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Permit CITY OF TIGARD MECHANICAL PERMIT _ ° COMMUNITY DEVELOPMENT Permit #: MEC2009-00112 • T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/18/2009 Parcel: 2S114BB18400 Jurisdiction: Tigard Site address: 10339 SW PICKS WAY Subdivision: Lot: 0 Project: Walch Project Description: Install gasline to range. Owner: FEES WALCH, JOHN D & RACHEL L Description Date Amount 10339 SW PICKS WAY Fuel Piping 03/18/2009 $5.40 TIGARD, OR 97224- 12% State Surcharge - Mechanical 03/18/2009 $8.70 PHONE: • Minimum Fee Adjustment - Mechanical 03/18/2009 $67.10 Contractor: ROTH HEATING & COOLING PO BOX•1265 CANBY, OR 97013 • PHONE: • 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,arid 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 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules • Issued By: /1f Y,1 n^ / Permittee Signature: V1 'n i17 {J� r Call 503.639.4175 by 7:00 a.m. for an Inspection that business day. LLL This permit card shall be kept ma 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 -16 -2009 MON 02:24 PM ROTH HEATING FAX NO. 5032663478 P. 02/02 Mechanical Permit Application � Fol� c)rrlc l_ Lisp: ONLY City of Tigard OCE r " P l aa i [, O / 1 /te_ 40 j�� C C// Permit No.: 114 13125 SW Hall Blvd.,1'igtud, OR 97223 plan Review Phone: 503.639.4171 Fax: 503.598.1960 '1 Ri g Da v y . Other Permit: ' III '(' I Ci A 1( Inspection Line: 503.639,4175 j / • :. i, 1 6 I / p ale KaidylBy: Ju . See Page 2 for Intense[' www.tigerd- or.gov �� r , Notified /Met od: , gy p Supplemental Information '1 y1S10 'T.1TE. OF, WOI*11.1)11VGv. COMM ;BEE #: SOIDULF. - - 1ST ❑ New construction Addition /alterdtiul�rt//rrreplacem. Mechanical permit fees* are based on the value of the work X. E. po etzie lndic(ue the value (rounded to the nearest dollar) of all ❑ Demolition / ❑ Other: r-1 ,, mechanic materials, equipment, labor overh and profit :: CATEGORY. OF . CONSTRUCTION ► Value. $ ' RESwENTIAL EQU�P. MkNT / SYSTEMS. F E E S *. . F 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. O Multi- family ❑ Master builder ❑ Other. Description Qty, 1 Ea 1 Total .` :•. JOB SYTE,.INF.ORMATION AND LOCATION:' : ., ' Heating/cooling Job site address: P (A) ➢ I c 4, ^^ Vv � Air conditioning or heat pump c GJ (minim pile plate showing placement) 14.00 City /Statc/ZIP: ; \ C I 7 Z. LL( Furnace 100,000 BTU (duetslvants) 14.00 Furnace 100.000+ BTU (duets/vents) 17.90 Suite/bldgJapt. no.: Project name: • Gas heat pump 14,00 Cross street/directions to job site: Duct work 10.00 Hvdronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct suspended, etc. _ 14.00 Subdivision: I Lot no.: Flue/vent for any of above 6.80 Other: 10,00 Tax map /parcel no.: A 6 / /1/ 6 6 I $gGY) Other fuel appliances . ... . . DESCRIPTION . OF WORK Water heater 10.00 • Gas fireplace 10.00 ` Flue vent for water heater or gas ^ ^ l I fireplace Log lighter (gas) 10,00 — "'°��/J I Log 10,00 Wood/pellet stove 10,00 Wood fireplace/insert 10.00 I Chimney /liner /flue/vent 10.00 '' �P� PROR'IY:`.OWNF(R, . • `' :....Q TENANT • Other 10.00 Name: (�C Environmental exhaust and ventilation _ Address: Range hood/other kitchen equipment 10,00 City/State/ZIP: W111--/ Clothes dryer exhaust 10.00 — Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) r toilet compartments, utility rooms) 6.80 " ©CONTACT.. PERSON , Attic/crawlspace fans 10.00 Other. 10.00 Business name: Fuel piping • Contact name: S5.40 for first four: $1.00 for each additional Address: Furnace. etc. Gas heat pump • City /State/ZIP: Wall/suspended/unit heater Phone: ( ) l Fax: : ( ) _ Water heater Fireplace E -mail: Range . • . CONTRACFOR _ . Barbecue , Business name: +-1 Cf5LNU Clothes dryer teas) Other: Address: D b 41,4s 114ECHANI AL:PERMIT *.,.... , City /State/L1P: (' ckl C) 13 Subtotal G, � � r ��� ) � 6. ' 4 ,�� minimum (ermit f ($72.50) "J r ]. t ✓t Plan Phone: ) l � Fax: review (25% of penult fee) _ CCB lic.: \ Lt) G 1 I I i I o _ - State surcharge (12% of permit fee) 4 Y . 0 TOTAL PERMIT FEE 7 Authorized si ! ture: 1 A K.ech This permit application expires it a permit is not obtalnedYv in 180 days after it bas been accepted as com p0.4e- Print name: I C ( t J We Date: j it to lb.- • Fee methodology set by Tri -County Building Industry Service Board I:\ auitdkupPermitx \MEC- PCrnu1App.dnc /)1110/07 4i0.4617T(I1/02!COM/WER)