Permit 1 p CITY OF TIGARD MECHANICAL PERMIT
11 11 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00121
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2011
Parcel: 1 S134AB01600
Jurisdiction: Tigard
Site address: 11333 SW IRONWOOD LP
Project: HALL Subdivision: ENGLEWOOD Lot: 73
Project Description: NC installation. Unit must meet minimum 3 ft. rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: HALL, VIVIENNE E REV TRUST
PO BOX 1265 BY VIVIENNE E HALL TR
CANBY, OR 97013 11333 SW IRONWOOD LP
TIGARD, OR 97223
PHONE: 503- 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Air Conditioning 0312312011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/23/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/23/2011 $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. • •
/
Issued By: di all 1111 1111 11111111 ft1111111 11 ermittee Signature: 15
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 -22 -2011 TUE 02:02 PM ROTH HEATING FAX NO 5032663478 P. 01
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Mechanical Permit Application t'URR 01,1•X1. IJSL ONLY
City Tigard Received Maire gli
`� g Date/By: ermif No.: m _ ,, �
ill — i i •
' 13125 SW Hall Blvd., Tigard, OR 97223 r,� AR 2 2 2011
Phone: 503,718,2439 Fax: 503,598,1960 Other Perini
Inspection
T I G A R u Inspection Line: 503.634. pat Ready/By: Ludt: l� See Page 2 far
I nternet: www.tigard- or.gov Notifed/Methed: ei Supplemental Information . , r ,: ` ; Mme. ' >7 y�y
Q construction "M-Addition/alteration/replacement M ll permit fees* value based on h IBC dollar) of all
� �JL � �1 I 1 I � � I ' ' I *�5:f�
the value of the wort.
to the nearest doll
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
�� I - T ale S
„I i ;`o Cik;ioIttre,i oN �I j! , 1 f 7 r I y �,+ 1.rw
. 4144.kil 11t;kfrI� r t++'�Ijl "" 4pliog�,1 s, ,
and 2- family dwelling ❑ Commercial /industrial 0 Accessory building For special btfurmaflwi use checklist
❑ Multi family ❑ Master builder Q Other: Description Qty. Es. Total
„ , 1' y a I �i ' . p ,:,.. ;0 4, ' T i f '. [1'' Headng/enoltng:
,` t f . iYQ Sl ' ' '"..1: *47M " i'li , `J' 1` i1. +t. \Ir n ' ,: l i 11;
Air conditioning
Job site address: 1 i 3 3'' gLo s oli e.r 0 8 1_, . F (requires site plan showing placement) / 46.75 z4103-
City /State/ZIP: -'C, ' i •a,- 2- Furnace 100,000 au (ducta/vents) 46.75
... -_ ■ S Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: / .5, � 1-I Heat pump
(requires site Phan allowing placement) 61.06
Cross street/directions to job site: Duct work 23.32
1ydronic 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
Subdivision: Lot no.: Flue/vent for any of above 23.32 -
- - Other I 23.32
Tax map /parcel no.: _ Other furl appliances;
7777 `00 00.: trnN i'w W).1* p I , + r „ i ,,1 ; 1 ' Water heater 2332
Gas fireplace 33.39
_ £. I t4 112- ON Y7 . Gt. e.e £J `, -iii/ Flue vent for water heater or gas
fireplace 23.32
-- Log lighter WO 23.32 ,
. ..... . _ Wood /pellet stove 33.39
Wood fireplace /insert 23.32
C ll i, l Q t r! irr,, r .. ;,r I Il +l . r j r �n I I r T „ �n , 1 , 1 y; ." Chimney/liner /flue/vent 23,32
:,. ^Sr,� �, ., 1 7.FiN�' I ,c .f. , :lit ,LI,. ,,,r -,I! .c A [;.. I d .r:I Other: 23.32
Name: Vi v ± . rt y.4 _ 4k", 1 ‘ Environmental exhaust and ventilation:
Address: )1 g ^ -3 s LA.., - e ft, aD d„ Range hood /other kilChen
�� � uec�i meat 33.39
City/State/ZIP: Ti 3e,f t9 4l • -�•� 3 Clothes dryer exhaust 33.39
I Single -duct exhaust (bathrooms.
Phone: ( a s'qq _ � y $ 3"1 _ Fax: ( p- ) / �s toilet compartments, utility rooms) 2332
Il ; ;i; t I. i l r !: "plpr Tr . , ��Gt 1 1 + I .I d;r t;, ;:1 1 qL ! P. . - 1 1 1 ' ., , ,, , ! : 1 , „r 1 , 1 ,:: r i C Attic/crawlspacc fans 23.32 '
Business name: 1-2._rD Other: 23.32
Contact name: G V y r k k for first four; $4.03 for each additional
Address: I Furnace, etc. .
- - Gas hcatpump
City /StBtc/zIP: - T
Wall /suspended/unit heater
Phone: ( ) -r Fax: : ( ) Water heater -
E -mail: Fireplace
Range
0,11j;,!, I 6 xl � _ i' r� 1 11 ;'1';',14!;1 Irl U „yi r ! v Ft�, �.,l, ,I r i . j „ r , n4� + a,{ +r J ^ 1.,i „ 4 �k; +r +i1 ( ,1" l� r4 — .
r ^
, ? I t iiYn)µ l 1 411 1PI I ∎ �, r. �r + , r„J 4,11;''. ,.r. n0'u F ,, m,: , I01i,.!� ,rAf, Barbecue
1J I r iYu
Business name:
o'd'N Raj) � ag o I;,l Clothes dryer (gas)
Other:
Address: rri1, x q l .�7�` ; .�
C7O`�L l2Cp!T> ICI .
- -- I , ,r c L ,;,I I A'.. l�'?Ir�,`,h
�L'�I�� �,''il'�
City /State /ZIP: e b d d1'. -C7 1 Subtotal
Phone: (S 2_4 6, F 2 Fax: (5,73) 3 L' , g Minimum permit fee ($90.00) ^ q i'a 1
Li c�( ( c Plan review (2$% of permit fee)
CCB lie.: / 4 1 b o 5 State surcharge (12% of permit fee) /0 . be/
TOTAL PERMIT FEE /, gG
This permit application expires if a permit is not obtained within 180
Authorized signature:
i J days Ater it has bean accepted as complete.
Print name: � v` "Ti ere - ; 1 / Date: / e Z//,/ ° Fee methodology set by Tri•County Building Industry SerVico Board
1 +
1: 110u0ding \PermilsWIEC•ParmitApp.doc 09/09/10 440.46177 (11 /02/COM/WEB)
MAR -22 -2011 TUE 02:02 PM ROTH HEATING FAX NO 5032663478 P. 02
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