Permit CITY OF TIGARD MECHANICAL PERMIT
- IS . COMMUNITY DEVELOPMENT Permit# MEC2011 -00472
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S103DA05501
Jurisdiction Tigard
Site address 13495 SW 107TH AVE
Project Shipley Subdivision FANTASY HILL Lot 6
Project Description Installation of electric furnace and heat pump Placement of heat pump must maintain 5' side and rear yard
setbacks
Contractor ROTH HEATING & COOLING Owner SHIPLEY, RICHARD
PO BOX 1265 13495 SW 107TH AVE
CANBY, OR 97013 TIGARD, OR 97223
PHONE 503 - 266 -1249 PHONE 503 - 620 -3064
FAX 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/26/2011 $46 75
Type of Use SF Heat Pump 10/26/2011 $61 06
Class of Work ALT Type of Const 12% State Surcharge - Mechanical 10/26/2011 $12 94
Occupancy Grp
Stories
Fuel
Fuel Types Electricity
Gas Pressure
Total $120 75
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By Permittee Signature / � p �f
II
Call 503 639 4175 by 7 00 a m for the next available inspection date
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection
OCT -21 -2011 FRI 01:20 PM ROTH HEATING FAX NO! 5032663478 P. 01
Mechanical Permit Application roN o1,rl( USE ONI
City of Tigard y ® Rece/By; nt; to a( // Peach No Wee50//-(�. `�7P—
q 13125 SW Hall Blvd , Tigard, OR 97223 D^[a
III I Phone. 503,718 2439 Fax: 503 598 I + `L0�� Date/By ew Oilier Permit'
- el CA It ❑ Inspection Line, 503639.4175 ( l\ y Dale Rend /B mite
Internet: www,Ugurd- ol.gov c, \ y y Sec Rage 2 for
icy_, h s �fied /Method Supplemental Worm /num
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h�Y� ` :li�i;'I r.,I I ,` I Fr' :'I�k( ° 'Y §Q�m[r I[,�'',r l�;irl¢cIE , t
❑ New construction ` �``\\'`ji• Mechanical permit fees* ale based on the value of the work
Addition /alterulion /rep�acy seal pct formed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit.
j ;i °� ",a „ Ib'Id "d + I``4 11 :'fI, D. f F,;C 1+� ";T74"1'Q!''Y•, a''.�fi li !� " "l'g :,l �� Value,$
,4hif,;, �,,,, :,., .'l,ul�.��.,,a�,` r`cA u 11$I 'p d, ) 1 i ' �� s�l'
' �,, r^ �,.1`,� �ko? /ls3 }l l l g y , : i,1:
® I. and 2- family dwelling El Commercial/Industrial ❑ Accessory building For special information are checklist
❑ Multi-family ❑ Master builder ❑ Other Description r Cry. 6a Total
' 4I uflil '��t,0Pli'S'hla 11 gi� T 4kO,J " 1 ;,II;i '� �,,I :l,'I „ Ilwu ling:
„r �r „`��,� ir � An contluionmg
1 Job site address. 13495 SW 107th fiegalrea site plan showing placement) 4675
City /State /Z1P Tiger d, Oregon 97223 Furnace 100 000 BTU (ducts/vents/ 1 46 75 46 75
Furnace 100,000* BTU ((laws/vents) 54,91
Suae/bldg, /apt. no • Protect, name' Shipley fl 23027 Heat pump
freggires site plan 4towinit placement) I 61,06 61
Cross street/directions to job site, Duct work 23 32
) lydrontc 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 I
Subdivision. Lot no.: flue/vent for any of above 23,32
Tax map /parcel no • Other.
23 32
1 , Otiher lier furl appliances:
,
Iliu l��f`i " �. Imi•: Dill,, liFirt ONti I i', d �� ,''l,l:)1'l�i�� n „ Water heater 23 32
Installation or sun electric turning and bent pump. Gas fireplace 33,39
Flue vent for water heater or gas
_fireplace ., 23.32
Log lighter (gas) 23 32
Wood/pellet stove 33 39
},.,, Wood fireplace/insert I 23.32
I.. 1, l''/' / �i fi,YgyiIPRQSaffir1D,»$2fl'�l',j 1 " il l ! ll`J,,I'I�.11'l1i14l ! i !,1',r,t7 ,N l' r' r'd�,i;l'd� ill Chimneyfincr /flue /vent 23.32
_
�d, l; I l�� :,,i�qj� �I Other 1
Name Richard Steele'? 5 If I PL4 23 3_
Environmental exhaust and vcmturhnn•
Address 13495 SW 107th Range hood /other kitchen I
equipment 33 39
City /Slate /ZIP: 7'igard, Oregon 97223 Clothes dryer exhaust 33 39
Phone. (503)620-3064 Fax. ( ) Single -duet exhaust (bathrooms, li n „„ � I I toilet compartments, utility rooms) 23 32
n
�' ,I'I "1' Ili�'PNI,cA1��� 1 � l I' , P� i ' `I' ,i I rin �, -
l� I N,6,,p�J �rl o�. l ,,i l „ 1,����'��f7 4 �",f,+,��,iP', (?���O�I� ,l f, � �� A[tw /cmwlsnaca Gus 2332
Business name: Roth Heating and Cooling 1 Other, 2937
- Fuel piping:
Contact name: Steve Merrill $14.15 for flat four; 54,03 for earls additional
Adds ass PO Box 1265 Purnace, etc,
Gas heat pump
Clly /State /ZIP; Canby, Oregon 97013
— Well/suspended/unit heater
Phone. (503) 2664249 I Fax, , (503) 266.3478 Water healer
E-mail: stevem@roth-lient.com Fireplace
(�r
_ Range
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Business name Roth Hearing and Cooling Clnthcs dryer (gas)
I
tip Addiess: PO Box 1265 - Other
'd'` 1 n :ill.U.'il1.alid ll:Fla9 1.1(ai'NfflVfd'liEiseip'liti ;, d�i.pljTl;'ii
Gq /Slale/ZIP: Canby, Oregon 971)13 Subtotal 107,81
Phone (503) 266 -1249 Fax: (503) 266.3478 Minimum permit Fee (590,00)
Plan review (25% of permit fee)
CCB lie,. 14008 State surcharge (12 ^/ nl'pcmnt tea) 1294
TO AL PCRMIT PL6 120.75
Authorized signature: This permn uppllcnimo r ;, rei if ii poets u not uhtnmed within Isla 1 ,
L
dnya after Ime been nccrpmd av ro pleh.
Print name Steve Merrill I Date 10/21/11 • feu methodology set by Tn Counry Buddm,t Industry service gourd
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0CT -21 -2011 FRI 01:20 PM ROTH HEATING FAX NO. 5032663478 P. 02
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