Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00297
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 1 S133DD08300
Jurisdiction: Tigard
Site address: 11624 SW 128TH AVE
Project: Locsin Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 120
Project Description: Install gas furnace, A/C, venting of water heater and gas piping for water heater, range and BBQ.
NC cannot be placed less than 3' from side yard property line per planning review.
Contractor: ROTH HEATING & COOLING Owner: LOCSIN, ARSENIO Z
PO BOX 1265 11624 SW 128TH AVE
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Air Conditioning 06/05/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 06/05/2012 $46.75
Class of Work: ALT Type of Const: FlueNent For Any of Above 06/05/2012 $23.32
Occupancy Grp: Flue Vent for Water Heater or Gas 06/05/2012 $23.32
Stories: Fireplace
Fuel Piping 06/05/2012 $14.15
12% State Surcharge - Mechanical 06/05/2012 $18.51
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $172.80
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: 0A7 /97 , A
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 24 2012 3:213PM ROTH HEATING 5032632513 p.1 5(
Mechanical Permit Application 1 ��I p a ■ l.()it o�: i li I: csr.. U I.1
City of Tigard 'k ' «rive ■ ate/By: d / f r?/ F emhs No. �! (�, /a-
_
13125 SW Hall Blvd., Tigard, OR 97223 '[ �f
• Phone: 503.718.2439 Fax: 503.598.1960 JUN 0 .1 2 DatefBPermit:
y: 6W Otherh • 1
1 i_ ., 1; 0 Inspection Line: 5(13.639.4175
Internet: www.tigard- or.gov /sI Date Reedy/By: twit: to StsPout2
..._.., -- [ „ F - ,�_,,. � 1. - -, v Notified/Method Supplemental tloa
R , I � I �FTIGA�D �' -� lotorma
..-[ :--•1 -. .:_ _ i'. :.� ✓I�u_ '. '1.�, 'tom :r -I �_ _
` .., ' ;. �.. - ": c..... :_: ,i '}- �iu.�u. ,ice�i���.� -im in�'u'�ia- SU�7�{ -? - y'* � J
❑New construction Mechanical permit fees' are based on the value o thework
® Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest doper) of all
❑ Demolition 0 Other:
mechanical materials, equipment, labor, overhead, and profit.
1 ' '_'.: F -'i'` _ 5.- w', _ � „ ' h . ,, , Value: S
_. . - ..- ._.!r_fa.' -' i� ..r- Yom__. -1L�:, ,.44: F : ; ,. - -. : .2.., - � 'y `.Y': :'1'' 11 - -5" i i i , • ' Y 1 _ 4._
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory buildin _ r _. . _ o _. . ' ' ' " "' "` ' j
g • .. For Information +ree checklict
❑ Multi- family ❑ Master builder ❑ Other:
_.,.,- -.-..1_' 1. Description I Qty. Ea. 1 Total
E' _..._.,3 . +a - - CIJ-9 _ 'ti' ; _r:° lf! Readng/eeolirlg:
"�"'�"��° Atr oondi
Job site address 11624 SW 128 AVE (requires site plan showing placement) 1 46.75 46.75
City/State/71P: 97223 Furnace 100,000 BTU (duueveou) t 46.75 46.75
Furnace 100,000+BTU (ducts/venu) 54.91
Suite/bldgJapt, no.: I Project name: LOCSIN # 31560 Heat pump
Cross street/directions to job site: S aite pl showing placement) 61.06
Duct work 23.32
Hydronic hot water system 23.32
. Residential boiler (radiator or
hydronic) : 23.32
Unit heaters,(flel -type, not electric),
in-wall, in -duct, suspended, etc. 46.75
Subdivision: I no.: Flue/vent Coy any of above 1 23.32 23.32
Tax map /parcel no.: Other 23.32
_ , r , : ^ .._ : , : _ ^ s �_ , :_ Other fuel appliances:
l•:T **. " : -,. le r he
-• , , : y,t._ •.I=.�,� . , .. _'� -n:�s` w..., -_'. -•.. _ ,... :: ..,;•. ;. : : :, �.. '";:_ Waater 23.32
INSTALLATION OF A GAS FURNACE AND AIR CONDITIONER VENTING OF Gas fireplace/insert 33.39
Flue vent for water heater or gas
WATER HEATER, GAS PIPING FOR WATER HEATER, RANGE AND BBQ fireplace 1 23.32 23.32
- Loa lighter (gas) 23.32
Wood/pellet stove 33.39
Wood lireplacce/htsert 23.32
!, � -71 mo ; a =1 _, = -x - 3 ,- : ^T _ Chien y/liner/tlue/vent 23.32
Name: LOCSIN Other: 23.32
Environmental exhaust and vendladon:
Address: 11624 SW 128 AVE Range hood/other kitchen
mo 33.39
City/StatelZIP: TIGARD, OREGON 97223 Clothes dryer exhaust 3339
_PhODe: ( ) Fax: ( ) Single-duct exhtesst(bethrooms
,; a
Phone: ( i i - �- s s €= �� `' � ' - toilet compartments, utility rooms) 23.32
f i r : -,;�f -•, =;i' '-� -r e_:;_ �?r :',•;,I1 Attic/crawlspace fans
• 1- �= �r =-..�, � -t: =- :,�_;�; £T3 �'�- . :` :. - 2132
Business name: ROTH HEATING AND COOLING Other. 2332
Fuel piping:
Contact name: STEVE MERRILL
514, is far tint Poor, s4.03 for sans additional
Address: PO BOX 1265 Furnace, etc
City /State/ZIP: CANBY, OREGON 97013 Gas heat pump
Wall/suspended/unit heater
Phone: (503) 266 -1249 1 Fax: : (503) 266 -3478 14.15
Water heater 1
E-mail: STEVEM@ROTH- HEAT.COM Fireplace
TR ••�;flt✓ ~'�.'h=- Jvr - =_',. "' :' 5� :c •�. -- ,4 , tip:, -
Range
• : :r� = : :� += �= s : :s , &- _ ::7iK'n'- 1 e�i' -'' � - � � ,-- ' "� 7= s'c ;�2 :: : r
Business name: ROTH HEATING AND COOLING ' Barbecue 1
Clothes dryer (gas)
Address: PO BOX 1265 Other:
ui .
City/StatelLiP: CANBY, OREGON 97013 , ,i ; '" M710 r r ' 1 ��, I
503 266 -1249 Subtotal 15429
Phone:
( ) I Fax: (503) 266-3478 Minimum permit the ($90.00)
CCB lie.: 140089 Plan review (25 %of permit fee)
' State surcharge (12% of permit fee)
1 8.5 1
Authorized signature: GYM TOTAL PERMIT' FEE 172.80
Tide permit application expires if • permit is not obtained within 180
I Print name: STEVE MERRILL +Date: 5131/12 days after it has been accepted as complete.
t,uluad • Fee methodology set by T ri- County Building Industry Service Board
itePermidttEGPormi+App doe 03/07/12 44 046171 (11 /01VCOMAV®)
•
o ° Building Division
Development Code Provision Review
T i c n R Residential Projects
Building Permit No: / a►ob1"OO.9.1 7 i ` (0.24 5,0 t�
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑
Routed Plans: � ! �I '
Original Plan Submittal Date: r
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact ■o 1 ✓t 0 (�//1 at 503 -718- °. '1 'or @tigard - or.gov)
Land Use Case No. l ` Name
❑ Zoning /e-46.c c /
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitiv�y�-ands T
Notes: /dirAf / ro'e i c s� ICS A '�� a /4-
V
Original Plan: Approved 9' Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @ tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
O Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
•
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
•
Page 2 of 2
May 24 2012 3:28PM ROTH HEATING 5032632513 p.2
Lc Sk,U
Outdoor Unit Site Plan
hi( a.e.kh i-N\ '4i
s0i 4
House
Street Address: 1\ea`A ¶ 1a2 PNE
City, State Zip: i cy?, gi-aa3
Front
Street
1