Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00357
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07!29/2011
Parcel: 1 S134BD07700
Jurisdiction: Tigard
Site address: 11675 SW PENN CT
Project: ALDER Subdivision: Lot:
Project Description: A/C and gas furnace installation. A/C unit must meet 5 ft. minimum rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: ALDER, MARK D AND CATHY L
6990 S ANDERSON RD 11675 SW PENN CT
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Air Conditioning 07/29/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 07/29/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/29/2011 $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 Permittee Signature: -.L Aar
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-29-2011 FR I 09 : 22 AM ROTH HEAT I NG FAX NO. 5032663478 P. 01/03
Mechanical Permit Application
Cl) FOR ()filo; I SE oNi..,\'
Ci of Tid e ,„ , , ,, 4 , \eft Received
nate/By: _ad r
AIVIMEMERMIIIIIM
I q 13/25 ty SW Hall gar Blvd., Tigard, OR 972p Plan Review
; 6 • Phone: 503.718.2439 Fax: 503.* . 960, % J • 1.0 Dat/By: Other PerM it:
e
inspection Line; 503,639,4175 ',..Ne• 61:4 ,,, Date Ready/By: JuriK GI See Page 2 for
T I G A IL D Internet: www.tigard-ongov . v\ ,--A.,,T` k Notifiedimethod; p.,, Supplemental Informillian
(-,,, ,,•,N..,
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:',....';,lij:;'i,',:•;;;•1';;;lil;',;:,;+ZI...lt;:;'•":.''41,.":E2i0giditi:NORRAi."674.•;;;,Vii'.14.:,•:,•..,1;;RiNit 'El0.044PPIAL:i:t•:00004-••'#4040.401,PT:',i'.■:
• - A Vs* Mechanical permit fees* are based on the value of the work
I: New construction glAdditionialteratianWineement performed, 'Indicate the value (rounded to the nearest dollar) of all
CI D ,, emOlition 0 Other; mechanical materials, equipmenl/abor, overhead. and profit.
Value; $
:'T'::::i'll:•::••'. l -.i!!::'.'•:.''' . ..i . ,i'll:•■:P PO,.... ,: •. 9r pcisTati; 1,. . 1. , r . ,i ,,., ! ,.. ,; .., , ,: ;4 .....‘ 0 , 4 . 0 ... N .... t . 1 , 8 . 4 , .., m6 . 1, 0 m - 0 . 9[ , , ,.. 1 . ,ovE34 .-- o tn g -0. t .. i ,, , ,,,,, ; . ;, , :. ... ; ... ,; ,. ;
Efl- and 2-family dwelling 12 Commercial/industrial 0 Accessory building For special infbratallon use checklist
11] Multi-family 0 Master builder 0 Other: Description Qty. L Ea, Total
$4.IiPigOOttki0OVW liefitingic°°"n: - .,
. • Air conditioning /
lob site address: i i ( ...q..g SL, ?_12, in c.,4., (rewires site plan showinn nIocemont) 46,75 '44 i.l''S
Fumace 100,000 I3TU (ducts/vents) /.
City/State/ZIP: ( ; ,..,,e_a '4-- 2- Furnace 100,000+ BTU (duets/vents) 54.91
-,—
Suite/bldg./apt. no,: j Project name' 14. 1 c le 4 a \ ., S S °7 Heat pump
(requires site plan showing placement) - 61.06
Cross street/directions to job Site: Duct work 23.32
11/Ironic hot water system 23.32
Residential boiler (radiator or
hydronic) 23,32
Unit heaters (fuel-type, not electric),
in-wall. in-duct. suspended, etc. 46.75 -
Subdivision: Lot
Flue/vent for any of above 23.32
no.:
- — Other: . . -
Tax map/parcel no.: Other fuel appliances: ..
.:;:l'.;r,..;•Fl ;''•:;),!'•,(ES6RIO:Ii0iir&i.*EIR011!;:grg•';1iPlll':'!'l•170:l•;:'ll•li,':••Til:'•i'41.:!''''" Water heater 2332
—
Gas fireplace 33.39
' 4_, //e,. I-7)1 0 , 14. a jr., 5 ,(1,....-" flue vent for water heater or gas
fireplace 23,32
a A
'k- Ceirl4 ve,.. . Log lighter (gas) 23.32
— , Wood/pellet stove 33.39
Wood filvplace/insert 23.32
i
vit p*'.14;q1 .,:i Chimney/liner/flue/vent _ 23,32
.... , . ......, ( . ....,;,;...., l, ;;;. 1;;::;;;rtt.1-5*.;?;1; :ff...2::!:;;
• • " - Other: 23.32
Name: .1 V. 1A-L-P-72— Environmental exhaust and ventilation: .-
• Range hood/other kitchen
Address: 1 1 (41 3' 5 SLO '... e. , "1". , equipment 33.39
City/State/ZIP: 7 .e.., , a coe_ q.-3-2.2_s , Clothes diver exhaust 33.39
i Single-duct exhaust (bathrooms,
Phone: ( wail) 51 o - 2.,E -4.4 F". ( ) toilet com.anments utilit rooms 23.32
""' k,i.'0';!: idi;!"':;:.;,'17126***11100i*; Attic/crawlsn ce fans 2332
, 111:t01,:,i,:il!'illll i';';. ',.. t ■.,.:)....=7....; ..5-5 .),,L. .. ,..'..'.........!...,,,: . , 977 . - - a
-
s rdune: -k,,,_ .1--\4_,4L..1.,\A A C--(:)19 :
i j () I A
Other; 23.32
Business
.. Fuel pipin — g:
Contact name: SA.e_ve.. YYLP-11-4- ,__t $14.15 for first four; $4.03 for each additional
Address:
— 4 Furnace, etc.
i4. - Gas heat pump _
City/State/ZIP: Wall/suspended/unit heater ,
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail; Rang
4.;14: ,;;,,: •!,,f..• ni:tt n
VR;' lq,;se;ott9.trdt,',A.4.0;;;;;o4 •tt'J',, , .;b1M.;;;14q1iiiipyr. i,i4:■i.:,; .arbeeue
usiness name:
Clothes dryer (gas)
B 49 4-i" A-A.e_c-,..4=, • ' , . , Cool,,,,,..
Other.
Address: ? O s,,,_ ri_c s. ' I v30:I,'1!,IW,:y $:!,!i:'!•!:1.:::::!:;6i::;:;;'ii
Cit 0_,,,,,,, ip, , ore__ 0 .13-0 1 '. Subtotal " 3, S7,
Minimum permit foe ($90.00)
Phone; 3) .1., Fax: (511 ,_ 4 Plan review (25% of permit fee)
CCB lie.; / 14 0 e" 5 State surcharge (12% of permit fee) A . 2.2_
' — ' TOTAL PERMIT FEE /0 4 /, ?-Z.-
oppticonen expirca iro permit is not obtained
Authorized signature; This permit within 180 ,—,._.--- days after it hos bean accepted as complete.
Print name. - Levy._ 114-e- vy / f Date: -7-• /1_4) he methodology sat by Tri-Couniy Building Industry Service Board
, -,...
IAB 09/09/10 440.461n 0 11021COmIWPO)
JUL -29 -2011 FRI 09:22 AM ROTH HEATING FAX NO. 5032663478 P. 02/03
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