Permit CITY OF TIGARD MECHANICAL PERMIT
1111 Z COMMUNITY DEVELOPMENT Permit #: MEC2012 -00481
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/20/2012
Parcel: 2S104DA22300
Jurisdiction: Tigard
Site address: 12938 SW PRINCETON LN
Project: Rhodes Subdivision:)UAIL HOLLOW SOUTH TOWNHOMEE Lot: 49
Project Description: Conversion of electric to gas furnace. Run gas line to furnace location.
Contractor: ROTH HEATING & COOLING Owner: RHODES, STEPHEN MICHAEL
PO BOX 1265 12938 SW PRINCETON LN
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 348 -8240
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/20/2012 $46.75
Type of Use: SF Fuel Piping 09/20/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 09/20/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 09/20/2012 $29.10
Stories:
Fuel
Fuel Types: Natural Gas
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 N. • - . . - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d -ct questions to O C • ailing 503.232.1987 or 1.800.332.2344.
I- ued By: l / let4/41(4.4 Permittee Signet re:
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.
SEP -19 -2012 WED 02:21 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application Firp „, .� IC OrricE list. ()NIA'
City of Tigard - , - ■ll• : ' ' /9 Permit No.: p 0/2 Gl' b
4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
m '' PI►ottc: 503,716.2439 Fax: 503.598.1960 SEP 19 2012 Date/By: Other Permit:
T I G A R D Inspection Line; 503.639.4175 Dine Remiy /By: mrin: 0 Sec Pngc 2 for
Internet: www.tigard-or.gov
CITY o f : `i , Notified /Method: Supplemantnl Information
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Mechanical permit fees* arc bused on the value of the work
❑ New construction ra Addition /alteration /replacement performed, Indicate the value (roundcd to the nearest dollar) dull
❑ Demolition ❑ Other: mechanical materials, equipment, tabor, overhead. and profit
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rEi 1 - and 2 - family dwelling ❑ Commercial /industri ❑ ory bu xor speelrrl Information use checklist
0 Multi - family ❑ Master builder ❑ Other: Description Qty, I fro. j Total
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Jo silt address: 12938 SW Princeton Lane site elan showing placement) _ 46,75 _
City/State/ZIP: Tigard, OR, 97224 Furnace 100.000 BTU (ducts/vents) I 46.75 46.75
Furnace 100,000+ HTU (duets/vents) 54.91
- Suitc/bldg. /apt. no.: Project name; Rhndes/35542 Heat pump
' (requires site plan showing placement) 61.06 Cross street/directions to job site: SW Guurt)e St/SW Walnut Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
• - Unit heaters (fuel -type, not electric),
S' in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23,32
Other: 23.325 i
i Tax map /parcel no.: Other fuel appliances:
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i 2 j*! 4 : : :: :!v I IQ ' b91 ... J ; i };i !.. ,... ii Water 23.32
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Change out electric furnace to gas furnace <1.. Gus fireplace insert 33.39
Flue vent for water heater or gas
Run gas line to furnace location fireplace 23,32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23,32
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fr �� 1 l {;_f,!�'•C Chimnev/lincr /flue/vent 23.32 23
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i I l tmilizotiff; ' �'� r'.f�� 01iik� limi�1! !!�!. ; 1 : ; ! • :H �! i { fl .!.. I ��'tl • a l r
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Name: Steve Rhodes .� Ether:
Environmental exhaust and ventilation:
▪ Address: 12938 SW Princeton Lane Range hood/other kitchen
- equipment 33,39
• City/State/ZIP: Tigard, OR. 97224 Clothes dryer exhaust 33.39 -
Single -duct exhaust (bathrooms,
Phone: (503) 348 -8240 Fax: ( ) toilet compartments, utility moms) 23,32
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Business name: Roth Healing Other; 23.32
- - Fu el piping:
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Contact name: Barry Zenner $14.15 for first four: $4.03 for each oddUtnnal
Addresit; 6990 S Anderson Rd. Furnace, etc. 1 14.15 14.15
a Cww heat pules
City /State/Z1P: Canby, OR. 97013 - Wall /suspended/unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater
Fireplace
E-mail: barryz@roth- hcat.com
Range
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Business name: Roth Heating Clothes dryer (gas) i
Other,
Address: 6990 S Anderson Rd. V :��J�!I�'itO, i iilIt iY IA , ° 4*ai.'s .TtRl ; ?i FS;'r :Ia. ,i��;�a ' ?i si��.'''
City /State /ZIP: Canby, OR. 97013 Subtotal 60.90
0
Phone: (503) 266 -1249 Fax: (503) 266-3478 Minimum permit fee ($90 -00) 9(1,(10
Plan review (25% of permit fee)
CCB lie.: 14008 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT F 100.80
Authorized signature: This permit application expires If a permit is not obtained within 180
d ays otter it has been accepted as complete.
Print name: Barry Zaunor / Date: 9/19/12 • Fee methodology set by Tri- County Building Industry Service Board
I ;IOuildi. Pe mit5'MEC -Put ltApp,doc 03/57/12 40 (11 /07/COM/WeB)