Permit lig CITY OF TIGARD MECHANICAL PERMIT
ii
I : COMMUNITY DEVELOPMENT Permit #: MEC2012 -00312
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
Parcel: 2S 115AA04600
Jurisdiction: Tigard
Site address: 10827 SW CHATEAU LN
Project: Templin Subdivision: REBECCA PARK Lot: 3
Project Description: Install gas line for range
Contractor: ROTH HEATING & COOLING Owner: TEMPLIN, RAYMOND JEROME
PO BOX 1265 10827 SW CHATEAU LN
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Fuel Piping 06/13/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 06/13/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/13/2012 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
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: OKI ? PPLI CAT7D1�
____ili*_&_e____ Call 503.639.4175 by 7:00 a.m. for the next available inspection date. c
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 30 2012 3:28PM ROTH HEATING 5032632513 p.! s� yjfi
Mechanical. Permit Application CE �' LD
Rm. I.I( t: -,tit: rt,t.l
City of Tigard Reoeivea
:� i' 131 25 SW Hall Blvd.. Tigard, OR 97223 JUN 0 2012 newsy: �P�I?-ll� tit �C ..lam- 'o 31a--
Phone: 503.718.2439 Fax: 503.598.1960 �rI Plan Review "
1 I , \„,, Inspection Line: 503.639.4175 CITY OF Gthl,) Da eadyBy �� I nor aD 33
Internet: www.tigatd-or.gov BUILDING DIVISIO I Notified/Method: S Bee ir e: Tor
npplemenhl [ntormetlm
� , -.-.._ . -- �'.'q+- .�{=,1 -i.y;S k'�-- _IN- sJ -_ .;.. is �.:.�- �a_meor- �..- -. uic; ,,a::nr
xc� 'i.r':a —7 rie r�zll.= fs=_ _: � i c:._ . ' 1� 1- :-; 1! :
-''.#e,:._. 4,r 'li...,-- • -I.T- :..._: ". __ ___ :. : �.. _ -:: .= ���'r°��_.e,� -_ '��:r�'. . ^' _ ^ r! '(_ � r . .. f�- '1(�Iill� r�Inl �,�'�• U.�; : _I.: i�.��� gtl' : f j 1,4 h_
n, , -_... -__. ,.::�� == - .... <�Y'c- - cr`tF.c•9:?_r - �, bra I ii n:i:v _ rtailF�,i kf¢•�.-oniu,�L.'
❑ New construction ® AdditiorJalteratiott /replacement f performed. Indicate the value (rounded to the nearest dollar) of all
1 Mechanical permit fees' we based on the value of the work
❑ Demolition
❑ Other: mechanical materials, s, equ ipmero, labor, overhead, and profit
LEI. _=3 -� � - u � - ° . 1< _
. . 4 - re. a' - - ��= Val
___ .�. . --... ` °+ ,v �IF " "F e 0'�R I'� '.��!? r_ - =s:: a�t�
® 1 and 2 family dwelling ❑ Commercial/industrial 1 - . - _ - -_ or special �„ � : 1;1= 1 _..: ;_
❑ Accessory building - �__ .• Forapecialigfonvnm(ou aaechecklist
❑ Multi - family 0 Master builder
_: , _. � - u cam . Other: Description I Qty. I Ea. 1 Total
am.- _ ?.riy�l 'x:211 E f a 2 i (� '�i't''�, . Y.,,;,.., a _r ; ;, . 01 Air ppi—. �
-=ii: 4n ut I �.-'-�=�,` -.a s -. r+. -. ' Heaconditiotlatin a ling:
Job site address: 10827 CHATEAU LN. ning
1 (requires silent= showing placement) 46.75
City/State/EP: TIGARD, OREGON 97224 { Furnace 100,000 BTU(ducta/venty) 46.75
Furnace 100,000+ BTU
! no.: (ducts/vents) 54.91
Suite/bldg./apt. 8 �' I Project name: ARTISTIC K1TCH�N &BATH � Heat pump
Cross street/directions to job site: ( sin N® sheaving placement) 61.06
Duct work 21.32
Hydonic hot water system 23.32
I Residential boiler (radiator or
bydronic) 23.32
I Unit heaters (fuel-type, not electric),
in -wall, induct, suspended, etc. 46.75
Subdivision: Lot no.:
Flue/vent for any of above 23.32
Tax map/parcel no.: ( Other: 2332 _
rt =',I _ F Vie, =n:� , - -, Other thel appliances:
0- -'' i•: _ , F -� • �i e�fn fLI �"�41i{�a3� �', .-tl� ° -. = _�:..t 0 -_. '^- 4ye _�4I Water healer -
�"' - � '� -`.:� ; -_ _` =•" : r:a` '��- _�''��� 2332
INSTALL GAS LINE FOR THE RANGE. ! Gas freplece/ints 33.39
� rim vent for water heater or gas
fireplace 23.32
Log lighter (gas) 1 23.32
(
Wood/pellet stove 33.39
nT ,I _ Wood fireplace./insert 23
= i l l �. [fll " = .7t I,rm,i :gi , .. �. rte` -
i a. 'ha ;l� - . . i i -- t —1ti k 15. : I: - 1 .ii �ryy otimneY/liner/Bae/vem 23.32
� .- o.� U n sc:l i � i -.._ � Is =: �_ c1i ::;i i! c: :Yl'`
Name: Other. 23.32 ,_
' Environmental exhaust and ventilation:
Address:
i Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer adieus[
33.39
Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms,
�=-- 11�:� -.- --- '_' - �: -- ,,=.z . .. toilet comPartm utility roornv)
toil ernes ut
F �r,-'_'rlC 1411 � E;::a =�81 ..) ' "a '—_-M - Il . _-__ cz� - 23.32
r,. _.....,_.- �.:_- �.= a r�:11�::.= .nr = -:' - . - _:._..... ;._..._ - _..� _:r.� -�i space fans
r iii � - • "� -�`` Attickrawl 2332
Business name: ROTH HEATING AND COOLING Other: 2332
es
Contact name: STEVE MERRILL Fuel plying:
514.15 for first Than 54.03 for each additional
Address: PO BOX 1265 Furnace, etc.
City/State/ZIP: CANBY, OREGON 97013 t heat pump
• Wall/suspended/unit heater
Phone: (503) 266 -1249 I Fax: : (503) 266 -3478 Water heater
E -mail: STEVEMQROTH- HEAT.COM
Range 14.15
� P .r. l' � ' tr'� -' f 1 Ran e '
- J
alr::.�nn �'R`- V�, —E. r i `''�{ :; t' :' — i+ r_ 9 _ 5 .
nTn• -- �k���x:�ua;R = -� ° Wr',� Barbecue
Business name: ROTH HEATING AND COOLING , Clothes dryer (gas) "
Address: PO BOX 1265 Other.
'f T III Yr17 i l i ""� - �I"R° 7P* -:u.i -_ .:-::., ; ,:_-:,.
. .:�uuc'adl�a,u i ` ui,L. Subtotal . �.�. c _ {y �' `
City/State/ZIP: CANBY, OREGON 97013 Sbtot r
Phone: (503) 266 -1249 , Fax: (503) 266-3478 - Minimum permit fec (590.00) 90.00
/GCB lic.: 14008 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 10.80
ma y ^ / TOTAL PERMIT FEE 100.80
Authorized signature: IC , ( T h i s permit application expires Ira permit is not obtained W ithin 130
days after it has been accepted as complete.
Print name: STEVE MERRILL
Date: 6/7 /12 • Fee methodology set by'I'ri.tbrmty Building Industry Service Board
r: Bulls .niuvteC- renitAn.doc 03/07/12
4.6-461 TT (1 i ioaico>.uwr:Bl