Permit CITY OF TIGARD MECHANICAL PERMIT
1111
. COMMUNITY DEVELOPMENT Permit #: MEC2011 -00131
T[GAR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011
S7
Parcel: 1 S135DC07200
Jurisdiction: Tigard
Site address: 11600 SW 91ST AVE
Project: BELL Subdivision: CHARBEN Lot: 5
Project Description: Gas furnace installation with fuel piping.
Contractor: ROTH HEATING & COOLING Owner: BELL, CARROLL M
PO BOX 1265 11600 SW 91ST AVE
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/30/2011 $46.75
Type of Use: SF Fuel Piping 03/30/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/30/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 03/30/2011 $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 1.80—
/
Issued By: �j_S�� ma Permutes Signature' I • i �' ��� ��, f
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 -29 -2011 TUE 09;17 AN ROTH HEATING FAX N0. 5032663478 P. 01
Mechanical Permit A lication
FOR 01.1 1/ L 1 ()NIA
City Tigard Received �
t ' 13125 SW Hall Dlvd., Tisard, OR 97223 Dete/By,
Phone: 503.718,2439 Fax: 503.598.1960
Plnn Review
Inspection Lino: 503,639,4175 Date/Ay, Other Permit:
P
1 I l A K D Date Ready /Ity; curie:
Internet; www,tigard- or.gov 5A See Page 2 for
Inter
Notified /Method: —/--6
. Supplcraentnl Information
ter ,.;
ii New 'constriction { t �A d" on/alter O !77.7.-j':',',-..,7
on/replaeemcnt ' N -�• al permit fees are based on the val a of ork
d
the work
D performed, Indicate the value (rounded to the nearest dollar) of all
Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
❑
� and 2-family dwelling ❑ ` C ,oYI OIr?';C,o S7`Ttmmereiul /industrial 0 7a A. ecesso !, '`"I "' h1 1 b(�'I 1VT /rSySTE Sy, E •
m building i . ,> SKD ; ---
❑ Multi builder � B Fa. special information use checkllsf.
�] Master build 0 Other: Description
Qty. Ea. Total
:; I I I I r !'. :; ! i :.`aQ* iilt4*E4it J QQ.i� '.slo,oY1'x11N' ilaP"r 7p:,: l leis fcating /coollnp.,:
Air wnditioning
_ Job site address: 114 as S t,.) CI 1 5 � (requires site plan showing placement) 46.75
City /State/ZIP: — T1 c...,,-,, o 2 0 ) .9, 7—,m Furnace 100,000 BTU (diats/vents) 46 -75 76, __,
Pumaee 100,000+ BTU (ducts /vents) 54.91
Suite/bldg./apt. no,: I Project name: 1 S 1 Heat pump
(requires iiit,Ian ahowink r! 1_iccmenl) 61.06
Cross street/directions to job site: Duct work
23.32
l hot water system 23.32
Residential boiler (radiator or
11
_ �_ dronic) 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
Tax map /parcel no.;� — Other; 23.32
—
Other furl appllnnc:
; , 1 711 Nip Pitt O 'l<1 11t1�1, II 1 ; ',I � 1 ` ! u - cs Water healer 23.32
a U a c 1-'1 e•�� c_ ., G as fireplace ne or water heater or gay
33,39
,/+ Flue vent for
/�/4 tc-/ 4, i .1•111,P .a r.� le Zs— fire p lace
23.32 ,
1.014 lighter (gas) _ 23.32
—
Woad /pellet stove 33.39
Wood fireplace /insert 23.32
yy qy y�
11, {1 E I+ 0,00, I tile , ; i 1 : Iif fil :i .: i it i: 11 Chimney /liner /flue/vent
�, Q T�I1 I f 23.32
! Other; 23.32
Name: � t �
_ Environmental exhaust and ventilation:
Address: Lei �j 4.4_1 n Range hood /other kitchen
I ( - -
`, $�-- equipment 33.39
City/Statr/ZIP: -- F 4 �,, G^I«},�Z' Clothes dryer exhaust
Phone: (51) ( 2_ - Reg s- Flu[: ( ) -- Single-duct exhaust (bathrooms, 33.39
toile) compartments,
''r ; �' ' ( r ,? 4 . i; I utility 23 3 2
rooms) ,
- • "�'� ;; it 1 , �I. " la ,,� �'�U1�1 ' .(T� L ttic /crawls ace fans
�Q�,r fr��•�hnl' A
s: 23.32
Business name: i Other: 23 32
Contact name: 4 Fuel piping:
$14.15 for first font; $4.03 for each a dditional _
Address:
— Furnace, etc. l 14 . �� /I/ l S
City /State/ZIP: Gas heat pump
Wall/Suspended/Unit h eater
Phone: ( ) Fax: ; ( ) Water heater
E -mail: Firellaca _
`'li,,` =. ?' i �; !. p , 4 i)j, A , �-p�� /�.� y� Range
, 71, 7': . � i`'n� 1 ('r I IF Zia ?i1� 1, i lhI 1'.1� f l 4h^p!": ; T' F fq M �J,1r X 1: 1 l I� I� il!; l �, I; i l •l;l 1 t1 I ; `I;II , I i I ' 1 � k lr B - -
"
1 : . ‘ 7/7'
h•.. ! i,fl.�i„II Ili , , i Y�4 �,,,I it (�Vil {i' l l a !:. rb arbecue
Business name: ‘,4.-1,..1/4 '� \_e_�� +� Cloth dryer us
co c��r 171 iG XG �„ c.. ., so , i,-- . �
Other
Address:
i 1}'1. T . .Ili;
City /Statc/ZIP: �v1 b 0 i �d I Subtotal 42, c] y
Phone: ( S`)3 ) 2.(p to - i 2 + Fax: (Q)) Z Minimum permit fee permit fee p, ap
ta 4 ' — � 3 Plan review (25% ermitfee
CC13 lie.: / `i G O { p fee)
State surcharge (12% of permit fee a e o
TOTAL PERMIT FEE Lop .
Authorized signature: am— . ° Thia permit application expires if a permit is not obtainer[ within 180
dive after it has been accepted ea ventilate.
Print name' - L./7 e t�'i/; / I Date: say � ' Fcc methodology sot by'fri -County Building Industry Service Board
lanuildinalPcrmitafne- PermltApp.doc esiociID 44o- A61 A Tr a 1/021C°MMEH)