Permit 1.
CITY OF TIGARD MECHANICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00531
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 1S134BD10100
Jurisdiction: Tigard
Site address: 11664 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: Bailey
Project Description: Gas Furnace and NC
Owner: FEES
BAILEY, CHARLES K AND Description Date Amount
SUSAN R, 11664 SW SPRINGWOOD DR
TIGARD, OR 97223 Air Conditioning 10/07/2009 $46.75
• Furnaces < 100K BTU 10/07/2009 $46.75
PHONE: 12% State Surcharge - Mechanical 10/07/2009 $11.22
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: Low
Total $104.72
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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: M A•1 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.
OCT-05-2009 MON 05:10 PM ROTH Ht !WEB /ED FAX NO 5032663478 P. 01
r
'Mechanical Permit Application volz 0141( .r. !is!: oNly
OCT _ _ Received
/ City of Tigard 020os
aite/By: Permit No.plic 3.1)0 -00
) III ---- 13125 SW 1-hdl Blvd.. Tigard,
Phone: 503.639.4171 Fax: 503.598.1960"-i t Y OF TIGARD Plan Review
Other Perrnit:
Dateaty:
Inspection Line: 503.639.4175
minim itillaillgillV44) Pate Ready Juris; la see Page 2 for
Internet www.tigard-or.gov
Supplemental Informadon
I wok -..„ .;•...:::.....::. - -•..,..::-....,.;::::,, ,.,.:;......, cOntiktikek4L F, i'''',itfc..Di4JE ':..7
0 New construction g Addition/alteration/replacement Mechanical permit f e e s * Are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
12 Demolition 13 Other.
mechanical materials, equipment, labor, overhead, and profit.
Value: S
••• i # 3100 : Ir r.ig : EQUI!* 1. 97:t•i l ftP0 t
1:g] 1- and 2-family dwelling 0 Commercia//industrial 0 Accessory building
For special information use checklist.
0 Multi-famil 0 Master builder 0 Other:
Description 1 Qty: 1 Ea. 1 Total
-;..... '''' ' ' . :' ,'1:. ! ;:-:. -•'":' '';'• ' ';';'..'.....::. . - : : : : ' '` ; :: 1 : ' : ::.'':: ' . : i ; :: :'.: lienthigkooling
Job site address: I I isi„ 5 6 1 , 16( (A ) 0 0 D( , Air conditioning or heat pump k i k _
Oceanus site plan showing placement) i 14.00 1
-
City/State/Zip: portio ',D9_---Jcri2:2-S Furnace 100,000 BTU (ducts/venis) i 14.00 1 -
Furnace 100.000+ BTU ideas/vents) 17.90
Suile/bIdgJapt. no.: I Project name;
Gas heat pump 14.00
Cross street/directions to job site:
Duct work 10.00
llvdmnie 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
Subdivisi '
Lot no • Flue/vent for any of above 6.80
on:
, .. — Other: 10.00
Tax map/parcel no.:
Other fuel appliances
, . r .:-• ::::•:'.‘:.•;.;:: .-•.::;:: ..,!,..,:, ..:,..,:::,'OF,.50R tpiickN, , ::, . ,.,:: .':.,. L ,;,E water heater 10.00 -
GAS hreplace 10.00
( - Filnoix I and Cl (C.1 Flue vent for water heater or gas
fireplace 10.00
Log lieu' gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
• .'. l'.,''':':',i.71F:#•iiiitilltig:rk,c)**1:i. '.- Chimney/liner/flue/vent _ 10.00
Other 10.00
Name: 1. 5us RA S ait Environmental exhaust and ventilation
a
c _
- Range hood/other kitchen
Address: it p . „ a i 611,Due
equipment 10.00
City/State/Z1P:
Clothes dpter exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( ,ir 40_67 „ Fax: ( )
toilet compartments, utility rooms) 6.80
:.:-,..;!;,-.' .';:-.;•:,....'::::;.:-. ::'.: r041;*11 ;•,*.:::".';?:::::;,.::. :•••• ...;: Altic/crawlspace fans 10.00
Other 10.00
Btsincss name:
Fuel pipim
Contact name:
$5.40 for first four; $1.00 for each additiona
Address: Furnace, etc.
Gas heat pump
City/State/ZIP:
Wall/suspended/unit heater
Phone: ( )
V7-- Fax: : ( ) Water heater
— Fireplace
E-mail:
Range
. '....,. ;.;:'•'...: :• :. ).,.-•, :-.4_ 7... _:. :;•., .-::....:, ' ?• ;.; ,:"::-.,.:...•;:,;;:,.•:!. : ‘,.......',. ......1
NI
Clothes dryer (gas)
Business name: O J I MIRIT • 13 . a. ‘ \
t
Other.
Address: 11 b to : - - 4 0 S ',.. ''. ' .. 1 ' .. . :;''.. • ■:'• ' StEtITANIC4 ttliNtirTgESff ..'-':.
. .. . . • , . .. . . . . .. . , , . • . • 1 . 1- ... 1-
City/State/Zip: _A --1P-4,4 alA f' 6 13 _ subtotal ..-sel---- (r3.5
Phone: gICF ) 2.,_Lo(ci, ( I L-4 4 9 Fax; 60> ) )-( 4 ) Minimum permit fee ($72.50) ir:S
Plan review (25% of permit fee)
CCB lie.: le() B
State surcharge (12% of permit fee) FARI, li 11. D.A.
_
TOTAL PERMIT FEE ri
Authorized signature: AIM Kea li '. This permit application expires If o permit is not obtained within ISO I 01 1.7).
days after it hue been accepted as complete.
Print name: A lt A,6 • , ._16. I Date: / MMINI • See methodology set by Tri-County Building Industry Service Board
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OCT-05-2009 MON 05:11 PM ROTH HEATING FAX NO. 5032663478 P. 02
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