Permit CITY OF TIGARD MECHANICAL PERMIT
311 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00190
Date Issued: 04/30/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134ACO2605
Jurisdiction: Tigard
Site address: 11365 SW COTTONWOOD LN
Subdivision: Lot: 0
Project: Burns
Project Description: Install electric furnace and heat pump (within setbacks allowed by zone).
Owner: FEES
BURNS, ROBERT B & PATRICIA ANN Description Date Amount
11365 SW COTTONWOOD LN Air Conditioning or Heat Pump 04/30/2009 $14.00
TIGARD, OR 97223 Furnaces < 100K BTU 04/30/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 04/30/2009 $8.70
Minimum Fee Adjustment - Mechanical 04/30/2009 $44.50
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503- 266 -3478
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Electricity
Gas Pressue
Total $81.20
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 -0100. You may obtain a copy of the rules
Issued By: � G� �` I , , I I I � Permittee Signature: ` / =;1',', !
e
_ _ O n
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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- 30T2009 THU 02:49 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application FOR (NCI IC 11i'11s'ONLY '
Ins
Ferric No.:
City of 'Tigard( Dare /By: • • • • ' 6 • „ . ( OC • 4 4 QO
Rh ' 131 25 SW Hull Blvd., Tigar OR 97223 I Plan Review — t //'77��
m Phone: 503.639.4171 Fax Fax 503.598.1960 DntelBy: s S �� 6. Ot Permit: a� ' VOI ��
eat en Line: 503.639.4175 '1'7 t./1 k i 7 P Date [ tcady /D . • •,-.1 ri:; for
Internet: www.tigard-orgov 4_ l c r _ 1 95 Notified/Meth. V..0 •'` ,, Supplemental Information
(� AA PP R `
.. TYPE O. WOR,' CU, NIMER _ C,I Jr`m t_ AI �I fi. °. SC f tDIfLE -USE CHECKLIST .
an `afe based on the value of the work
III New construction - Addition /alteratio! RI I � / ±� — r . )
r • " '� � � o value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: ,�' - O • ' ,,kli 'c` i materials, equipment, labor. overhead, and .rofit.
' ' , • 2 • .CATECORY OF CONSTRUCTION,: ' Value: $
RESIDENTIAL EQI)IPMEr' T /:SYSTEMS I'aIsS* .
' l - and 2-family dwelling Q Commercial /industrial ❑ Accessory building
For special igfarnlaiion use checklist. _
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty Ea. Total
. •IOII SITE INFDR*IATION AND: LOCATION '., ' , Heating/cooling
' , 1 1pa� + Air conditioning or heat pump
Job site address:
. L 5 S u 4. '1. W Wc& 1 (requires site plan showing placement) / 14.00
City /State/ZIP: --c Cr 7 2:-z_3 Furnace 100,000 BTU (ducts /vents) I 14,00
1 Furnace 100,000- BTU (ducts /vents) 17.90
Suite/bldg. /apt no.: Project nacre:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
1ydronic hot water system - 14.00 _ _ _ 1
Residential boiler (radiator or
hydronic) 14.00
- . Unit heaters (fuel - type, not electric),
in - wall, in -duct, suspended, etc, _ 14.00
Subdivision: Lot no,: Flue /vent for any of above 6.80
. . Other: 10,00
Tax map /parcel no.: Other fuel appliances
�--� - "" OF ; ;VORIC. Water heater 10.00
01.`b l/�1 t•.� � Gas f replace 10.00 k os" � ' ' Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
'+ Wood/pellet stove 10,00
, kv r..4 l Wood fireplace /insert 10.00
' ''PROl'1sR"1'Y. Q ',1;:it 0 TENANT' � ,,,, Chimney/liner/flue/vent 1000
4 � ^ O ther: _ 10.00
Name; 15 V.� ,/ E a Iunnst and ventilation
Address: Range hood /other kitchen
10.00
Ci ty /State/ZIP: equipment
dryer exhaust 10.00
Phone: ( ) Fax: ( )
I of 1 - Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
. ., ?APPLICANT . CONTACT PERSON: • Attic /crawlspacc fans 10.00
Business name: Other: 10,00
Fuel piping _
Contact name: 55.40 for first four; S1d111 lirr each additional
Address: Furnace, etc,
Gas heat pump •
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: 1 � Clothes dryer ( its)
Other
Address: ) � ME CFIAIVI2AI- PERMIT FEES °; '
City /State /ZIP: Co,,, 1r�'( �. ck7 0 13 Subtotal y'
P l
Phone: ( i) 2 (.c � .2(449 Fax: ) ( -1 , Minimtm permit f- a E
Plan review (25% of per
CCB tic,: , L> State surcharge (12 %ofpermi! fee) r ,70 '
` \ TOTAL PERMIT FEE R.'l . U
Authorized signature: 1 p 1 Koc fri I 0 J� This permit Application expires if n permit is not nhtair ∎ Win] 180 yr VVGG't days after it has been accepted us complete.
Print name; I C,l (/ f �� /' Date: '" 0 w * Fee methodology net by Tri.Cetmty Building Industry Service Board
C\ Budding \Permits \MEC•Perm i\pp.doc 0 il; v/07 -'us.n 44045 I 11 (it /e? /COM /WES)
APR-3.0-2009 THU 02:49 PM ROTH HEATING FAX NO 5032663478 P. 02
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