Loading...
Permit NI CITY OF TIGARD MECHANICAL PERMIT . ±±. COMMUNITY DEVELOPMENT Permit #: MEC2009 -00192 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2009 Parcel: 2S103CD06000 Jurisdiction: Tigard Site address: 11670 SW FAIRVIEW LN Subdivision: Lot: 0 Project: Roth Project Description: Reconnect furnace and heat pump. No heat situation may already be installed. Owner: FEES KOEHLER, JAY Description Date Amount 11670 SW FAIRWAY LN Air Conditioning or Heat Pump 05/04/2009 $14.00 TIGARD, OR 97223 Furnaces < 100K BTU 05/04/2009 $14.00 PHONE: 12% State Surcharge - Mechanical 05/04/2009 $8.70 Minimum Fee Adjustment - Mechanical 05/04/2009 $44.50 Contractor: ROTH HEATING & COOLING PO BOX 1265 CANBY, OR 97013 PHONE: 503 - 266 -1249 FAX: 503 - 266 -3478 Type of Use: Class of Work: Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: 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: 44 .- n. Permittee Signature: \ e (I ` (>n � t l j7f CA `�► 'Vr ` v 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. Al'R -9 -2009 WED 05:06 PM ROTH e E �hNC4' FAX NO. 5032663478 P. 02 Mechanical Permit A f i troth City Of' Tigard % \I "' t '''' v 9..0 LOO Receivo<i �.('� Q permit No; �r Dale /By: l • J. - i;`� 1 3 o O 1 l r 7 13 125 SW Nall Blyc.1„ Tigard, 0l� �O ^� Dale /(3y: t m Plan Review P hone: 503.639.4171 Fax: 503.598.1960 �a Other pertain: �!� I' I Li Alt D Inspection Linn: 503,639,4175 \ O� , w 1���`i Dote Ready /By hat: 61 See Page 2 for Internee: www,lisurd or.gov � ` P- r ('� otilied/Metltod, - 1 t 5 Supplemental Information 1'.YPE'OT WO I( ( CQMMERCJAL BEI *:SCHEDULE -;US CHECKLIST LIST . ❑ New construction Addition /alteration /rep n Mechanical permit fees" are based on the value of the work Demolition ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all me chunieul_meteriais, cyuipment, labor, overhead prolt. � - - Value; $ . CATEGORY OF CONSTRUCT f N • ~ 1 IAL EUIPME 1- and 2- family dwelling ID Commercial /industrial III Accessory building For AL.EQ ir(fp use checklist. s "Er NT I,.SYTEMS FEES* Matti family ©Master builder [] Other: RESIDENT Description Qty. Ea. I Total . ..IE13• SITE • INFORM. ION AND LOCATION • Heating/cooling • Job site address: 1 7 D 5w --' 0 `,�,3 �,,�,,�� Air conditioning or heat pump l ` (requires site plan showingpincement) / 14.00 City /State /ZIP; - ' - t - 1 11 , 'L--3 Furnace 100,000 BTU (duccdvents) / 14.00 Furnace 100,000+ BTU (duels /vents) 17.90 Suite /bldg. /apt. no.: Project name: Gas heal pump 14.00 Cross street/directions to job site: • . Duct work 10.00 . 1-Iydronic hot water system 14.00 • 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 ' ,.DESCRIPTION • • OF WORK . • • .. Water heater _ 10.00 ,�� Gas fireplace 10.00 11 /� p Q Flue vent for water heater or gas - l fireplace 10.00 Log lighter (gas) 10.00 ..--1 Wood/pellet stove 10.00 ' C.... ' rL I�r T Wood fireplace /insert 10.00 ' PROPEliTY •OWNER, . O. TIENANT .. nncy /liner /fluelvent 10. - • Chit 00 Other 10.00 N ame: Cx-1,q L O� Environmental exhaust and ventilation Address: �J Range hood /other kitchen --�.� A equipment 10.00 - City /State /ZIP: Clothes [1 10.00 1 � .9 S 9 ` toilet omp rt exhaust s (utility rooms) , Phone: ( ) �p J Fax: ( ) toilet compartments, utility rooms) 6,80 - ' API'114 %NT ❑ (CONTACT`PERSON, crawlspace fans Attic/ 10.00 Other 10.00 • Business name: hail piping Contact name: $5.40 for first four; 51.00 for each additiona Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended /unit heater .V Phone: ( ) I Fax; ; ( ) Water heater E-mail: Fireplace Range 'CONTRACTOR • • Barbecue Business name: ' . . . , ' . . i C k � Clothes dryer (gas) L Address: qq�� i� may • ` Other: it ' 4y iI � 4 ... ., MECHANIIc:AI. 1 PtCS *' ` City /Stale /ZIP; C}t C.ti 6 Subtotal Minimum permit fee ($72.50) 7'Z, Phone: (Gr3 ) 2.--t Fa x: )65-> . ' - � Plan review (25% of permit fee) CCB lie.: `1 g State surcharge (12% of permit fee) 17 — TOTAL PERMIT FEE k. l 20 Authorized signature: C'1 f /' This permit application expires If a permit is not obtained within 1a0 days after it has been accepted as ctrmprete. A' �I .� l Print name: ' LD .ki �=L j Q i( Dale; ' Fee methodology set by Tri'Counly Building Industry Service Board I1lanil<liny \Pcrmitn1MIeC- Pornni App PIte 111/19/07 440.46! Tr (I I /02 /COM/WE13) APR-29-2009 WED 05:06 PM ROTH HEATING FAX NO, 5032663478 P. 03 6 _ . Atc N',/p v t5 • 5.E „ DIP-EL-71M.) rpoo-r • S7REPT • ( D 7° (-1( tt-AP