Permit . • ti
CITY OF TIGARD MECHANICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00547
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/16/2009
Parcel: 1 S134AD06800
Jurisdiction: Tigard
Site address: 10562 SW WINDSOR PL
Subdivision: Lot: 0
Project: Warren
Project Description: Changeout gas furnace
Owner: FEES
WARREN, ROBERT E Description Date Amount
10562 SW WINDSOR PL Furnaces < 100K BTU 10/16/2009 $46.75
TIGARD, OR 97223
12% State Surcharge - Mechanical 10/16/2009 $10.80
PHONE: 408 - 655 -3421 Minimum Fee Adjustment - Mechanical 10/16/2009 $43.25
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:
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, o • . ' uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Center. hose -s are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100 ou may obtain a copy of the rules
or • ect questions to OUNC .Ilin • ' or 1.800.332.2344.
/
I sued By: / �/ j 4 / Permittee /4/1/.
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-15-2009 THU 11:43 AM ROTH HEATING FAX NO, 5032663478 P. 01
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Mechanical Permit Application �'( ` -,/ � volt OWW I.I( r. I BSI': i)Nl,\'
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City of Tigard ' O C T a 5 2009 R atie' y : , ArO' . Gq ' p _ M. ;M- v Z . 7
ill ,--- • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 GIB OF TIGARD °atJ�' Other Permit:
,
,.,, A Inspection Line: 503 94175 BU DIVISIO' mot` 1 F M 2tor
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Mechanical permit fees* arc based on the value of the work
❑ New constriction MAddidon/aheration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: - mechanical materials, equipment, labor, overhead, anprafit.
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.0,1 -and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For specie! Information use checklist
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I �� r� Air conditioning or heat pump
Job site address:
to s Q .au, ) �) l S� Lk ( A , _ fr aims silo ahowm beement 14.00
City /Stale/ZIP: — r1 0 6 11 a Furnace 100,000 BTU (eneta/vents) I 19 W
1 Furnace 100,000+ BTU (ducts/vents) 177,90 0
Suite/bldgJapt. no.: U Project name: _Gas heatpump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic 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
Flue/vent for any of above 6.80
Subdivision: 7 Lot no.: - • Other 10.00
Tax map/parcel no.: Other heater e appliances 10.�/�
"I I Idl ,_,�'-11�..-..iv-40.0..~ Z I ' .;:.rl':• , C.�"..•,:t. Water heat 1
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rvy��.y pt� ' r •• r €,, �,��( %,, -' Gas fireplace 10.00
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C.. -1 (kS --y t f r\ �c _ C� 0 ,— K Flue vent for water heater or gas
V fireplace 10.00
L lighter (gas) 10-00 •
Wood /pellet stove 10.00
Wood fireemlace/insert 10.00 .
I _•,•.,, ri , i.•, �� , . 1 �'." , ^+, y' �' d`'• "' ' ^t' Chimn Ainer /flue/vont 10.00
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i ;" w�izlue 'lb� -f4 `' +.,aw' 7n�f, �,, 1 "ial��..ts 'Ri'.i�..h,1 -e..l ti +- !a•;:i YCtr 10.00
Name: ]‘c) W ('l C Environmental exhaust and ventilation
Range heed/other kitchen
Address: C.,, ( J _ equipment 10.00 _
City/State/ZIP: Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms,
Phone: (1j) (. 5, _ 3 a Fax: ( ) toilet compartments. utility moms) 6.80 -
Y) , 5u s Y (1 �' ! 1 ,t,y [ . ,r' e i �1/��}ry� (1 Sit,. ; Attiderriwls eCe fans 10.00
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Other _ 10.00
Business name: _ Fuel .1. in!
Contact name: $5.40 for first four: $1,00 for each additional �-
Furnaee, etc.
Address: G heat pump
Gas
aI U•
City/State/ZIP: ded/unit heater
1 Fax: ( ) Water heater
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Phone: ( ) Fir ' lace ,
E - mail: Range
p'., �, � J Ib ,u;,.�'••t I •V :. :-4 . • ?'• <r f`.'� J{ i L1 arbecue
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Business name:
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Other. y 'fah —� r . .. X11 >'1' "h '! -`r. r Address: pq—ti_4211(1:421s,
_ - �.� ..n, � ` • �t' Ire�9'fti�` -?. � ,t� h _.T1;'b City/State/ZIP: ( � \� 0 13 '',O. 'a' Subtotal II "7 — 4
) 2 {,p, l �(-(� 4 Minimum permit fee nmt fee)
Phone: 1 Far ) �jj (gin • P l an review (25% of permit fee)
CCB lie.: \ LtK� O State surcharge (12% of permit fee) n.„...-1-t) /0' OD
�/�/� �/ - -�- 1 TOTAL PERMIT FEE "� -�Cf'
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Authorized si rre: J days offer k ine boccepte complete. rJ�
Date: 1 d I I S Fee methodology set by Tri-County Building Industry Service Boar • �'
Print name: l
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