Permit CITY OF TIGARD MECHANICAL PERMIT
II COMMUNITY DEVELOPMENT Permit #: MEC2011 -00104
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/11/2011
Parcel: 2S111 DD03900
Jurisdiction: Tigard
Site address: 15645 SW 88TH AVE
Project: WASHBURN Subdivision: STRATFORD Lot: 19
Project Description: Gas furnace and NC installation. A/C unit must meet minimum 3 ft. rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: WASHBURN, ROBERT HAROLD
PO BOX 1265 15645 SW 88TH AVE
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
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Specifics: Description Date Amount
Air Conditioning 03/11/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 03/11/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/11/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� � Permittee Signature:
_cC?
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.
MAR -11 -2011 FRI 09:38 AM ROTH HEATING FAX NO. 5032663478 P. 01/03
Mechanical Permit Application FOIi OFFICE USE ONL1'
City of Tigard Received
Date/By: • t
r 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
y
I, Dat e/BBy: y:
Phone; 503,639,4171 Pax; 503,598.1960 Other Permit:
1 Date/By:
l
T I C A R 1) ttspection Lino: 503.639.4175 Date Ready /By: RJ See 1'ntle 2 for
Internet; www.tigard - orgov Notified/Method: s Supplemental Information
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N ew c onstruction Mechanical permit fees' are based on the value of llte work
New ' xcd dition /ul lcra.tion /replacemellt performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Land 2 Ittmil dwelling � Trrw;ORY �rc'al/�t Sll r ` 1 ItTs 13].
! '' k 1 1 I 1 J : i.l 1 1 ,'.r Val
master _
Y ❑ Commercial/industrial Q Accessory building PM1 J ,'' SY a Y " „, I Sw ,
Multi -famil r b uilder 0 Other: For special pI1ormatlon use checklist.
y Description L Qty, Ea. Total
II 'i1QIIISI* tA *1 iION::,4'11fD'IOC�.rl1Q l;lf' !1 IIe atu1/ conl inr.
Job site address: / ( 2 4 s” , GQ 4 u Air conditioning
ti{ G (requires site plan showing placement) , 46.75 y .
City /Stete/ I ,'C 4 t� . r 4 Z Furnace 100,000 BTU (duets/vents) 1 46,75 �t-i f/ .
J Furnace 100,000.1• BTU (ducts /vents) 54,91
$ uncfbldg,/apt, no,; Project Heat pump 61,06
Cross street/directions to job site: _Duct work • 23.32
Hydronic hot water aystcm 23.32
Residential boiler (radiator or - -
hvdronic) 23.32
-- Unit heaters (fuel -type, not electric),
in -wall, in -duct, sus2 ided, etc, 4.6,75
Subdivision: Lot no.: Flue /vent for any of above 23,32
Other; 23.32
Tax map/parcel no.: Other fuel appliances
' 'i D r 4 iiON' ;011 ` WiQRJ};! '' ; I il,' 1k p j 11 I I Water heater _ 23.32
S I Gas fireplace 33.39
' ✓mot _ U•tG Gt. (' C w v' c. or,n a� Fl ue vent for water heater or gas
fireplace 23.32
Air _ train Gil +01 -1 /--. r
Log lighter (gas) 23.32
Wood /pellet stove 33,39
Wood fireplace/insert 23.32
:' ...i!PRO,.RTk ... .'` , ' ' ' I, . %.A .. !: I Ot v /liner /Out /vt nt 23.32
Other. 23.32
Name: Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 33.39
City /State /ZIT': Clothes d er exhaust 33.39
- Single -duct exhaust (bathrooms,
Phone ( ) Fax ( ) n ' T � toilet compartments, utility rooms) 23.32
( I �. ;' 7 " : 14: : � r � I i iiA i t I ?� I� VI : , .,,,•,.. (' NTA CT y0 { ] 9 '' . §. ., r,. i 11 x . f �tuc / l
eriws�aCe fans 2 _
23 ,32
I � w / � Other: 23,32
Business name: / r h � � Fuel pining
Contact name; - , ��p ,49,e f // v $14.15 for first four; $4.03 for each additional
Address; 'Pa i ,..r Gas heat etc.
�^ _ —_ Gas heat pump _
City/State/ZIP:
C.�t /I b rZ.., i 3 Wall /suspended /unit heater
Phone: ( ) 2-'€t ,_ (4 i a tax: : ( ) 2. l . ......3v-9_ Waletheater
E-mail: Fireplace
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1 'I l i ;i, : G li i rl "�; "Iw �,:' i.!;'�1. '4 xr ( 9 . ,,: k :.I r, '1 ?;; ;:kl,;1 �,4^1! �,i ,II' �1 1 ;lirl� ,i iCi ,, � ;�; iL
I Barbecue -
Business name; Clothes dryer Sea)
Roth u h i-i f Cpc�l,r n .
Address: ther
CO O 1Mx l 2LP 5 ';'' 'i;'', I' „40ii t ll0 Alfzi 4'rg# !r1,, I
_City /State /ZIP: ! aZI) _ c
by , 012 .1 01
Subtotal 13
( . �) 21 p I.L) I (JO3) 2 Left,- 7 p
Minimum permit fee r mit fee
Phone: f” � , , G Tax: l Plan review (25% of permit fee)
CCB lie_: } L4, ( 0 g State surcharge (12% of permit fee) // Z.- 1.
3
TOTAL PERMIT FEE /pa/ , y7.
Authorized ei store "his permit application expires if a permit is not obtained within 180
n • t 4 +L ��%f' / (K dor after it has been accepted ns complete.
Print name: I , , a , f Date: // / . pee methodology set by Tri- County Building Industry Service Board
1:1nuililing \Petlnili \M.L'C - fete lApp.dou 10/01/09 440- 4617r(It /n2 /C0M /Wb13)
MAR -11 -2011 FRI 09;38 AM ROTH HEATING FAX NO. 5032663478 P. 02/03
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