Permit CITY OF TIGARD MECHANICAL PERMIT
II • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00349
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2012
Parcel: 2S110BA06000
Jurisdiction: Tigard
Site address: 14252 SW MCFARLAND BLVD
Project: Roth Subdivision: SHADOW HILLS NO.2 Lot: 43
Project Description: (1) duct work, (1) range and (1) fuel piping for range relocation
Contractor: HYBRID HEATING & AIR CONDITIONING CO. Owner: ROTH, DAVID
PO BOX 329 14252 SW MCFARLAND BLVD
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503 - 357 -5663 PHONE:
FAX: 503 - 357 -0668
FEES
Specifics: Description Date Amount
Duct Work 07/09/2012 $23.32
Type of Use: SF Range Hood /Other Kitchen 07/09/2012 $33.39
Class of Work: ALT Type of Const: Fuel Piping 07/09/2012 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 07/09/2012 $10.80
Stories: Minimum Fee Adjustment - Mechanical 07/09/2012 $19.14
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
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Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. �. /► —� f ,O1W
/ /
Issued By: 3 .232. Permittee Signature: 9 .s p iL.
Call 5(03639.4175 I't
by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Mechanical Permit ApplicatHECENED FOR OFFICE I. OINL\
City of Tigard Y . I ` a Pe tmit N• i • - 00
UL O 9
W 13125 SW Hall Blvd., Tigard, OR 972 Z 12 Plan Review
Phone: 503.639.4171 Fax: 503.5g$, Other P • ST 90(1 0001'
1 , oat�ray:
1 i i s A It. I. Inspection Line: 503.639.4175 OFT/Gq pn Date Ready/By!' twit if See cage 2 for
Internet: wigard or,gov BU QD N1S1 U 01� Notified/Met od: dig Supplemental Informat
,./ TYPE Of WORK COh RCI(AL:.]f> E . SCHEDULE - USE CHECKLIST
12 New construction LY1 Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials. equipment, labor, overhead, and profit ,
CATEGORY OF CONSTRUCTION Value: S
g 2-family dwelling , RESW EQU�T / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family 0 Master builder ❑ Other: Description J Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION 'Heating/cooling
Job site address: Air conditioning
i tiaes� u �G � , � �� , (requires site plan showing placement) _ 46.75 •
City /State/2IP: 1 j AR 77193 Furnace 100,000 BTUSducrs/venta) 46.75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg. /apt. no,: Project name: CM - 744 Af Heat pump 61.06
Cross street/directions to job site: Duct work r 23.32 ar
Hydronic hot water system 23.32
Residential boiler (radiator or •
hydronic) 23.32
Unit heaters (fuel -type, not electric).
in -wall, in- duc�uspended• etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
• Other: - 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF • WORK Water heater 23.32
_ Gas fireplace 33.39
/ -f t /_, % r' "' i , ,�, L I . _ / / - - Flue vent for water heater or gas
fireplace 23.32
J - /VOA / 0/44 s r `i > 0 6e Log lighter (gas) 23.32
/9714Er::... ( 199 - Wr�I�T Wood/pellet stove 33.39
,�/ '�-'''"''"" Wood fireplace/insert - 23.32
tr PROPERTlt OWNER • I 0 TENANT OtnneyAiner /fluel 23.32
Other: ' 23.32
Name: i pA.� Q o Environmental exhaust and ventilation
• Range hood/other kitchen
Address /`
/ W )fl S : a ui o PR. ment I , 33.39 33.FT y�
City /State/ZIP: j ��e OR 72.127 Clothes dryer exhaust 33.39
C' / Single -duct exhaust (bathrooms,
Phone: ( ) , I Fax: ( ) toilet compartments, utility rooms) 23.32 •
I2 APPLICAN ..0 CONTACT .PERSON • Attic/crawlspace cans 23.32
Other; 23.32 _
Business name: 04, i
Contact name: R✓.tN 514.15 for first four; $4.03 for each additional
Furnace, etc.
Address: a'30 , N p , - ' ` ,1, SQL-se t 9 Gas heat pump
City/State/ZIP:edgma ' ' / 'm us l WaWsuspended/unitheater .
Phone: ( l5 j 35 / 3 /� 0,, Fax:: (t5b3 as7 Cage Wreerea er
E -mail: 4 4 g NY13 n 4L O14 . 6.4 - Range 1 . / 1 4 16-
CONTRACTOR . Barbecue
,9yy -4� 6 r-R t� N / 1 i Other: dryer (Ras)
Business name:
rQ - D- ' d other: i�iz oC.9r�'" a95
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Address: •
._ % L ..- / y y R. > rr i« ►> < :PERIrm FF,>ES*
City /State/ZIP: Ci ( L d .77147
subtotal 70.
($90.0
f 7 f Minimum permit fee ($90.00) rr& O�
J Pone: ( �0,3 ) 33 7- 6bU Fax: (� ) r 5 7 o6480 Plan review (25% of permit fee)
B Ho.: / cer 763 . State surcharge (12% of permit fee) 40. /
• TOTAL PERMIT FEE /al. $Q
i This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
Print name: ��i�/� I Date:�� 7 �� /� -,' • Fee methodology set by Tri -County Building Industry Service Board
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ll tiuildingt ?amiu 10101/09 440.461Yr /COM/WEB)
Hybrid Heating & Air Conditioning •
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McClenny RHC
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P. O. Box 329
Cornelius, Or 97113
Phone: 503 -357 -5663
Fax: 503- 357 -0668 •
Fax
1 . 14 1 4 Prom: Hybrid Heating & AJC 44EVI#' &A
Date lei / v
Pages incl. Cover. -a 10k-
Fax: 5 03 — SW- /905 • CC: •
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