Permit V CITY OF TIGARD MECHANICAL PERMIT
. • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00544
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 2S114BC01000
Jurisdiction: Tigard
Site address: 10100 SW RIVERWOOD LN
Project: Boekelheide Subdivision: PICK'S LANDING NO.1 Lot: 65
Project Description: Installation of gas furnace.
Contractor: ROTH HEATING & COOLING Owner: BOEKELHEIDE, LINDA TRUSTEE
PO BOX 1265 10100 SW RIVERWOOD LN
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 - 620 -4641
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: 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 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: Cea Permittee Signature: CD)
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 11.11 AN ft' I :QED FAX NO. 5032663478 P. 01
Mechanical Permit Application OCT 2 2 2012 colt OFFICE, USE ONLY
Received e /a — �ss / ,
City of Tigard ^ OF Dale/By: /o R . r PI3rmit Na.:
q 13125 SW Hail Blvd., Tigard, OR 972:a..
�1 �ryry��qq
NI C ' Phone; 503.718,2439 Fax: 503.503 ILU11VG DI SION m- Doiduy cw Other Permit:
T I G A R D Inspection Line: 503.639 Dale Ready /By: tug el Sea Page 2 for
Internet: www•tigard- or•gov Nntifled/Methnd: Supplemental Information
• . . Ti 00:: WORK • CIAL h'itir�: aCREEKJI:� ::: 1SE•CHECK�:IS^e
. coMNiit
Mechanical permit fees* are based on the value of the work
❑ New construction El Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipmcnt overhead, and profit. -
...' CATEG QR011+. ::QONVS1'RUCTION; ..:..
_ RESIIDENTIAG EQUfPM1.NT�•I:SYSTEMS :illP6.. .
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spec al Information use checklist,
0 Multi - family ❑ Master builder 0 Other: Description Qty. Ea. Total
• • JOS SITE IOVFORMATION. •AND LOCAT1O NcutlnPJcoulins:
-- Air conditioning
,lob site address: 10100 Rivcrwood Lane (requires site plan showing placement) 46.75 _
City/State/ZIP; Tigard OR 97224 Furnace 100,000 BTU (duets/vents) I 46.75 46.75
Furnace 100,000+ B'I'U (dum/vents) 54.91
Suite/bldg. /apt. no.: I Project name: Boekelheide/36874 Heat pump
(requires site plan shewin jacament) _ 61.06
Cross street/directions to job site: Duct work 23.32
Idvdronic hot water system , 23.32
Residential boiler (radiator or
hvdronic) 23.32
— Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flu/vent for any of above 23.32
Other: 23.32_
Tax Wrap /parcel no.: ' Other fuel appliances;
DESCRIPT1ON ;'.i`. Water heater 23.32 •
Gas fireplace/insert 33.39
installation of gas furnace Flue vent for water heater or gas
ftre .lace 23.32
Log lighter (gas) 23.32
Wood/. cllet stove 33.39
Wood tirettacc/insert 23.32
' ! ®,p ..:, 0; TENANT Y mcr /iluelvent
Chimn A� 23 3�
- Other. 23.32
Name: Karl Bockeiheidc Environmental exhaust and ventilation:
Address: 10100 Riverwoad Lane Range hood/other kitchen
equipment 33.39
City /Statc/ZTP:'l Tigard OR 97224 Clothes dryer exhaust 33.39
Phone: (503)620-4641 N ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) _ 23.32 _
® APPLICANT. . • ':: • ; [o CONTACF: ` Attic/crawispace fans - 23.32
Business name: Roth Heating and Cooling Other: 23.32
Fuel pining:
Contact name: Angela McCraw $14.15 for first four, 54-03 for each additional
Address: 6990 S Anderson Rd Furnace, etc.
Gas heat pump .
City/State/ZIP: Canby OR 97013 Wall /suspended/unit heater
Phone: (503) 266 -1249 1 Fax: : (503) 266 - 3478 Water heater
E -mail: angelam(a�roth- beat.cum R a n g e lace
Range •
. • . .. CONTRACTOR ' Barbecue
Business name: Roth Heating and Cooling • Clothes dryer (gas)
Other:
Address: 6990 S Anderson Rd :81geB iCA1 a1RNi1T:I1E S! .' • •
City /Statc/ZIP: Canby OR 97013 Subtotal w 46.75
Phone: (503) 266 -1249 I Fax: (503) 266 -3478 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit tee)
CCI3 lie.: 14008 State surcharge (I2% of pemiit fee) 10.80
—
t� TOTAL PERMIT FEE 100.80
Authorized signutur )i0 t This p er mit app licat ion expires if a permit 4 not obtained within 180 -
! � , / i �� / , _ day after It has heea accepted as complete.
Print name: Angell" ■ Date: 10/19/12 • Fee methodology set by Tri -County Building Induauy Service Bon d ,
Imelldiratramlw\ EC -P rmi:App�dee 03/07 /1: 44(N6ITr ICoM/wea) �uIJ