Permit CITY OF TIGARD MECHANICAL PERMIT
CO MMUNITY DEVELOPMENT Permit #: MEC2011 -00396
Date Issued: 09/08/2011
TIGARD, 13125 SW Hall Blvd., Ti OR 97223 503.718.2439 Parcel: 2S105DD05800
Jurisdiction: Tigard
Site address: 13645 SW SANDRIDGE DR
Project: Stanley Subdivision: PACIFIC CREST Lot: 34
Project Description: Install gas furnace and NC. Unit must meet 5' minimum rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: STANLEY, GARREN
PO BOX 1265 13645 SW SANDRIDGE DR
CANBY, OR 97013 13645 SW SANDRIDGE DR
TIGARD, OR 97223
PHONE:
503 - 266 -1249 HONE: 503 - 590 -5780
FAX: 503 - 266 -3478
FEES
Specifics:
Description Date Amount
Air Conditioning 09/08/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 09/08/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 09/08/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104.72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,, /
Issued By: r el � A ��' f/ �i T w r` _ Permittee Signature: (M/ / / ° /° L- / 7 /ti 4/
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
SEP -07 -2011 WED 12:56 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application
City of T 1\' Received �;/
q ° Tigard
�` Date /By: a " ,( Permit No,A
soft . 003,
ih 13125 SW Hall Blvd„ Ti OR 97223' `"- °�
t 0 • n '0' \ Plan Review
f hone: 503,718.2439 Fax; 503.. '11 � Q� Date /By; Other Permit:
'I t G A ItO Inspection Lau; 503.639.417$ 9 Date RcadyBy: turfs: fii! See Page 2 for
Internet'. www.tilurd- or Q "7 �/
i Notit ied/IVlethod• l7 Supplemental
I IIt'f;',I Information
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�* 0'. - Mechanical permit fees'” are based on the value oldie work
N ew construCtiOn
❑ ® Add ition /alteration /replacement perforated. Indicate the value (rounded to the nearest dollar) of all
III Demolition
Demolition Other: mechanical materials, etlui meet, labor, overhead, and profit.
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CO 1- and 2-family dwelling ❑Commercial /industrial D Accessory building For Special information use checklist. __
1=1 Multi-family I: Master builder El Other: Descript Qty, t✓a. Total
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:;$ '1 �;!Iii "i i:' ;:; 'liilr ,,'',tili li;l , ; ' 1'p ii; ., ?' . 11 ,, V ' , '1 ., ., , ii 1 ,1, , ' i r'i1 ''r` i l{IT' ' II attin g lcoolin g .
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' _- �TMx - � f l,l:, 4'i l �,�llarr a lsN�� -I l�'1, Air conditioning
Job site address: 13645 SW Sandridge Dr. - (requires site plan showinu placement) , 1 46,75 46.75
City /State /ZTP: Tigard, Oregon 97223
Furnace 100,000 BTU (ducts /vents) I 46.75 46.75
. Furnace 100,000 +BTU fdiieu /vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: Stanley fi 21078 bleat pump
(rec)ulreu silo elm showing placement) 61.06
Cross street/directions to job site; Ductwork 23.32
I- Ivdronic hat 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: 1 hel no.: Flue/vent for any of above 23.32 -
Other: 23.32
Tax map /parcel no.: . •
Other fuclippliimccs:
'41':1111 '.i1'
';P "1 Ll`�i:
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Installation of a gas furnace and air conditioner. Gas fireplace 33,39 .
Flue vent for water heater or gas
fireplace 23.32
Lob lighter (gas) 23.32
Wood /pellet stove 33.39 _
Wood fireplace/insert 23.32
1;!ah;iiy')i^y1,;i!i' };: ;1' .,' .,1,, ;,II; ;�r.,'.I1q;i > ^' , •.,., +r. y °,ol!1,o a'Ci Chimney/liner/flue/vent /liner /flue /vent 23.32
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Other: 23.32
Name, Curren Stanley Environmental exhaust and ventilation:
—
Address: 13645 SW Sand ridge Dr. Range hood/other kitchen
equipment 33.39
City/State/ZIP: Tigard, Oregon 97223 Clothes dryer exhaust 33.39
Phone: (5D3)590 -5780 Pax; ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
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Business name: Roth Heating and Cooling Other: 23,32
- --. Fuel piping:
Contact name; Steve Merrill $14.15 for first four; $4.03 for each additional _
Address; PO Box 1265 Furnace, etc.
Gas heat pump —
City /State /ZiP: Canby, Oregon 97013 . Wall/suspended/unit heater _
-
Phone: (503) 266 -1249 Fax ;: (503) 266 -3478 Water heater _
fireplace -
.E- mail;stevema@.roth- hcat.com - -- -
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Range
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Business name: Roth fleeting and Cooling Clothes dryer (pas)
iili1 {1 I,
Other:
Address: PO Box 1265 i
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City /State /ZIP: Canby, Oregon 97013 . Subtotal 93.50
Minimum permit fee ($90.00) ,
. hone: (503) 266 -1249 • Fax: (503) 266 -3478 Plan review (25% of permit fee) ..
CCi3 tic,: 14008 State surcharge (12% of permit fee) 11.22
TOTAL PERMIT FEE 104.72
Thus permit application expires if n permit is not obtained within 1 HO
Authorized signature'. "�- . - days after it has been neee rled nx cOmptele.
Print nrune: Steve Merrill Date: 09/07/11 ' Fee methodology set by Tri- County Building Industry Service Board
I: lttulldlna \I'ennireMFC-PiniiiIApp.duc 09/09/10 410 (1 I /OJCOM/Wi0)
SEP -07 -2011 WED 12:56 PM ROTH HEATING FAX NO. 5032663478 P. 02
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