Permit 71 CITY OF TIGARD MECHANICAL PERMIT
`` COMMUNITY DEVELOPMENT Permit #: MEC2011 -00015
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011
Parcel: 2S103DB05400
Jurisdiction: Tigard
Site address: 13320 SW GENESIS LP
Project: GRIMES Subdivision: GENESIS NO. 2 Lot: 51
Project Description: Gas furnace replacement.
Contractor: ROTH HEATING & COOLING Owner: GRIMES, DARIN
PO BOX 1265 PO BOX 10145
CANBY, OR 97013 BURBANK, CA 91510
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/11/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/11/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/11/2011 $43.25
Occupancy Grp:
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 1.800.3 -344...
Issued By: Permittee Signature: , ERp___e_
Call 503.: `. 175 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.
JAN -10 -2011 MON 09:38 AN ROTH HEATING FAX N0, 5032663478 P. 01
mechanical Permit A licatiOn .
of Tigard
City ; rein oFFice USI ONLY
t ' 13125 SW hall Blvd., Tigard, Olt 97223
�� � 9 , Received Phone: 503,639,1 Dine/By: 1 // �r 1'cnTlil'No,;
l l 7l Fax: 50 3,598,1960 Plan Review "- —gi
TIUARD inspection Line: 503,639,4175 p ( j—
AN 1 2 11 Date/By: ��
Internet; www.ti ard- /32 OtherPcrmit:
5 or.g Dalc RepdyBy;
CITX OF TIG I) Notified/method:
e Pasta! for
Supple,ncn
IrucTl 'I ii '.,:.�'�!'�I'pr r ,�'N J
New cons on Ad ,:': l ,,. q.P:kl141 1 7 0 (4 L f'X.p'° 4C'fg.pf)TI ' ' g l��b 1
dit /alteration /replacement Mechanical permit fees* are based on the valu of t work
Demolition
performed. Indicate the value (rounded to the nearest dollar) of all
t ?1fM'! n mechanical materials, e.
Other:
F 0 Corn a cial /Indust Acces
ur meet, labor overhead, and relit.
#" ;CONS! h C,Tt10N ,. '
1 - And 2-family dwellil7 I g
- family (] Master builder rial O1:hc building � R IE
! Sll�,, (SYSPtIV�S�1*17' t
0 hQultc y
t special ht/brraarion use checklist
JCll) 5!! I2 lT' I4)R�y1A Io �, Description
,!. tDC�;7PIN 1 L:. Qty'' Total
t� 0 s , , } Beaton• iti o olin
kb site address: 13
W �Yl S i conditioning 9 a re aims site tun shmvin locemeni)
Q , -J r - 1..._2_ Furnace 100,000 BTU (ducts /vents) 46, 75
Suite /bidg,/Apt, no.: Project name: i' _ 4fi. ,
! Furnace 100,000 + BTU (duets/vows) 54.91
Cross street/directions to job site: Heat urn
Duct work 61.06
H drnnic hot waters stem Nil 23.12
Residential boiler (radiator or 23.3
h dronic)
Unit heaters (fuel -type, not electric), 23 32
Subdivision;
Lot no,;
in - wall in - duct, sus ended, etc.
Flue /vent for u'w of above 4(,75
ccl Ito all
Tax map/parcel other:
23.33
y) EC,fty CiQfY Q'!I kV(L" � I Other fuel a • fiances
�`- rY1C _ .. ;:I l 't'rl �' Water heater �MiiM
C,h, Gas fire lace
• Flue vent for water heater or gas
fire -lace
23.32
La 1i 'titer as
Wood/ eliet stove 23,32
33.39
Wood fireplace /insert
:' �i':;PTtf1PJ'ItTY r� � � - �
OVIJYAJi� • " 23.32
Name: !..n i� ,{Nf#N1 „ , Chunnnv /liner /flue /venom— 23,32
�Q �} Other: _
Name:
Address: J l inviraumenial exhaust and ventilation MEI
Range hood /other kitchen
CityiStatc /ZTP: e• ui.mcrtt
Phone; ( �) Clothes d er exhaust 33 39 MN
�- ry �✓ 3 • S3N a Single -duct exhaus 33.39 i n
i' 11' r " L::.t � � fir. ?; r r n toilet c
I 1�1�'�ANI,f ���� i I , r , � . ' (r 1 Om artmcnLS, utilit rooms) 1i4 t Attic /crawls. ��
Business name;
'.I n'l:i ace fans
Other;
Contact name: G r1 r11 Fuel i i
Address: p� �X S1d,15 far Tim four; $4.03 for each additional
Furnace, etc.
OA=
City /State /ZIP: r 1_,LV h a , Gas heat um
� , ' Wall/sus rended/unit heater
Phone: ( )
3 -7 L'' ( Fax:: ( ) Water heater
E -mail:
Fire•lace
II II I , t i ,.,It�'ai, r1, , :.�.,� O� ./.4P' 9 $1 ''; r' i , a � i , ,,�. ,
RangeI � , !�I 1 1 . „,.I�Idj r9� I r ',�i� lr I , �j, i��. I11 i niI 0 Ai ” tirr �I 1 , ;, fdancecue ainal
y G(, 1 1l 0__.t.7 , Clothes dryer (
Business name:
Address: � 12 -t.(> � ...4JJJI � .. � � ��
�1 •
City/State/ZIP: ■ !'' � ,
l ter
1V�C
('�,r} � /� ', , ,, , r�', -f ,
[ 7 iC-. r � t � � J ' ��,��'�-.`f,� rl-IR1FI.':�TI'��'E$'� 'j � ,
Phone; ( ',) Z t" G Subtotal
W Fax; ( j3) L � p Minimum permit foe ($90.00)
trall
CCB O S ,S1-17E Plan review (25% of panel! fee)
State surcharge (12% of permit fee `
Authorized sigttature:� �� , ! `� TOTAL PEItM1T FT$ 0
l 9 v/� Le._ .v This want application cxpiccs if a permit is not obtained within 180
Print name: i c( ( • t days after it has limn accepter! ae complete. -
Date: V i . 7ti . Fee mcthodolofry sot by Tri- County Building
1: 1Build IItIU rmits`MEC -Per tApp.doc 10 /01!09 6 industry Service Born
440.017T (11 /0:/COM/WEa)