Permit � q CITY OF TIGARD MECHANICAL PERMIT
f: COMMUNITY DEVELOPMENT Permit #: MEC2012 00549
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 25111 BD00301
Jurisdiction: Tigard
Site address: 14530 SW 100TH AVE
Project: Quinn Subdivision: PEMBROOK HEIGHTS Lot: 1
Project Description: Installation of oil furnace
Contractor: ROTH HEATING & COOLING Owner: QUINN, DONALD R JR & SHIRLEY A
PO BOX 1265 14530 SW 100TH AVE
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 - 684 -0866
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/22/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/22/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/22/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Oil
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: I /4 _ALA Permittee Signature: .
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.
OCT -22 -2012 MON 03 :16 PM ROTH HEATING FAX NO, 5032663478 P, 01/01
FOR OFFICE 11Sl: ONLY
Permit Application Received ��� PannitNo ��.��� -�s�
City of T i g a r d A� Date/By: I
C
v 13125 SW Hall Blvd., Tigard, 0 9 Plan Review Other Permit:
il
i Phone: 503,718.2439 Fax: 503.9. 960 Dote/By: a Page for
Inspection Line: 503.639.4175 OCT 2 2 2012 Date auly/By: 0 See P 2 2 laformulion
T i v n li D R
Internet: www.ligard „nr,gov Notified/Method;
TYPEan MIMIC* 'COMMERCIAL M� p it tees` arc bused on the value of thew work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ New ut lion Oth erion/it{teration /replat emcnt r: mechanical materials, eyuipmcnt. labor, overhead, and profit.
El Demm ollitiition on ❑Othe Value: $ •
.. CATEGORY, .13F . CONSTRtJCTION. RTSIngr r1AC FQl1CP14tl;NT, / FizEs+
buildin For apedar information use checklist
® 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory g Description Qty. . . ToG31
CI Multi - family ❑ Master builder ❑ Other: -
Heatin coolin •
JOB SITE INFORMATION AND L'OCATiON.: Air conditioning 46,75
_ r uires GIN Ian shnwin l
Job site address: 14530 SW 100 Ave — Furnace 100,000 BTU (duels/vents) 1 46.75 46.75 -
City/State/ZIP: Tigard OR 97224 -
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt. no.: I Project name; QUInt1/34858 H eat pump
(requires_lta plan showing placement) 61.06
Duct work 23.32
Cmssu sweet/directions to job site: Hydronic hot water system 23.32
Residential boiler (radiator or 23 32
hydronic) ,
Unit heaters (tlrel -type, not electric), 46,75
in -wall, in•duct, suspended, etc.
Fluc/vent for any of above 23.32
Subdivision: Lot nn.. Other: 23.32
Tax map /parcel no.. Other fuel a liance -
Water hearer D ES CRI PTION UI +, WOR1G 33.39
' Gus ire. u insert
installation of oil furnace Flue vent for water heater or gas 23.32
fir place
Log lighter (gas) 23
_ Wood /pellet stove —. 33.39 -
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32 •
PROPERTY.OWNER �..TEPiANT Other: - , 23.32
Name: Dun Quinn Environmental exhaust and ventilation:
_ Runge hood /other kitchen 33.39
Address: 14530 SW 100 Ave equipment -
Clothe exhaust 33 -
City /Stute/LIP:Tlgard OR 97224 Singlc -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
F ax: ( )
Phone: (503)684-0866 ,
C ' Attic/crawls . ace fans 23 32
. .. .. • 0:'C,,QNTACif : PERSON .-- • . .0. APPI,ICAN'1'. Other: _ , 23.32
Busing name: Roth Heating and Cooling fuel piping: •
Contact name: Angela McGraw _ $14.16 for first four: $4.03 for each additional _
_ Furnace, etc.
Address: 6990 S Anderson Rd _ Gas heat pump
City/State/ZIP: Canby, OR 97013 _ Wall/suspended/unit heater
Fax :: (503) 266 -3478 Water heater
Phone: (503) 266-1249 I Fireplace
E -mail: uagefam@roth- heat.com Range
•
CON TRACTOR
Barbecue
Clothes d el ( )
Business name: Roth Heating and Cooling Other
.r ” :. '.,M.G'CHANICALPERMI� PERMIT .
Address: 6990 S Anderson Rd Subtotal 46.75 Ciry /State /ZTP Canby OR 97013 Minimum permit fee 90.00
Phone: (503) 266 -1249 Fax: (503) 266 -3478 Plan review (25 % uf permit fee)
State surcharge (12% of permit fee) 10.80
CCB lie.: 14008 i TOTAL PERMIT FEE 100.80
Authorized signal • Thls permit application net o
tion erplres f n permit Is oabtained within 180
M id / a-- doss after it has e s f accepted as et obtained
l'e.
., A r • / , � �� : 10/22/12 • Fen methodology set by Tri•Coun7 Building Industry 5erviw Board
Print name: Ang � _ Dote
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inHuildinulPUmitnlMEC- PermilApp�du 97!07 /l?