Permit CITY OF TIGARD MECHANICAL PERMIT
114
• COMMUNITY DEVELOPMENT Permit #: MEC2009 -00170
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009
Parcel: 1S136AC04200
Jurisdiction: Tigard
Site address: 7130 SW PINE ST
Subdivision: Lot: 0
Project: Dickoff
Project Description: Replace gas furnace, install a /c.
Owner: FEES
DICKOFF, WILLIAM G & MARGARET Description Date Amount
7130 SW PINE ST Air Conditioning or Heat Pump 04/21/2009 $14.00
TIGARD, OR 97223 Furnaces < 100K BTU 04/21/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 04 /21/2009 $8.70
Minimum Fee Adjustment - Mechanical 04 /21/2009 $44.50
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: Natural Gas
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 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 -0100. You may obtain a copy of the rules
Issued By: t; ^`)\al' 0 t h/ Z Permittee Signature: _
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.
.APR -17 -2009 FRI 04 :16 PM ROTH RE EIVE I FAX NO. 5032663478 P. 02
Mechanical Permit Application VV CC FOR OI II(:E USF ON1.1V
City of Tigard APR 17 2009 0 1, 13 • �4 .', Pcrm;tNo.: V , �� • lido �,•
I N
44 1 3125 SW Hall Blvd., Tigard, Oft 97223
Phone: 503.639.4171 Fax: 503.598,1960 CITY OF TIGARD tlate/By: Other Permit:
Plan Review
. f I (i n li I) Inspection Line: 503.639.4175 �, I r, r Date Rowdy /By: luris: pace 2 for
Internet: www.tigard - or.gov � Nonfied/Muthod: ¶1 r Supplemental Information
• ... .7'YPE'Q ..OR'
�"'^` •.. • .. � .- . clop � ..� ,COM1�'IERCIAI: :FEE* SC S CHECKLIST
. ,HkDU1::E ;— .0 .
El New construction Addition/alteration/replacement Mechanical permit fees' aro based on the value of the work
perforated. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other, mechanical materials. .ui.ment, labor, overhead, and .roftt.
' CATEGORY. OF':CONSTRUCTION - ', ..• . `.
a t
11- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family Q Master builder ❑ Other. Description Qty. Ea. Total
`';IOR SITE INFORMATION AM) L OCATION '• ''.. ' '•
: Air conditioning or heat pump i� t
Job site address: -7 'so S y V P 1 n-r, aims site .Ian showin dacement 1 14.00 1 q. DD
City/State/ZIP: -T1 CksiTI i 012 9 12-2.3 Furnace 100,000 • 1 14.00 1 ` • co
tt •1
Suite/bldg.apt_ no.: Project name: Gas heat um 14,00
Cross street/directions to job site: Duct work 10.00
livdronic hot water stcm ti
Residential bailer (radiator or
t
- Unit heaters (fuel-type. not electric).
11
Flue/vent for an of above :t
Subdivision: Lot no.: 10.00
Tax map /parcel no.: r 'Dances
DESGRIP770N OF WORK '. Water heater RE00
.:. .: 10.00
elcas 1,r►■u ( i , e , !.V1 R ,YICI Vat q ft10-- Flue vent for water heater or gas
fir lace tt
10,00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /fludvent 10.00
V I • ' P R O P E R T Y ..OWNER. :. I .. • . •• ` -..' • '' . D •TENANT• .' . ' Other. 10.00
Name: M (A ,ri ( ,U" `t- -1> c.L -of. Environmental exhaust and ventilation
Range hood/other kitchen
Address
S�,Vn f,. equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (3 111—• 2 (1l / Fax: ( ) toilet compartments. utility rooms) 6.80
.. APPLICANT; . '0 CONTACT PERSON . '! Attidcruwlspacc fans 10.00
Other 10.00
Business name: Muel piping
Contact name: $5.40 for first fnar: 51.00 for each additional
Furnace, etc.
Address: Gas heat pump
City /State/Z1P: Wall /suspended/unit heater
"Ni
Phone: ( ) I Fax:: ( ) Water heater
Fi • .late
E -mail: Ran . e
Clothes d cr as)
R
Business name: � k.. r %. S 0 ; a1A .tf Other
Address: P C to, c'
1 City/Stale/IP: CCL viso, ` p ck Q t3 i
minimum permit /� "")(1> 1
Phone: (0 •) ZID�c) °1 Fax: t ) �D 4 ICI Plan rev icw (25% of permit fee)
CCB lie.: \ I.i J) State surcharge (12%ofpermit fee) •!
• TOTAL PERMIT FEE 1 t
Authorised signature:
K L.Y � This permit application expires if a permit is not oMnlned. ihin Ilia
?� /�Fnp � days actor it has been accepted as complete.
Pt'i name• /'.' , � a ' , " ° ��J `" r ' �r Date: y— 1 ( —0 o • hoe methodology set by Tri- County Building Industry Service Board
I:1t4dldingWeraia MEC -Pc nn 01/19/07 440.46I7T (Iion/COM/an)
APR -17 -2009 FRI 04:16 16 PM ROTH HEATING FAX NO. 5032663478 P. 03
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