Permit •
CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00163
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012
Parcel: 1 S 133DD00900
Jurisdiction: Tigard
Site address: 11725 SW 129TH PL •
Project: KRUGER Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 48
Project Description: Gas furnace and A/C installation. A/C unit must meet 5 ft. minimum rear and side yard setbacks.
Contractor: ROTH HEATING & COOLING Owner: KRUGER, SCOTT & ANN
PO BOX 1265 11725 SW 129TH PL
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description ,Date Amount
Air Conditioning 03/30/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 03/30/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/30/2012 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth In OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _� _ Permittee Signature: •
AMP f
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
MAR -30 -2012 FRI 07 :43 AM ROTH HEATING FAX NO. 5032663478 P. 01
—
Mechanical Permit Application I•(llt l)i Fi <'i: t sr. ()NIA.
City of Tigard RECEIVED PlD°`°' . z , _.,. .
l t, v I3125 SW Hall Blvd., Tigard, OR 97223 plan an Review
I Phone: 503.718.2439 Fax: 503.598.19 De tclBy, Other Penult:
r I C. A I1 Lh Inspection Line: 503.639.4175 MAR 3 0 2012 Date Ready/8y: RI See Page 2 for
Internet: www.tigurd -or.gov = Notified/Motltod: ,. , Supplemental Information
CITY OF TIGARD
N FEE* ,$t
,. • : .. . :, .. � COMMT�RCfpY. DULT�. � USE CHECKLIST •. . •
.
'1!1'!'E . G Y)���0 . Mechanical permit • are
' ' :� .� • ' • cchan perm fees* based on the value of the work
❑ New construction ® Addition /alteration/replacement pedlar/tied. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition [] Other mechanical materials, equipment. labor, overhead, md profit -
: . , .. .
Value: $
CA'1 EGQRY;:OF::CONSI R1JG` CON.
. , . ,• ' • ::. •. I�SIDT�N•PIAII. :TQUiPM &l`R`/ SYSi'1>:MS•1>�3 .
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Far special h((omaallon use checklist
0 Multi- family ❑ Master builder ❑ Other: Description I Qty. i Ea. I Total
N; Al D 'LOCiATION
.::.:....:::.1:' . :1013 81T , .. . Hcafin coo ng:
Air con ditioning
Job site address: 11725 SW 129 Place ► requires site plan ebowinn pincetnent) 1 . 46.75 46.75
- Furnace 100,000 BTU (due s/ve:us) 1 46.75 46.75
City /State/ZIP: Tigard, Oregon Furnace 100,0001. BTU (duets/vents) 54.91
Suite/bldg./apt. no.: Project name: Kruger # 29654 Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronie 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
Subdivision: Lot no.: Flue/vent for any of above 23.32 •
Other: 23.32 _
- Tax map/parcel no.: Other fuel appliances:
.., •• • . • 1ESCRIPTIUN .OF :WORM(• • .. • . � : ' • , • Water heater
Installation of a gas furnace and air conditioner. Gas fireplace/insert ant water 33.39
R Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplatxlinsert , 23.32
. . . .._ 23 32
BROP8,R7'1'.'OWNER> � ` .. ;'� :T'C1�I71;NT Chimney/liner/flue/vent
.: I:,::,." . , Other. 23.32 -
Name: Scott Kruger Environmental exhaust and ventilation:
Address: 11725 SW 129 Place Range hood/other kitchen
equipment 33.39
City/State/ZIP: Tigard, Oregon 91223 Clothes dryer exhaust 3339
Single -duct exhaust (bathrooms,
Phone: (503)590.3018 Fax: ( ) toilet compartments, utility rooms) 23.32
•, •
...•..a.APPLXCANT'• •• .., '• •• ": ' :•CONTACT. PERSON:• .' Anic/crawlspacefans 2332 • Other 23.32
Business name: Roth Heating and Cooling
. Fuel piping:
Contact name: Stove Merrill $14.15 for first roar: $4.03 for each additional_
Address: PO Box 1265 Furnace, etc,
Gas heat pump
City /State/ZIP: Canby, Oregon 97013 Wall /sus nded/unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater .
- - Fireplace
E -mail: atevem®roth- heakcom Range •
... . .. - COIVT!RACTOR , . • Barbecue
Business name: Roth Heating and Cooling
Clothes dryer (gas)
Other: _
Address: PO Box 1265 : , . .. MECHIANICA RMM17' FEES' •
.. , •
City/State/ZIP: Canby, Oregon 97013 - Subtotal 9330
Minimum permit foe ($90.00)
Phone: (5113) 266 -1249 Fax: (503) 266-3478
Plan review (25%of permit fee)
CCB lie.: 14008 State surcharge (12% of permit fec) 11.22 _
TOTAL PERMIT FEE 104.72
This permit application expires Ira permit is not obtained within 180
Authorized signature; days after it has been accepted as camptate.
Print name: Steve Merrill I Date: 3/30/12 • Fee methodology set by Tri- County Building Industry Service liour4
!AB uildlna ermlalMP.GPermitApp.doc 07/07112 410.4617r(I1/02/COM/WBS)
MAR -30 -2012 FRI 07:43 AM ROTH HEATING FAX NO, 5032663478 P, 02
A/C OR HEAT PUMP SITE PLAN
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ADRESS: 1 1. 2 £� I 2 ° � 7) Ac-C.
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