Permit CITY OF TIGARD MECHANICAL PERMIT
:'� COMMUNITY DEVELOPMENT Permit #: MEC2011 -00334
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
• Parcel: 2S103AD07400
Jurisdiction: Tigard
Site address: 12667 SW 108TH TER
Project: Gripp Subdivision: Lot:
Project Description: Install (2) A/Cs. Units must meet 3' minimum rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: GRIPP, ERIC M
6990 S ANDERSON RD 12667 SW 108TH TER
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 360 -3179
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Air Conditioning 07/15/2011 $93.50
Type of Use: SF 12% State Surcharge - Mechanical 07/15/2011 $11.22
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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: OA/ 151,1j9‘..,/C•4-%7oi✓
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.
JUL -14 -2011 THU 08:43 AM ROTH HEATING FAX NO. 5032663478 P. 01 •
Mechanical .Perm it A lkation
• FoR OFFICE USE ONLY
• City of Tigard
R CCCIVCCI / _
Date /fa -7i /0 Permit No e Lra0// � DDj3r
'• 13125 SW ( -Iall Blvd„ Tigard, OR 972 /
i Ill 8 Plan Review
Phone; 503,718.2439 Fix: 503. • 4 e. 0 OdlerForme;
p • �� Dale /8y:
TIGAItD lnS et:ilonLine: 503.639.4175 bi Faris' tt'1 Page 2for
Internet; w`,vw.ligitrd- or.guv \` � Gq�l Date Natil'i Ready /Dy:
dlMethod: /f�' ' Supplemental Information
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a'' i w, '6 I[kCh • 'r ".. , . �- ,.�..,� „ .' S� ?:1;17a�t»,�- ;i.�9�;.G;'G I,[ST' ;; a.:.
Mechanical permit fees* Are based on the veltic of the work
❑ New construction Addition /alteratl • . ncemerit performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other; $ mechanical materials, equipment, lehnr, overhend, end profit,
" °•j' 'ItTS1AT:01A11,1:0 TT�1VtigI�SVst.rM.S` :• .
E I- and 2-family dwelling ❑Commercial /industrial ❑ Accessory building For special blfarmalIon use checklist. _
O Multi - family ❑ Master builder ❑ Other: Description Ql:y, la. Tote(
1r
!''' : JOB: .ShfE': "iN11O1tivflo io '� 1 G' a' !(eati / eoolin
Ni e 1y Q T OT�r;
Air conditioning
lob site address: 12667 SW 108 Terrace (r iuires sileplan showing placement) 2 46,75 93.5
City/State/ZIP: P' Tigard, tl, OL egos 97223
furnace 100.000 BTU (ducts /vents) 46.75
Furnace 100,000=r BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: Project: name: Gripp ll 19187 Heat pump
-- ('requires situ plan showing ploeenierill _ 61.06
Cross street/directions to.job sift Duct work 23.32 _
l-Ivd1•onic hot water System 23.32
., Residential boiler (radiator or __
hvclronic) 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: 23.32
Tax nu" fuel appliances:
map /parcel p
Olhc h'!'u•Cap t _
.32 • .' . .1)1:' ( :'fRIP.`I'1ON> OF.;WORk , ' Water heater -- I � 23
� _OILS fireplace 33,39
Installation o1'(2) air conditioners. ,•,..._„ 1 vent far water healer or gas
fireplace 23,32 •
' ' °- Log lighter (gas) 23,32
Wood /pellet stove 33.39
Wood /)replace/insert 23,32
•.,.. , 1 , .: • Chimney /finer /flue /
a . ,.... r ill : l' IR01 010, Y' , 01VN1:E1R::.I. : Psi!, 1 NA:NT.. : : : :',, 1 ;. ' vent 23,32
..� .
Other -- 23.32
Name: Erie Gripp --
Environmental exhaust and ventilation: __-
Address: 12667 SW 108' ]terrace Range hood /other kitchen
- equipment 33,39
City /Stole /ZIP: Tigard, Oregon Clothes dryer exhaust 33.39
Single -duct e,xheust (b at h rooms, • ����"
Phone: (503- )360 -3179 Fax: ( ) toilet compartments, utility rooms) 23.32
13 Al'P1 ,(CANT.. 0 (t1N I AC, :PERSON AllicJcruwltiface 23,32
Business name; Roth Heating and Cooling Other; 23.32
-• Fuel piping:
Contact name: Steve Merrill $14.15 for first four; 54.03 fur each additional •
Address: Furnace, etc,
- Gas heat pump
City/State/ZIP:
Wall /suspended /un it (neater —w_ _y _
Phone: ( ) - I Pax: : ( ) Water heater
E-mail; Fireplace
_ _.._ -_
Range
' : ; :CO N'FRACT.OR• ,. • ••'::, Bet•bcctie �.
Business name; Roth Hearing and Cooling Clothes dryer (gas)
Address; NU Box 1265 -- "- Other:
g•IiicilI '1VIE'p .il4lvtl'T', ltl LSi' .;1, ii,:;.. h
City /State /ZIP: Canby, Oregon 97013 Subtotal 93.5
Minimum permit fee ($90.00) _- -. -,•, ,
r none: (503) 266 -1249 �.J -'Fa,c (503) 266 -3478 Plan review (25% permit )
t (2 /° of permit fee
1 COB lie.: 14008 State surcharge (12% of permit ice) 11,22
TOTAL PERMIT FEE 104,72_
Authorized signature: • This permit application expires if a permit is not obtained within 180
_ , days after it has been accepted as complete.
Print name: Stove Merrill Date: 07/12/11 • Fee nmthodology sal Ity'I'ri- Cuunly 13uildintt Industry Service Board
I•1au ilding \Permiisuvll'C.l'°rnti ;App,doc no /n ?' in .• 4g1c1-46171 (1 I1o2 /COM/wao
JUL -14 -2011 THU 08:43 AM ROTH HEATING FAX NO. 5032663478 P. 02
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