Permit CITY OF TIGARD MECHANICAL PERMIT
' '! : COMMUNITY DEVELOPMENT Permit #: MEC2011 -00606
-FIGAO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2011
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Parcel: 1S135DB02700
Jurisdiction: Tigard
Site address: 11435 SW 91ST AVE
Project: SIMONSEN Subdivision: CHARBEN Lot: 14
Project Description: Gas furnace and NC installation.
Contractor: ROTH HEATING & COOLING Owner: SIMONSEN, RORY L &
PO BOX 1265 ADAMS, CINDY L
CANBY, OR 97013 11435 SW 91ST AVE
TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Air Conditioning 12/28/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 12/28/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/28/2011 $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:
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.
DEC -28 -2011 WED 08:30 AN ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application ��� - FOR OFFICE (SSE UNIX
Ci} of Tigard ��� �� Received •J �� Date /By: /� oJ/ Permit Nu,; 4 __ t om ' - ' I r 4
t ° 13125 SW Hall 131vd„ Tigard, OR 972 Ao
• Phone: 503.718.2439 Fax: 503,598:1 P`� Other Permit.
TIC', Ati17 InspCCtion Line: 503.639.4175 , ` V �'
or ris:
v (� �� polo l'Loyily /ley; C>? See Page 2 for
Internet: www.tigard- ur,i4ov Q " � O � �' ` Notified /Method: SupplcmentaI Inrurmtttiun
,r,. apmt..v :'IL i' i .;I
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�„ ' ; � ::. . ,I i+ 1 T. =Y�:�. ,O l yl(;�� � 1.1 �,�� I .l. "!:'� t, i s.1a,1'.1,I II ,, ' Mechanical permit fees* are based on the value of the work • ,, :,, , , �, �,.,, � ,,, , .:, , . .
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❑ New construction ® Addition /alteration /rc performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
..,;; ,:,.' { ''G:C.:,. .,,. ,�. .}:,d, ,-�,.... ..�,. + ..,7.4 ,S ;Il7;h; ';i� ✓II'mli. , ' 1 ;;1 Value:
i ,,,(:, , _ . d :, ' . ' , Lr ! ;'I' ! �„ !! „ RI'; ,, . ,,,,.� F�.,., � �i' t ., 6 Ir l ?1I': 1:1„ ,.III p., ,1.,,'..i " d l 61 .,,., .,. „ ,. 040000 '..K;; : Cr . ,,
® Y dwelling 0 y g For special hifemallon use 2 -famil dwehin Carnmeraial /industrial Accessory buildin r. dteckllrt.
❑ Multi - family ❑ Master builder 0 Other: Description Oty. I ra. I Total
FI`C, : 1 , , i ; i a l! I'l r 7� itiu fU4. :;, n ::,; ,, (t i; r.' .. 11 1;1;; l 1!',: 1lc /wul'rog:
+' , . ? :1' , ! '.' ,+ k �M!'� ''l .., 'r,T � i � l; li, „ :, ., •h, ?, f I I , ,H,, I, l 1',! ',I „':?
� Air cnndilioning
Job site address; 11435 SW 91 AVE (requires site plan showing placement) 1 46.75 46.75
- Furnace 100,000 BTU (ducts /vents) 1 46.75 46.75
City /State/Z1F: TIGARD, OREGON 97223 Furnace 100.0001 BTU (duets/vents) 54.91
Suite /bldg. /apt. no.: Project name: SIMONSEN #76388 Fleet pump
. (requires site plan showing placement) 61,06
Cross street /directions to, job site: Duct work 23.32
ITydronic hot water system - 23.32 --
. Residential boiler (radiator or
hydranic) 23.32
•
- . . Unit heaters (fuel- l:ype, not electric),
in -wall, in -duct, suspended, etc, 46,75
Subdivision: LUl no ; li'lue/vcnt fo an o f ahov 23,32
Other: 23.32
Tax map /parcel no.; Other fuel appliances:
., I p �.,�}} ..... ; 6 1i; : Ip;c. . , . '4'� � ,:�.. -^"-, ' �..'+"""' .1°; 11 ''!,,', It",,, 1:1 " ' 9
�:j'r .�{ ., ..I I, .,s ..�i,(.� jll, '' �i: � ' ', I'I'jta.1, ' II. Ili'.I Weter'water 23.3_
• „ .:( irl . ., y �.I X2 1, IZ'IG. ';,i ! , ' 1 tr ,., -: I'
���',.,�, �,, " :�. ,'I,:1. ' ��,! ! ��,.k• � �!1'�I;M.,��,r, "1 ..•.,:w, ',�j;,. i ��I'� I r, ... ..._�.
INSTALLATION OF A GAS FURNACE AND CONDITIONER ens 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 23.32
„J . ,�, ! ',I �,,. p, , l „ :, .i. ; .:i '.t '.,,:,.r, Chimney /liner /flue /vent 23.32
3 .:i` Fe � b"1'i I 'iii:• : 'ii;i ;, ',I, ii. , f' .,,, „ ':,.
Il; �;; I �'TUI* ;U� ?.: •j(;1;; l '1' f' � I!',,,.(, i;: I;h7���h ! r' ' . ;; ;,:.,ai';:'' -.
_ 23.32
• 4thcr:
Name: RORY SIMONSEN Environmental exhaust and ventilation:
Address: 11435 SW 91 AVE Range hood /other kitchen
equipment 33,39
City/State /LIP: '1'IGARD, OREGON 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)684-1448 Fax: ( ) toilet compartments, utility rooms) 23,32
.E)Al)i?41C' i LI i 6; 1, ' '; Q :. 0 , lit: Attic/crawlspace fans 23,32
Business name: ROTH HEATING AND COOLING Other: 23.32
_ ... _ . Fuel piping:
Contact name: STEVE MERRILL 514.15 for first four; $4.03 fur each otlditional
Address; 1'umacc, etc, __^ 1
Gas heat pump
City /State /ZIP: Wall /sus ended /unit heater
Phone: ( ) Fax: : ( ) Water heater
E-mail: Fireplace
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( t 1'I I �',jiitFa �.. ry,,�. �'ri:'I m " ly;d*1;'' `:(';I nt;nij'.ii ''1 ahi �:1�: di s ac
_.d,. d' :1.',,,,, I '',7 ,.6 I .', . aj1p. l'n.,,Ih ' "I'1� :r Barbecue
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Business name: ROTH HEATING AND COOLING as)
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Clothes dryer (g
Other:
Address: PO BOX 1265 , i! F T d' .' n '
h�'�'I� �I,:fj i��::,�14C1{ A1S1. I�! r1' f, �: ��I%' I���` 1',':, ���,' t���:,I':`i•:i;
City /State /ZIP: CANBY, OREGON 97013 Subtotal 93.50
Phone; (503) 266.1249 Fax: (503) 266 -3478 Minimum permit fee (590.00)
Plait review (25% of permit fcc)
CCB lie,: 14008 Shoe surcharge (12% of permit fee) 11,22
- TOTAL PERMIT FEE 104.72
Authorized signature: This permit application expires if a permit ix not obtained within LSO
g days a fter it has been accepted as com plete.
Print name: STEVE MERRILL Dale; 12/28/11 * Foo methodology set by Tri County Building industry Service Board
i.. IOuilding \PermitOML'C•ParmitApp.dac 09/09/10 '11O- 1617T(11 /O2 /COM/W813)
DEC-28-2011 WED 08:30 AM ROTH HEATING FAX NO, 5032663478 P. 02
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