Permit t • • y I .
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00350
'� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/16/2005
PARCEL: 1S134CC-02300
SITE ADDRESS: 12311 SW KATHERINE ST ZONING: R -4.5 •
SUBDIVISION: YE OLDE WINDMILL LOT: 003 JURISDICTION: TIG
Project Description: Installation of A/C unit.
CLASS OF WORK: OTR FLOOR FURN: • EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
BLOORE, PETER & VIRGINIA Description Date Amount
PO BOX 231148
TIGARD, OR 97223 [MECH] Permit Fee 6/16/200: $72.50
[TAX] 8% State Surcha 6/16/200E $5.80
Total $78.30
Phone: 503 - 579 -1698
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Phone: 503- 266 -1249
Reg #: LIC 14008
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: r
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business d ay.
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.
6/16/2005 O7:2 15032632513 ROTH MECHANICAL PAGE 03
11 -rh- /bSc2-/ --
•
echamcal Permit Application Fok 0141(.1.1 list oNi.)
City of Tigard Re :- 60' , ) Permit No.V -001 )
Datehly; ,
13125 SW Hall Blvd" Ti „ 3 0;frik, 1,1( E r Plan Review
Phone: 503.639.4171 , .',. rt 9 .
. • • :496(f,4 fi , .... ,; V r ,,,,,,,;!;01,4„tii,y, .N Date/Br Other Permit
:
Inspection Lim: 5 • 75 .' 1 ' ri .„'"'--- ' - ° •11 Date Ready/By: lim El See Page 2 for
rn
Inteet: Www,ci.figard.o .1 Notified/Method! supplemental Information
_____________ -
„•;;;:;:4,4,N!-;i:,iy.:1.:.;;.■:i;::::i:1,!:•::!;';..... ::•:.-':;,': .':; par :cii .:r -.'.,.;::: :;.C
,!).,,,N COMMERIAL
,,K,,,. ,,,,,:::,.::,..,......,, .!, • -,..,• .• - •-••• ••••. •• •••-z • ••:•• ••• •-•:, ••••• •s••••, ••)•••••••••• •••,•••• -• •,• • ••• • . ,.. .
.....,,, i 1 . " Mechanical pernt fees* are liased on the value of the work
0 New construction la'Addi
v performed Indicate the value (rounded to thc nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor overhead, and profit.
. Value: $
01 •,.,::;•:. - • •:: • : '::: .: .. . ' . . ... ---- • ...:'' '; - - - ..':••-•.;""- :
/Mr.91:•Py.,
'"1- and 2-family dwelling El Commercial/industrial El Accessory building AV 107 #; FR rql!il
For special Information use checklist.
0 Multi-family 0 Master builder 0 Other: Description
I Qty. Ea, Total
1,01,100 _ ri . A.T.10,..,..*** : 4..' 1 041.I .. 0•1';... : 1:1'..;'.. , ; ; ;.:' ;': .i . ! . ,:F!' , ' ; '::).z':;,: 4 ; ,' Heating/cooling
Air ctmditioning or heat pump
Job site address: / 2--3// SW P 51 (irquires site plea showing placement) i 14.00
City/State/ZIP:
-Hsol-P-ak. e2-12. Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ ETV (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14,00
_
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: I Lot no.:
Other 10.00
Tax map/parcel no.: Other fuel appliances
44`t11 ' 315314.;.cit.!VVOR1C.":;:::' :::: ';:,'., -;...". :.:. : '' •••':';. .• 10.00
Gas fireplace 10.00
Flue vent for water heater or as
• fireplace 10.00
a \c__ aria. Crv\ Log lighter (gas) 1P. ,
Wood/yellet stove 10,00 .
Wood fireplace/insert 10.00
,
4,,,, ; ,-,, v ,o- v : • i. i. ,.-; ..i ....:;,..•.,.......... , mu . 4, ...,..,...,,,..;;,... . ,.;:..;:,.,..,,,' Chimneyjner/flue/vent 10.00
PA il., - rlif,:lpr i . ...1 , 1,7 - ,•.•,,t•p!:••.:::'!:',.. i'..:1;t:.i.,..; ,:,: ::. ::::,;..i H.:1' , •,,„1:1 .. .i..e.::::',;.!;:!1.!. f other 10.00
Name: 1- litt.th V5 13 adr-e - ?... e .,\ r -vc Environmental Exhaust and ventila Ion
i Range hood/other kitchen
Address: JO f1 ` afip
so equipment 10.00
. .
City/State/ZIP: 77 . 9 2_7,3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( ) 7 111 /CI)? P . e"ax: ( ) toilet compartments, utilE rooms) 6.80
o
ri pm 4gpko .. ,,,..!:_!.::•:•:.:,:,:: .,:ii.••• a .., Attie/eruwlspace fans 10.00
,;::40114i) ,..„.,.......„,..:,• ...::::.i::••:•!: ,,,... ,T7.• ,.:•;••.,•...•,.,..,7.1..Y::•••••.•,::
Other 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each additiona
Furnace, etc. .
Address: _
- , Gas beat pump
City/State/ZIP: Wail/suspended/unit heater
Phone: ( )
- -
\[/// Fax: : ( ) Water heater
-
Fireplace
E Range ' ,---
11 3 , 0t I tliiiP;4124 1 : 1; g4A! i Sil.0:41*0041,ElF,i - 4.1l . 11# : : ;: il:1] : 1 . `k: s . : l,-.;'` 4 :q . 11l , Wf. 1 ; 4 0 : glA i i ttl i ill : ; Barbecue
Business name: f (]/it / _kat Clothes d er : as
. Other
Address: . 04) / d- I 2...4‘ Trommotqlow41.1t...,:;',1•,,ototAccnN.:).,
City/State/ZIP: ea.vi ...y O"R„ 70/3 Subtotal
„ MilliMUM pennit fee ($72.50) 7 2,s
Phone: (5a5) ilda --( 2 L) Fa (505) 2.i4 .- , _ .. 3 1. 7/ - _
Plan mview (25% of permit fee)
CC13 lie.: / 1 4 I) 0 f 4 I 1 . State surcharge (8% of permit fee) -- KO
' TOTAL PERMIT FEE
th 40 ;.• - 1 , A This permit application expires if n permit is not obtained Tvithln 180
Auorizcd signature=
r . days after it has been accepted as complete.
Print name: ''‘' A /,... : rywk- Date: A ( / * Fee methodology set by Tri-County Building Industry Service Board
EE6/16/2005 07:02 15032632513 ROTH MECHANICAL PAGE 04
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SIRE Tr
A -DR E S', /a37, 5 vu
CITY OF TIGARD
,/ BUILDING DIVISION A PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MEC200SS - 00350
Phone: (503) 639 -4171 ,, „444111?A 5116/2005
Inspection Requests (24 Hrs.): (503) 639 -4175 °T__..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
7127!2005 7:15AM Cl
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 12311 SW KATHERINE ST LOT #: TYPE OF USE:
PROJECT NAME: YE OLDE WINDMILL 003
DESCRIPTION: BLOORE
Installation of NC unit.
OWNER: PHONE #:
CONTRACTOR: BLOORE, PETER & VIRGINIA, PHONE #: 503. 579 -1690
ROTH HEATING & C .INO 593 266 1 2 /19
Inspection Request Scheduled For: Date: Pour Time:
7!27/2005
Code # Inspection Description Confirm # Contact # Message
695 Misc. inspection 012183 -01 5 503- 572 -1545 Y
Corrections /Comments /Instructions:
,46- 1 y src / /alo., OK
PilA4 I ft cc 1 O -K z
lutoe Leila,- L S c iS'? II T
L
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL "•R INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: —D� Phone #: 503
p p / k � a� c ) 718 -