Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00346
Date Issued: 07/19/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S103DD00420
Jurisdiction: Tigard
Site address: 10825 SW FAIRHAVEN WAY
Project: Sample Subdivision: Lot:
Project Description: Install gas furnace and A/C. Unit must meet 3' minimum rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: SAMPLE, SUE
6990 S ANDERSON RD 10825 SW FAIRHAVEN WAY
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 620 -5231
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount E
Air Conditioning 07/19/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 07/19/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/19/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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:
Sz•
Permittee Signature: � J �� c -4_7-7 0/ 1
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 -18 -2011 MON 04:08 PM ROTH HEATING FAX NO 5032663478 P. 01
RECEIVED
Mechanical Permit Application I+:oI4 opftcv usE O 1 1 . , V , ,
City of Tigard :JUL 19 2011 Received 2 1 9 // PermitNo.: 6-C,2 -d03Y6
1 1 1 11 "r 13125 SW Hall Blvd., Tigard, OR 9727,E Plan Review
II Phone: 503,718.2439 Fax 503.598.1.96A1 I OF TIGARD Date /By, Other Permit:
Inspection Line: 503.639.4175 BUILDING DIVISION Date ltnady/By;
j'I4;ARl3 lath: el s Page 2 for An)
Supplemental NaliRod /Mcgtod; .77 � pp lementallnh+rmation c
Mechanical permit fees* arc bused on the value ate work
El Mditi on/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
■ Demolition • mechanical materials, equipment, labor, overhead, and profit,
Value; $
n m .'il,l 31 t" 1 4 '•••
•,r +ifP.Otio; 1' 1;1!1}1.., Ag t;
+ Il �. ',�i � i aF , 1: M, ,i,;S,YS`j°S�;f1��j�, ,,
.
is] 1- and 2-family dwelling El . building For *Mal information use checklist. . .
El Multi-family 0 Master builder • Other: Description [ QtyJ Fa.i Total
o f a a m Heating/cooling:
Air conditioning
Job site address: 10825 SW Fairhaven Way (requiressii phunshowinitplacoment) 1 46.75 46.75
Furnace 100,000 BTU (deers/vents) 1 46,75 46.75
City/State/ZIP: Tigard, Oregon 97223 , Furnace 100,000+ BTU (duets /vents) 54,91
Heat pump —
Suite/bitlglapt. no.: Project 11£1111C: Sample # 18789 (requires silo plan showing placement) 61.06
_ _
Cross street/directions job site; Duct work 23,32
ironic hot water system 23.32 L _.,,
Residential boiler (radiator or
hydron_ ic) 23.32
Unit heaters (fuel -type, not electric),
in- wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Lot no.: —
Other; — _ 23.32
Tax map/parcel no,: Other fuel appliances:
a a Wate h eat er _ 23.32
Gas fireplace 33.39
Installation of a gas furnace and Flue vent for water heater or gas
fireplace 23.32 ,
Log lighter (gas) 23,32
Wood/. el l ct stove 33,39
Wood fire ce/inscrt 23.32
•
Chimney /liner /tlunh eat 23.32
Other: 23.32
Name: Sue Sample Environmental exhaust and ventilation:
Range hood /other kitchen
.Address; 10825 SW Fairhaven Way _ equipment 33.39
City/State/ZIP: Tigard, Oregon 972223 , Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)620-5231 toilet compartments. utility rooms) 23.32
V a Attic /crawlspuce fans 23,32
Other: 23.32 l
Business name: Roth - and Cooling Fuel piping: _
Contact name: Steve Merrill $14.15 for first: four; $4.03 for each additional
Furnace, etc.
Address: — ..
Gas heat "um
Wall /suspended /unit heater
Water heater
Fireplace
Range _-
( 3 urbecue
Clothes dryer (gas)
e Other:
AChlress: PO Box '' .5i ';;i;i fk.S l�43 '� 1 1a; , k+>;yh/ m7} r� � �; 1 .., f;i { i ! i;''
1, �1: i �) ;il.�f f �'1'�i�l �� �1��4 Y7 �I. ±'
1111�^1�� ��'ll: i �:.1111�1 �:I�
Subtotal
City/State/ZIP: Canby, 1 1
Minimum permit Ice ($90.00) 93,50
l . Plan review (25% of permit fee)
COB lie.: 14008 State surcharge (12% of permit fee) 1 1,22
_ TOTAL PERMIT FEE 104.72 eV-
This permit application expires if a turrhit is nut obtained within LSO
Authorized signature: � days after k has been accepted as complete.
Print name: Steve Merrill Date: 07/18/11 " Fee methodology sot by Tri- Coutdy Building industry Service Huard
440 -4617T (11 /ovcoM/Wta)
JUL -18 -2011 MON 04:08 PM ROTH HEATING FAX NO 5032663478 P. 02
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