Permit CITY OF TIGARD MECHANICAL PERMIT
is COMMUNITY DEVELOPMENT Permit #: MEC2012 -00258
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/17/2012
Parcel: 2S104AB03300
Jurisdiction: Tigard
Site address: 13327 SW SCOTTS BRIDGE DR
Project: Dickerson Subdivision: MORNING HILL NO.3 Lot: 66
Project Description: Install A/C and Furnace
Contractor: ROTH HEATING & COOLING Owner: DICKERSON, GARY R & ROSE A
PO BOX 1265 13327 SW SCOTTS BRIDGE DR
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 329 -3707
FAX: 503 - 266 -3478
•
• FEES
Specifics: Description Date Amount
Air Conditioning 05/17/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 05/17/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/17/2012 $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: e� Ate Permittee Signature: QIJ 74" 1
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.
MAY-17-2012 THU 12:10 PM ROTH HEATING FAX NO. 5032663478 P. 01/03 SI
2_0o LA+
Mechanical 1
Permit Applic F ix i I 11 ) Pmit c rl . ,,,,),, ,„.„.,„.„,,„sv„Ni..i'
City of Tigard A.I L.1-4 Received
Data/By: ‘ 11 1 er 1406e.,200__. tyoc
0 13125 SW Hall Blvd,, Tigard, OR 7 ‘''''
71 Plan Review
a ' Phone: 503.718.2439 Fax; 503.598.191g 1 7 2012 Date/By: Other Permit:
Inspection Line: 503,639.4175 Date Ready/By: !uric WI See Page 2 for
Internet: www.tigard.or.gov CITY OF TIGARD Notified/Method: 11 Supplemental Information
. .
, . ..... .:. . .E oFtNArtZ 71 .: :: ::'!'.,:,:''.!;.... '...::::•••:'!; i : ::•dohar4 1 : 11 C 1 4 : Fit*'!k0E00111::11S1MtfOOK4I#1:_ :
. ,.
Mechanical permit fees* arc based on the value of the work
ID New construction E Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
12 Demolition Ei Other: mechanical materials, equipment, labor, overhead, and profit
. , Value: $
• .. • . • :, • .. ..
CATEGORY . OF CONSTRUCTION . . :.: : ' . :-.:!.....: ' '-':-: i.' i :•:: ' • RistEiMlilit•VAIIPMENt, iklignirOirAtS!'!"
.... . ..
gi 1- and 2-family dwelling ID Commercial/industrial 1:1 Accessory building For special Wynne:don use checklist.
I: Multi-family El Master builder CI Other: Description I Qty. I Re. I Total
JOB SITE INFORMATION: AND LOCATION . • ' : : 1 ." : ' ' . ' . : ; ; ': 1 : . ' '''• H A i 'a rt i on i n I f
Job site address: 13;21 gu, s( c) , k-}, 6 ri . (requires she plan showily( placement) 1 46.75 1, 4 ti/ riS
Furnace 100,000 BTU (ducts/vents) i 46.75 ,9 1p 1 S
City/State/ZIP: 1.--i_ j'-d i OR_ q 72-'2_ Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt. no.: I Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hvdronic hot water system 23.32
Residential boiler (radiator or
hvdronic) 23.32
Unit heaters (fuel not electric),
in-wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.: -
Flue/vent for any of above 23.32
1
_ ..
Other 23.32
Tax map/parcel no.: Other kid appliances.
....: ....:.. :. E'., : .: ' . :. .. : . :.: • i . '.. DOORgfffoNi.,cir ,.. Water heater 2332
Gas fireplace/insert 33.39
/Aism-z. ,i/e.. i /a . Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove _ 3339
Wood fireplace/insert 23,32
. .
. :: • , ar PROPERTY:•OSIER ' :' g . .1 . :!.... • ' . ' i'!:• In. : :':::...;;; ....:::;;:::,:::: Chimney/liner/flue/vent 23.32
i Other 23.32 ..
Name: en ainj 1,-„ „irsoyi Environmental exhaust and ventilation:
Range hood/other kitchen
Address' SCUM e .., equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
— Single-duct exhaust (bathrooms,
Phone: (s) 37,q - 310 Fax: ( ) toilet compartments, utility rooms) 23.32
- .. : . '• , :1=1 APPLICANT:: : :.: ''...:. • :: ! ': ' : ;:.: 0 coNT*cr. Attic/crawlspace fans _ 23.32
- Other 23.32
Business name:
Fuel piping:
Contact name: $14.15 for heat four; $4.93 for each additional
Furnace, etc.
Address: —
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater ..
Phone; ( ) I Fax: : ( ) Water heater
Fireplace
E-mail:
Range
::..:' : ':.. .. • .: .. ..: .. ' • : : : : .• • . 'CONTRACtOR', ::" : : ' : " '. :. ,'': ::'•:::..:•::;::'.;:, :: Barbecue
Business name:
_Clothes dryer (gas)
1Z , A.A..0 cAil ns /. _..,(:x_)..i.nc3 Other:
Address: Po 60)( 12,kps
Cit c .kn o 4 I oft C11013 Subtotal 43.50
4 Minimum permit fee ($90.00)
Phone: Ira • i , , rae4C) Fax; 8C 21P IP . 3 /8 Plan review (25% of permit fa) . .
C B lie.' I q 00g c i t / i ( State surcharge (12% of permit fee) / I d 12-
TOTAL PERMIT FEE
Authorized signature: ;4 1 ,,, e • ...t 1 This permit applkaiion (=pima if a permit Is nol obtaIned within ISO
dart Sfter it has been accepted as complete.
CM:Mt 4 - I. CA IL-0 . .4 , l(' Date: 5 11;1 z... • Fee methodology sot by Tri-County Building industry Service Board
IMuildinfi Tenni IAMEC- • ., • pp dan 0/07/12 940-4617T (I 1/02/COMMD)
MAY -17 -2012 THU 12:10 PM ROTH HEATING FAX NO, 5032663478 P. 02/03
Outdoor Unit Site Plan
45, House
Ex;s 1
*_621s,."Ec
Street Address: 1 3321 5v.► scaTrS Se 1) LiJe
City, State Zip: - i - A R-o, 4O- gm
Front
Street -