Permit CITY OF TIGARD MECHANICAL PERMIT
" COMMUNITY DEVELOPMENT MECHANICAL
MEC2009 -00127
Date Issued: 03/26/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133DC15600
Jurisdiction: Tigard
Site address: 12901 SW LAURMONT DR
Subdivision: Lot: 0
Project: Balogh
Project Description: Change -out gas furnace.
Owner: FEES
BALOGH FAMILY TRUST Description Date Amount
BY BALOGH, ALEXANDER & JOYCE I TRS, Furnaces < 100K BTU 03/26/2009 $14.00
12901 SW LAURMONT DR 12% State Surcharge - Mechanical 03/26/2009 $8.70
PHONE: 503-524-4865 Minimum Fee Adjustment - Mechanical 03/26/2009 $58.50
Contractor:
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 $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done iri accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifica ion Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
lssu d By: J yrk P ermittee Signature: k 4 , (t __1
• Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
MAR -24 -2009 TUE 12:20 PM ROTH HEATING FAX NO, 5032663478 P. 02
Mechanical Permit A kicat fl " Z ! i 1 ` Iii' f!j FOR Oil 1(1 LIST ON 11,,N'
111 City of Tigard r' � `�" I ' L , Fr p • 13125 SW 1 Blvd., Tigard, OR 97. � • Permit No.: � ea0� (��(�
t O Phone: 501639.4171 Fax: 503,598.1960 '1 r. i s A I I t Plan Raview`
Detc /By; Other Permit
1'L ,\RI) Inspection Line; 503.639.4175 -
Ti Carte Ready /By. iarla.
Internet: www.tigard or.gov li � ► r f - 1 y S Sec Page i for
i p Na litied/Meth n t l;
t + upplemrnta information
a
TYPE OF' WORi� .... ., .• t 'T RCIAL FE$'.+: _SCHEDULE'.- USE CHECKLIST'. '
[] New construction Addition/alteration/replacement "` ' 17; cchatticial permit fees* are based on the valu of the. work
Demoiil.ion i ormed. Indicate the value rounded to the nearest dollar
[� O ther: �` + ' ( ) of all
MAR 2 hau,ical materials, c•ui•ment, labor, overhead, and .rnfit. • . .. CATEGORY 0 1 ? CONS'rltLlcT1ON Value $
•
'gr. l- and 2- family dwelling ❑ Commercial /industrial j] Accessory b ui . I Cl
� ' SID. ENTIACEQIfIPMENT /SYSTE14iS.1 +LE5* " •
Multi- family 0 Master builder ❑ Other: B DING DI • For special information use checklIs
Description Qry. I a. Total
JOB SITE • INFORMATION 'AND LOCATION • . ` Heating /cooling
—
Job site addres IVY . J Air conditioning or heat pump
wt (re wires site •1811 stowin .Incement 14,00
City /State /ZIP: I
♦ +l Z 3 li'umace IOO,OOO BTU (dacrs/vcnts) I4,00
fP
INIMI
Suite/bldg./um no.: Project name: Furnace 100,000+ BTU (claws/vents) cots) 17.90
Gas heat tun. 14.
Cross street/directions to job site: Duel work 10.00
Hydronic hot water ystcm 14,00
Residential boiler (radiator or
. hydronic) _ 14,00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: 1Lot no.: Flue/vent for any of above 6.80
"fax map /parcel no.: Other: 10,00
Other 15ac1lplalinnees
. DESCRIPTION OF woim ` ' . Water heater 10.00
Gas fireplace 10.00
for water heater or gas
(r;Ij�r�T r�' I (1i '�V� J Flue ftre.lace vent
1 0.00
i -- Log lighter (gas)
— 10.00
Wood /pellet stove 10 00
Wood fireplace /insert 10,00
' PROPERTY OWNER Chimney /liner /flue /vent 10.00 • 1,:._. : �/ TEN .. Other; •
Name: [\� 10.00
Cuvirunmental exhaust and ventilation
Address: Range hood /other kitchen
City /State /ZIP: — equipment 10.00
Clothes d er exhaust — 10.00
Phone: rt r) r •1- Fax: ( ) Single -duct exhaust (bathrooms, III
lei i Up toilet corn ailments, utili rooms) 6.80
�� CO Attic /crawls
— D 'CONTACT PERSUN . pact fans 10.00 '
Business name: Other 10.00
Fuel piping
Contact name: --
_ $S.40 for first four; $t.0i1 for each additional
Address; Furnace, etc.
—
City /State /ZIP: Gas heat .um
Wall /sus ended /unit heater MEE
'VI — Phone: ( ) Fax; ; ( ) Water heater
E-mail: .. Fireplace
Rune
T CONTRACTOR
[iurhncuc
Business name: t \ Clothes dryer (gas) M ill
�t r -..e G —
Address: r` ^ p 5 Other:
"' ''�S MECHANICAL PERMIT FEES* ,
City / /ZIP: C }
, ,ma Cr�` 7 Q 1 subtotal
Phone: ( ) �.t�I0 _ � 1`(.ty Fax 7 Minimum permit fee permit r J
1 ' 1 flan review (25% of permit feee) )
CCB lie.: 1s- r
State surcharge (I2 /o of permit fee) ' .
_ _ _ __ e TOTAL PERMIT FEE v
Authorized signature: I This permit application expires if a permit is not uhtaine; within 180
Print name: E---{ . . "O 1 Date: 4 Tr days slYur it accepted us complete.
P;
F ee methodology set by Tri- Coiun ounry Building Industry Service Board
C1Ruildio[pee mitL42C- rermennp.uo 01 /19 /07
4.10.401 1/02/('UM/WL -2)