Permit CITY OF TIGARD MECHANICAL PERMIT
"' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00654
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010
Parcel: 2S103BA00201
Jurisdiction: Tigard
Site address: 11545 SW WALNUT ST
Project: NIHILL Subdivision: Lot: 0
Project Description: Gas furnace replacement with fuel piping for range.
Contractor: ROTH HEATING & COOLING Owner: NIHILL, GERALD T & DEANNA LYN
PO BOX 1265 11545 SW WALNUT ST
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/16/2010 $46.75
Type of Use: SF Fuel Piping 12/16/2010 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/16/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/16/2010 $29.10
Stories:
Fuel
Fuel Types: Natural Gas
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.
r
Issued Permittee Signature: •
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.
DEC-15-2010 WED 03:07 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit ApplicatiroJCPCIVED FR O OFFIcIE tiSE ONLY . .
. .' kil Received
City of Tigard tj 1 Permit Nu.:
Date/By: . 1
• 131 SW Hall Blvd Tigard OR 97223
1 :I,! .. phone; 503,639,4171 Fax ' 503.598.1960
D E C 1 5 2010 Plan Revew
i
Date/By, Otlior Permit: •
flei Inspection Line: 503 75
rt1101 Dine Reutly/By: El see Palle 2 far
Internet: www.tigard ('T\( OF TIGARD Notilied/Moiliod: BM Supplemental lltiformation
; ' 4 I! nING DIVISION
1,*Ot' ,...;!i: d'.i00k441:400.'.i*O..i11000g:
Mechanical permit fees* are based on the value of the work
0 New construction Z Addition/alteration/replacement performed, Indicate the value (rounded to the nearest dollar) of all
El Demolition El Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
:'.::,..:.;,;:::''',....:-."•,:''','...:''::.::.:::: 6 :kifi'.' , !06' .1 0!la ,I .:i 7 :.i*O*00,;.0gFirgINjfi:IfF;('''' , ::::' , U ; i i ' - ., ., ,............. ,. , „,...-. ,,,, ,, .: .„ . -,.. . _........,...,.. „.. . ., - -,.. , .. .....
. ,,,. • •• • • --.- ---- •••' ---- - — • ' - • ' . . • - - — '
0
r,'/O.0.$4 , !4A*0'Ir'',7
el 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
P'or special iriformailon use checkli.O.
0 Multi-family 0 Master builder 0 Other: Description Qty. 1 Ea. Total
• ,,,:::: :i::., :„,,.... :::..::::::;•::::,i...... ..,.„„,,„:•:..„,,..-: r.:1
1.;:P .!!:..1:!;:1;!!' Heating/cooling'
job site address: 1 1 5 Li 5 k o 1 ,-, tkl---- it' Air conditioning
(requires site plan showing placement) 46,75
City/Statc/ZIP: t G yOr ") R 9 1 2-2- Furnace 100,000 BTU (ducts/vants) 1 46.75 1 15
Furnace 100.0001 BTU (dacta/vents) 54.91
Suite/bldg./apt, no.: Project name: Hem pump 61.06
Cross street/directions to job site: 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.: Other fuel app _
, ! , ,..4:, :,,...';,; ...,: '',:,. ;!:.::;„!..:,..,..;: , ,•!:,;. :•;,:•!.Y ,..,;;,.bii,,■.i,v ; .,i ; ;..4: ! 1:.!.!..; ; ;' ; F.; , •..;;.: , , , , :'rli f Water heater 23.32
, ,,,,: ,,.; ,,,.,::;!,,, ,;,, ,.,.:.,, ,,,:,.,...., ,.,,:..,,:......!.,,.,: ,::•,: ..!191t1:,.!!! ... Itl., '., i' .■ • !:i. 1 `:';i:4 ::
( C '1 . klr na .
, °
f . • ..: 1 .A vent for water Gas fireplace
S ' ' e_, Flue hcarcr Pr .1.1_,.i 33.39
I, ' fireplace 23.32
n-).-el- r -t -t\ii-ch eir." .- floc tv rt. va-TIT-- Log lighter (gas) — 23,32
Wood/pellet stove 33.39
- Wood fireplace/insert 23,32
-
- ,, ::;,, .. .:..,. , , -.. , .... 7 Clamney/liner/flue/yent 23,32
0:041t0;:OW:i!,4*d:1:'.,'!g'6ir:R . 5,i;: Other: —
_ 23.32
Name: laz.ckn n.a_ K) ■ VII l„ Environmental exhaust and ventilation
- Runge hood/other kitchen
Address ()■• ne)q_ . equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (a) le39 - LI? 1_ LI Fox ( ) toilet compartments, utility rooms) 23.32
1,tiiii ;!.:!Hi'b!;'Iiii0jiiliiefiriiiiigi AltiderawilPace fans 23.32
Other: _ 23.32
Business name; 2 ail in a Ni a 1 1 ( Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
. - - Furnace, etc. —
Address: IA 51—) Gas heat pump
City/Stale/ZTP; wail/suspended/unit heater
Phone: , 11 ) (1) 9 - up Lp 1 G Fax: : ( ) Water heater
, .
Fireplace .
E-mail; fIangc i Tq7c
1 21, /:1 l' " , ' .. '0 ,*#.*0104t:i . j4,11g. 11 !! .■',.0i'.‘'4'.`1dg.;1'R'?'..1:),V!$I1 l3aibectie
Clothes dryer (gas)
Business name; 0 o , . ' L-1 - ) 11 f t __.0 ) .j c Other: . .
. .
Address: 1 b0 X ( 2 -( 19 6 _ ..... 1 *,00114:i'ii00:044.140,P:M'i.;:,;..,:.t''
Subtotal ( p0 ,9 0
City/State/ZIP: c J , 0 p_Mlir 0 1 5
Minimum permit fee ($90,00) D. 00
Phone: (F3, fp • i 2.. Fax: 603) 2 Le co . ;: z? . ,L,i-1 g
in review (251/4 of permit fcc)
— .
CCR lie.: )9 0 State surcharge (12%i of permit fee) 1
TOTAL PERMIT FEE l 00 . VD
This permit iipplicotion expires if A permit is not obtained within 180
Authorized signature: 1 t. tCLZ0-01 1 days After it hoe been Accepted as complete.
niCini name: 4 y(1.,( r'. V.--6-eikl 11 .i.'"? Date: 1 i c., 1 1 . rtie methodology net by 71'i-enmity Building Industry Service Board
' 1 ' •-•-'
1:\nuildins.Rormluw.ac-rcrapp.dcle i0/01/05 4 (11/02/COMAVER)
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