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Permit CITY OF TIGARD MECHANICAL PERMIT !PI COMMUNITY DEVELOPMENT Permit #: MEC2012 00546 TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012 Parcel: 1 S125DD02800 Jurisdiction: Tigard Site address: 6845 SW VENTURA DR Project: Ross Subdivision: WASHINGTON SQUARE ESTATES Lot: 19 Project Description: (1) gas furnace installation Contractor: ROTH HEATING & COOLING Owner: ROSS, CAROL PO BOX 1265 6845 SW VENTURA DR CANBY, OR 97013 TIGARD, OR 97223 PHONE: 503 - 266 -1249 PHONE: 503 - 245 -6842 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: Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 7 or 1.800.332.2344. , I A Issued By: Permittee Signature: DIU 4PPGIe4 Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. OCT -19 -2012 FRI 03:16 PM R /0 1 f E 1 . FAX NO. 5032663478 P. 01 Mechanical Permit Application FOR OFFICE IISE ONLY City of Tigard OCT 2 2 2012 o i /0 / - 0-- sf PermitNa1/6C Ap6a - D05 13125 SW Hall Blvd., Tigard, OR 97223 ,.„ P lan Rev • Phone; 503.718,2439 Fax: 503.598.1960t>fl 1 C�� Data/By: Other Permit: DIVISION T I G A K 0 Inspection line: 503.639,4175 BUILDING Date Ready /By: Jtiru, 65 Sec Page 2 for Internet: www,tigard- or.gov Notified /Matttad: 11 5, Supplemental Information . . MMIRICIAL. •FE *! •$QQTD,l1LE USE C1IE 9YRE: OF V1!.ORI( ;• . �.. ..:.. : CO' G ... - • � .,1 Mechanical permit tees• are based on the value of the work ❑ New construction is Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all mechanical materials, equipment, labor• overhead, and profit. I=1 Demolition ❑ O ther; Value: $ •CATEGORY OF 'CON TRUCT101 . .: g _ � � iRl; lVCIAL ,EQiIIEMEN1' /SVSTEMSFCo".. .: :'; El I- and 2-family dwelling ❑Commercial /industrial 0 Accessory building For special information use checklist ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. [ Ea. I Total " SITE . INFORMATION AND LOCATION .:.:, . lleating/couling: Air conditioning Job site address: 6845 SW Ventura Dr re aims site Inn Armin Inoonient 46.75 Furnace 100.000 BTU (ducts/vents) 1 46.75 46.75 City/State/ZIP: Tigard OR 97223 Furnace 100,000 -i- BTU (d 54.91 Suite/bldg. /apt. no.: Project name: Ross/36912 Heat pump (requires situ plan showing placement) 61.06 Cross street/directions to job site: _ Duct work 23.32 - jronic hot water system 23.32 Residential boiler (radiator or hydronic) 23,32 Unit heaters (fuel -type, not electric), in -wall in -duct, suspended, 46,75 I Lot no,: Flue/vent for any of above 23.32 Subdivision: Other: , 23,32 'Tax map /parcel no.: Other fuel a fiances: DESCRWTCON...0Fi WORK : .. Water heater 23,32 Gas fireplace /insert 33.39 installation of gas I•urnace Ffue vent for water healer or gas fireplace 23.32 Lo li ter ( us) 23,32 Wood/. act stove 3339 Wood fireplace/insen 23.32 PROPER OWNER' n v mcr /(]ue/vcnt ...., , .::: � Other: 23.32 Name: Carol Rosa Environmental exhaust and ventilation: Range hood/other kitchen Address: 6845 SW Ventura Dr e•ui.meat 3339 City /State/ZIP: Tigard OR 97223 Clothes d er exhaust — 33.39 Single -duct exhaust (bathrooms, Phone: (503)245 -6842 Fax: ( ) toilet com.artments, utilit rooms) 2132 APPLICANT' ' ' , • :; 0! CONTACT PERSON Attic/crawls ace fans 23.32 • Other: 23.32 Business name: Roth Heating and Cooling - Fuel piping: _ Contact name: Angela McGraw -- for first four: $4.03 for each additional •_ Furnace, etc. Address: 6990 S Anderson Rd Gas heat pump City /State /ZIP: Tigard OR 97223 Wall /suspended/unit heater Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater Fireplace E-mail: angelam ©roil -heat cum Range •• CON F'RACTO , . .. , . Barbecue • Business name: Roth Heating and Cooling Clothes dryer (ga _ — Other: EES " Address: 6990 S Anderson Rd 1;.';,':. :. :::: '.. Mf�G7iA'N[CAL.P1~RMl' ' ,...:. ' , ; . . ' SubtoGll 46.75 Ciry /StuX&Z1P: Canby OR 97013 Minimum permit fee (190.00) 90,01) Phone: (503) 266..1249 Fax: (503) 266-3478 T Plan review (25% of permit fee) CCB lic.: 14008 State surcharge (12% of permit fee) 10.80 TOTAL PERMIT FEE 100.80 / This permit application expires if a permit is oat obtained within 180 Authorized signature' , O , (l \ days after it has boon accepted as complete. Print name: Ante • - raw ( u j r Date: 10/19/12 I • Fee methodology set by Tri- County Building Industry Service Board 1:1nuidiii \pem+itmEC- PermitAPP.doe 01107/12 440.4617T (I1/o;/COMAV68)