Permit CITY OF TIGARD MECHANICAL PERMIT
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• ;.. COMMUNITY DEVELOPMENT Permit #: MEC2010 -00606
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/22/2010
TIGARD Parcel: 2S104CA05100
Jurisdiction: Tigard
Site address: 13668 SW MICHELLE CT
Project: SMITH Subdivision: HILLSHIRE Lot: 51
Project Description: Gas furnace replacement.
Contractor: ROTH HEATING & COOLING Owner: SMITH, MARK H
PO BOX 1265 13668 SW MICHELLE CT
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/22/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/22/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/22/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: ��._ / " - Permittee Signature: I / i 7
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Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV -19 -2010 FRI 09:46 AM ROTH HE' S: if; 'MED FAX NO 5032663478 P. 01/02
�Vdechanical hermit A lilicatio>ry NOV 9 2010
1�o oti'ocii: U5t ONLY
II City of rI igard R°aoivdtt
' t 1312$ SW Hall Blvd., Tigard OR 97223 CITY /. Date /IJ �16 Permit Na.l 6 � r
. R I IT d OF TIG' ' 'I Plan Review �J
Ph one: 503,639.4171 Fax: 503.598,196
inspection Line: 503,639.4175 � �LpIN I)1V1S111 ►' ay, other Permit:
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Intcmet: www.tigard -orgov Sec Page 1 for
Notified/1A elhod;
/'n Naitfi Supplemental mental It r rmnlron
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❑ New canstructton rg Addition /alteration /replacement Mchanic.�l permtt tees r tai based on the va lue of the work
El Demolition performed, Indicate the value (rounded to the nearest dollar) of all
11 I p
Othci
mechanical materials equipment, labor, overhead, and rout
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1- and 2-family welling l ❑ Co nmc cial/industrial❑ ry r j y it 111 :ri Value $
ONS PRj Tt
y Acoessa building 1 1Rrsr11)CNT1�1X. �Q T7�'M'� J 5� ' ��1>I?M s FE�,$�
bor special (r
❑ Multi - family 0 Master builder ❑ Other; ( %nrmn /ion use checklist.
Description Qty. Ea, Total
1aO , P4N 04*.f lh ` ,1ac;4iri.'P I' ri i,! i '∎ , r eatin /coolin _ _
Job site address. /3 i W g s 1 I r1 L - Air conditioning
CA
�l (requires site plan showing plaoemcnt) 46.75
Ci ty /Stat /Z IP:
I
O12 — ��3 Furnace 100,000 BTU (inlets/vents) 1 46,75 gyp,
Suite/bldg./apt. no.: - Project name: 111'N- Pomace 100,0001 BTU (ducts /vents) 54.91
Heat pump 61.06
Cross street/directions to job site: Duct work
23,3.
1 lydronic hot water system 23,32
Residential boiler (radiator or
hVdronic) 23.32
Unit: heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 16.75
Subdivision: L ot no.: Flue /vent for any of a bove 23.32
Tax map /parcel no.:
Other, 23.32
Other fuel appliances
/v�y ` pp Y 1
�� „ , :iitkg_P n #tQ1�11 ¢Rli : ..,, I I. 1 it 11 ',ti 1! t" r 3
.... ` 1� ( 'i 1 Water heater 23.
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S ill /__ Gas fie It for 33.39
L g �� 4 " J ` Flue vent for water heater or gas
0 fire lace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
l 11 C C O
t .�1 ` Cltimncy /liner /0 c
� ,R t � * 1— E 1 i u /vent 23.32
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�' 1 ' 1Q�� ;. ;'11 1 � , r l a' ::
„� _ i Other:
23.32
Name; ► Vl.{aJ -4 rt
Cnvirouinental exhaust and ventilation
Address: Range hood /other kitchen
_equipment . _ 33.39
City/State/ZIP: _ Clothes dryer exhaust 33,39
Phone: 33 ax: ( ) Single-duct exhaust ( utility coo s.
I�dl �� F Si -duct
i' ''. I iIPLkANT r it lr 1 I y ! . ;i '; i (r 800.$17' lr i „ � , l 1
toilet compartments, u ' utility rooms) 23.32
r ,rr�A>zQ "f '' I�i • i' l ii Attic /cruwlspace fans 23.32
-
Business name: Other: 23.32
Contact name: -
Fuel piping
$14.15 fnr first four; $4,113 for each additional
Address Furnace, etc.
Gas heatVump
City /State /2fP: Wall /suspended /unit heater
Phone: ( ) Fax:. ( ) Water heater —
F - mail: Fireplace
i i > ,fl I1 l , � Ronan
a,r r u.l .. 41r lilt 1 ry �p l u 4 I 1 l i i . -
, a .1 rll.rl pi„ "*f a. �,n, t I i r r +; :{ i '�i ' j r d { i i I
I1 r lifl;l, P1r . �fi �,iilltti Barbecue
IIu stness na me; �t C� t� �. Clothes dryer (gas)
Add ress: . ) x 1 0 1
c. �f7� f t�
Other _
1 , . x
city /slatc lL1r: 1 � � -� � r �u� �� �r���� N>�?n �'� 1 + ! .,1;. + '
L9 1 0 i2 1 01' ..> — Subtotal �,--
Phone: (} + { F ax: G' n Minimum per mit fee ($90
� -,_ � (50a) 2. Plan review (25% o R0.Oc7
I " O f permit lee)
CCB Iic.: 1 T State surcharge (12% of permit fee) j b. (
/ TOTAL PERMIT PEE 100. pry
Authorized signature: / /1 . - . /Y ./ 0 i I / This permit a tllention ex tit-es if n ern'
11 l L�lv LiLI .A� �-� : tom' t Pl t P it is not n
drays offer It hem boon ueccirtod htAi
as °mnlro ncd within 180
4 C( 4,0 ',f Date: 1-1 V 1 • Tee methodology ; et by Tri- County Buildi tndustry Service Bond d •
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440,4617T 01 /02 /COWW613)
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