Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00173
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/21/2011
Parcel: 2S110BA07300
Jurisdiction: Tigard
Site address: 12155 SW WILDWOOD ST
Project: WEBBER Subdivision: SHADOW HILLS NO. 2 Lot: 58
Project Description: Gas furnace replacement.
Contractor: ROTH HEATING & COOLING Owner: WEBBER, JOHN & CARLA REVOCABLE LIVING
PO BOX 1265 REVOCABLE LIVING TRUST
CANBY, OR 97013 12155 SW WILDWOOD ST
PORTLAND, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 - 684 - 5522
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/21/2011 $46.75
Type of Use: COM 12% State Surcharge - Mechanical 04/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/21/2011 $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
Issued By• Permittee Signature: • — i
C. I .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.
APR -21 -2011 THU 08:36 AN ROTH HEATING FAX NO, 5032663478 P. 01
Mechanical Permit Application FOR OFFICE l''. IISE oNi,v'
Cis/ of Tigard � CEIVED Received
City g Dom/Or ��
o w 13125 SW Hull 13tvd.,'figard OR Plan Review
Phone: 503,718,2439 Fax; 503.598.1960 Daio/8y. Other Permit.
T I c; ,..‘-it i7 Inspection Line: 503,639,4175 APR 21 ?011 Dale Ready/By: MI ® See Page 2 for
Internet: www.tigard- or,gov Notified /Method; Supplemental Information
OF TIGARD
' . ; ;; ''i '' 'I'Y'� o i ' e 1 ; ;;V,,.. + y, lT : ; ` ;I CU1 fl I AL FE SCI i L Sl , , • f)r .!J, ' f' , .i :. : .
Mechanical permit fees* are based on the value of the work
❑ New construction '2f- Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit,
h uo $
2-family dwelling - Commercial/industrial 11 ' X11 ;, i 1 I $1, T0
1: RI'I A .,S' 'E$S
' and 2 y g 0 Com e c ndustr al 0 Accessory building 1 For special information he � W
use checklist,
d Multi - family ❑ Master builder ❑ Other: Description I Qty. I La. l Total
r--
,. : n' l i I','.' r i +• i •. I 1 1 1 it He0tf 0a/COOIhI�,:
„, , ,;IQj3 7ilE ; INI'q d1.6 N , i 1 0:00f,1�?tl 1 1 l { :,a l Air conditioning
Job site address: " IckAdati a (requires site plan showing placement) 46.75
City /State /211': Furnace 100,000 BTU (duets/vents) if 46.75 9"
�' ((tr CAL ZZ6f Furnaee100000 +BTU (dnots/venis) 54. 91
Suitc/bidg. /apt. no.: Project name: / r WUJ H quires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
m Hydronic hot water system 23,32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (1 iel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
:. :: ::iik liWiiiisty: '�><? WA' ::: I : ; :b : r nl 1 1 N1 •�; ;1 Water heater 23.32
dV 1) C ✓-Jt4`
S / 1 1 Gas f ireplace 33.39 _
je'` I ��Ch �' A T� . L --e- Flue vent for water heater or gas
- fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33,39 _
Wood fireplace/insert 23.32
l 1 ` 1 1 -�. r rrl' a I �yy i Chimney /liner /flue/vent 23.32
I'I:i4 , 1:41 41,•FT'•!•ryi ;T,r.$ � ' � { �Il'llyli . 1'1 � i r '. 1 ! i: 4ti i� �','w' " '1'i 11 t iA ,. �. f ii
I Other. 23.32 1
Name; Sc, rk'v- („U4- t,5 be r _ _ Environmental exhaust and ventilation:
Address: s 4 i 4, f,DV Range hood /other kitchen
_ equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone (SV .. to 9y _.. �"5 Z- 2- Fax ( )
1 ' �� ,> I+1(,1 1 I( "II , 1 '� ����� '�� toilet compartments, utility rooms) 23.32
1 1,,,1 + i, l ,
1 h •, , I'R 12,04-.1,-,, T.l � t � �' �� � ■ � i:'i I. I, r: •: Other: fans 2332
Anti
c
Business name: � -V er 23.32
Fuel alpine,:
Contact name; s' l v - e,.. / , 1; ( 1 $14.15 for first four; $4.03 for each additional
Address: / Furnace, etc.
4 - Gas heat pump
City / State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
B mail: Fireplace _ _
��•i r It L..I ! , n n: i r p Range ._ _ _ �.
:gi II ' .�.; � i �� I 1 t ) �� y�i i i "' l it �� 1 i GrI p ��, l i 'I l ' : l'i 1 1 1 . yJ �
i 11�.iI':'Li ±w��:�M"1""r`� lllUti.,,.111�11t.lr,_�'.II ul�l!(.a�itiil 11 BarbCCUe
4.� A. `� O ti�;ri Clothes dryer (gas)
Business name:
o Gltp� Coo
Address: Other
S. � � OS� f �2 � 0 !i h !; .i 1 1 „ ; REeTt*NwACrT1ICfigIf1'i.A!i141. ,', I ,..
City /State/ZIP: e_0,,, k)._ 1 - Q tom. (DI 1 '3. Subtotal
Minimum permit fee ($90.00) b
Phone: (c-,3) Z1. t 1 2 `i c'I Fax: (Sjj 2 t t ^ 3 LI 7. 6 Plan review (25% of permit fee)
CCB tic.; / 4/ G p a State surcharge (12% of permit fee) )p /150
�� TOTAL rr:Rms not obtained NO
/�, I 8D
O
Authorized signature: n This permit application expires if a permit is not obtained within
days after it has been accepted as complete.
Print name; IV ; / Date: 'Mr`r/ • Fee methodology set by Tri- County Building Industry Service Baa<'J
I:1fuilding1Permits4ME4IOrni IApp.dec 09/09/10 44 - 17T (II +1 /COM/WB7)