name: 514.15 for first four; S4.03 for each additional
Furnace. etc.
Address: Gas heat pump _
City/State/ZIP: Wall/sus ndcd /unit heater
Water heater
Phone: ( ) Fax:: ( ) Fireplace
E-mail: V 1 9
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Clothes dryer (gas)
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Business name; 1`� E1 G(, 09 1. CA(7tkn Other: ,-••
Address: 0 LI , u0 ...... .. ,l .
City /State/L1P: II-- IL `7'1
YJ� . 0 Minimum permit fee ($90.00) ". O. Ii'
Phone: (tj.) 3) 2.(,p to • 12 LI el Fax: ( `2, Le (L7 . /7 g — Plan
State nr eview (25% of permit fee)
(12% of permit fee) �� (�]
CCB tic.: 14 ( � — -
TOTAL PERMIT FEE 100 ■ rill
This permit application eipires if u permit in not obtained within 180
Authorized nibroaturo /I �l y �e_.- t�.a6 � L Q , f/ / days after It has hem) accepted as complete.
/ 6 ` El 0 • • Fee methodology set by Tri•County Building Industry Service Board
Print name: �(" t
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