Permit MI 1 1 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00131
.TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/14/2008
PARCEL: 1 S 134DC -02400
SITE ADDRESS: 11630 SW 114TH PL ZONING: R -4.5
SUBDIVISION: 114TH PLACE LOT: 017 JURISDICTION: TIG
PROJECT: FAREN
Project Description: Replacing gas furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN: •
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
LORI FAREN Description Date Amount
2809 SW ARROWHEAD CT
LAKE OSWEGO, OR 97034 [MECH] Permit Fee 3114/200E $72.50
[TAX] 12% State Surch 3/14/200E $8.70
Phone: Total $81
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 266 -1249
FAX 503- 266 -3478
Reg #: LIC 14008
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:� Permittee Signature: ,, //� J
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
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 -13 -2008 THU 03:26 PM ROTH HEATING FAX NO, 5032663478 P. 01
Mechanical Permit Applicati 2.. EcEIVEI
` rc>'It tlh6'1C'h, I lse: ciNl,v
C I of Tigard Received P—" N„ `
, t. hr g MAR 1 3 �UUS Date/By! �// .3 US �Tf '" auU� -(�v J'
13125 SW Hall Blvd., Tigard, OR 97223 . pia eviow
Phone: 503.639,4171 Fax: 503.598.1960 Date /By: Other Permit:
TI C AItD Inspection line: 503.639.4175 ®1 i ®�NG D� Read /11y tcris m Sec Pngc for
vU
Internet: www,tigard -orgov IL Notified /Melltud' Supplemental Information • •TYPE • OF WORK COMM FEE' SCI•IEDULE .- USE CHECKLIST •
� Mechanical permit fees" arc based on the value of the work
1 New construction XI Addition /alteration /replacement performed, indicate the value (rounded to the nearest dollar) of all
[] Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. ' CATECORY„ OF .CONSTRUCTION .. .. - Value: $
• RESIDENTIAL EOUIPMENT /;SYS'I7 :MS FEES*
1- and 2- family dwelling ❑ Commercial /industrial [f Accessory building
For special !r(forrnatrnn use checklist.
❑ Multi - family 0 Master builder ❑ Other: Description Qty. _ Ira. I Total
. ,IOIU SITE,' INFORMATION • AND' LOCATION . Heating/conling
` c Air conditioning or heat pump
Job site address: 1 ` l.p �0 t `,0 i , LI th 1D1 Gt. 0- (requires site plan showing placement) 14.00
City/State /ZIP: -- r-
1 l curd t ("� "r �j Furnace 100.000 BTU (ducts/vents) \ 14.00 L '. (�
`-} furnace 100,000+ R'1'lJ (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to, job site: Duet work - 10,00
Hydrnnic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duel, su!ended, etc, 14.00
• Flue /vent for any of above 6,80
Lot — Other: .
Subdivision: 10.00
Tax map /parcel no.: Other fuel np Ip iunces
DESCRIPTION OF :WORK,, •., Water heater 10.00
Gas fire -lace 10.00
us `t • A L IL A , A. ` g , Flue vent for water heater or gas
I ; ce 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood freplacc /insert 10.00 ,
. Chimney /liner /flue /vent 10.00
' . PROPERTY .OWNER .. n :. 1... , .. ' ..O TENANT' . • .. Outer. 10.00
Name: L , Fa_ r-_ in Environmental exhaust and vermin ion
Address: I t 0 D L{ , J`p Vl 1 �� „ „ equipment ry r r
Range hand /elite, kitchen
equipment 10,00
City /State/Z1P: 1 Clothes dryer exhaust 10.00
`` �” �Q ��� - 0,4
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
PERSON' • .:.,
Attic /crawlspacc fan 10.00
Other: 10,00
Business name: Fuel piping
Contact name: - $5.40 for first four; $1.00 for each additional
Furnace, etc.
—
Address:
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Fax :: Water heater
Phone: ( ) ( )
--- Fire lace
E -mail: Range
C ONTRACTOR ' . Barbecue
1 \ Clothes dryer (gas)
,
Business name: ak% • L : C.i C r
Other:
Address: r • tip it OS .,. ., ' :: MECIL&NCCAL PERMIT FEES*,... • .
City /State /ZIP: kiC.{ e C'IC-1 6 `j Subtotal i Li .00
Minimum permit fee ($72,50) _1 r.20
Phone: (G ) 2 -.kJ:(p, ( LVI Fax: 63> )).kot 4 man,„view ( 25% of permit fee)
CCI3 lie.: 1 u g - State surcharge (12% of permit fee) / D
TOTAL PERMIT FEE ( 20
Authorized signature: This permit application expires If a permit is not obtained within 180
BTt f days alter it has been accepted as complete.
Print name: j act ! PCICt- -- D ate: ` ) 0 E • Foe methodology sot by Tri- Colmry Ouilding industry Service llosrd
l:\ auildin8 \permlt5\MEC'permltApp.d5t 01,14107 aa0•4617T (I t10n_ /COM/WEB)
CITY CF TIGARD
BUILDING DIVISION PERMIT #: Mt;C008 04131
h A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/19/20013 TIME: 7:01AM PAGE: 24
SITE ADDRESS: 11630 SW 114TH PL CLASS OF WORK:
SUBDIVISION: 114TH PLACE LOT #: 017 TYPE OF USE:
PROJECT NAME: FAREN
DESCRIPTION: Replacing gas furnace.
OWNER: FAREN, LORI PHONE #:
CONTRACTOR: ROTH HEATING & COOLING PHONE #: 603 -266- 1249
Inspection Request Scheduled For: Date: 3//30008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 066946 -01 503- 266 -1249 1`
Corrections /Comments /Instructions:
t c
• L • ..no.L - L - S8-z21 &' � -e ed
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL A CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 �
Inspector: % \ Date: /F--d & Phone #: (503) 718- ,4-