Permit ... L J
CITY OF TIGARD MECHANICAL PERMIT
111 '- COMMUNITY DEVELOPMENT Permit #: MEC2009 -00201
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/11/2009
Parcel: 2S111BC04700
Jurisdiction: Tigard
Site address: 10190 SW INEZ ST
Subdivision: Lot: 0
Project: Heyworth
Project Description: Ductwork alteration, vent dryer, rework gas line for new meter location.
Owner: FEES
HEYWORTH, SEAN A & MEGAN E Description Date Amount
6333 SW GARDEN HOME RD Duct Work 05/11/2009 $10.00
PORTLAND, OR 97219 Clothes Dryer Exhaust 05/11/2009 $10.00
PHONE: Fuel Piping 05/11/2009 $5.40
12% State Surcharge - Mechanical 05/11/2009 $8.70
Contractor: Minimum Fee Adjustment - Mechanical 05/11/2009 $47.10
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:
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 i .. - uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Center. The e r -s are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Iss d By: / Permittee Signatur • CC��
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.
:- ,. \ - MAY -07 -2009 THU 09:38 AM I H.IHEATI NGF r -- FM N0, 5032663478 P. 02
i. Mechanical Permit ApplicatiolhY 0 7 2009 FFOk OFFICE USE, ONLY
'III Rcce L l y; , Permit No.: Pee k:209'-- 0/ 40
City of Tigard Da,an3y: 5 4
■ 13125 SW Ball Blvd., Tigard, OR 972.11 TY TIGARD Platt Review
la Date /l) Other Permit;
P hone: 503.639.4171 Fw�c: sos.59:,,,.� + ® � l� ' y�
Inspection Line: 503.639,4175 Dale Ready /By; kris: 0 Sec Page: for
I
TIGARD lincrnet: www.tigard -or.gov ' N NotiliedMtothod: J Supplemental Information n.
TYPE P' .FEE. 'S(rREDtiLE - . USE cilECKLIST •
Mechanical permit fees* arc bused on the value of the work
❑ New construction :ETAddition /alteration /replacement performed, Indicate the value (rounded to the nearest dollar) of all
[] Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
,CATEGORY OF •CONSTRUC TION RE FQ17..MENT /SYSTEMS FEES* - '
1- and 2- family dwelling I] Commercial /industrial Q Accessory building For special lgfi>rrnation use checklist,
LII Multi - family ❑ Master builder ❑ Other Description _ j Qty. I Ea. Total
.JOB. SITE' INFORMATION : :AND. LOCATION ... ' • Heating/cooling - —
Air conditioning or heat pump I4,UU
Job site address: , b l C I 5 -a `l\ � (reguires site m shawin 1yl/ uemcnt)_
• Furnace 100,000 BTU (ducts /pants) 14,00
City/State/ZIP; -t- sat, �Furnace100,000 +BTU(ducts /vents) 17.90
Suitc/bldg. /apt. no.: Project name: 1 t L / 4 G1 r c (/y'1 Gas heat pump 14.00
[J l Duct work 1 10.00
Cross street/directions to job site: — 10.00
I-lydranic hot water system
Residential boiler (radiator or
hydronic) 14
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended etc. 14.00
r — Flue /vent for any of above 6.80
Subdivision: _ I Lot no.: _Other: 10.00
Tax map /parcel no.: Other fuel ap I�lanees -
Water heater i0 00
DESCRIPTION ; OF , WORK
10,00
Gas fireplace 10,
C `r—A Th g e � 1 — Flue vent for water healer or gas
' Log lighter _ a 10,00
Log ighter (gas) 10.00
t --.- J ),r i Vl4..l`3L� &_ 1, IT 1() Wood /pellet stove 10.00
• 10,00��
i�1 �� Wood fire lacclinsert
Chimney /liner /flue /vent 10.00
PROPERTY OWNER TENANT :;: L 10.00
_ ❑ Other: _
Name; ♦ g � Environmental exhaust and ventilation
a Range hood /other kitchen
Address: equipment 10,00
= , Clothes dryer exhaust 1 10.00
City/State/ZIP: Single -duct exhaust (bathrooms,
Phoneyy ) 1 0 V 3C. ` Fax: ( ) toilet compartments, utility rooms) , 6.80
Atticicrawlspaccfaas 10.00
APPLICANT ■` CON'fr♦CT .; PEftSON;. - 10.00 •
Other:
Business name: _ _ Fnelpiping_
$15.40 for first four; 61.00 for cult additional
Contact name:
_,_ Fumacc, etc. --
Address: Gas heal d ump
City/State/ZIP: Wall /suspended /unit heater —
V/nter heater
Phone: ( ) Fax: : ( ) Fireplace ____
E-mail:
Range _- -.
CONTRe#C I OR
Barbecue _
\ Clothes dryer (gas) _
Business name: ' 1r R 11 Other: ( -�
C M.ECHANFNCAL PERMIT ItEES"
Address: ,D___) _ _ subtotal
City /State /ZIP: 0 , \I l4 l3 Minimum permit fee (572.50) i Z. —
Phone: (a ) Z 4p, L(it71 Eax: ✓) �• Plan review (25% of permit feel
y � State surchluge 02 °/n oCpclm
TOTAL P E R M I T FEE (, 70
, —771—t ��' r / [� 'Me permit a pplication expires if o permit its not obtnimd within tau
Authorized signature: 1 r _e r ��� �I� cJ JJ tt days after it has been accepted as complete.
Date: I/d f • Fee nlethodoiogy set by Tri- County 13uilding Industry Service Board
Print name: it � ,Ake _ � ��
b / // 7
1' \ Nine LAMCC.Perm Ayp,doc 0Ill 9/07 440.4617T (I /0'JCOM /WEa)