Permit CITY OF TIGARD MECHANICAL PERMIT
in
III c COMMUNITY DEVELOPMENT Permit#: MEC2009 -00394
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 2S114BA10600
Jurisdiction: Tigard
Site address: 16355 SW WOODCREST AVE
Subdivision: Lot: 0
Project: Sherwood
Project Description: Replace gas furnace and heat pump.
• Owner: FEES
SHERWOOD CHARLENE Description Date Amount
3240 NW 112TH PL Air Conditioning or Heat Pump 08/04/2009 $14.00
PORTLAND, OR 97229 Furnaces < 100K BTU 08/04/2009 $14.00
PHONE: 503-690-2828 12% State Surcharge - Mechanical 08/04/2009 $8.70
Minimum Fee Adjustment - Mechanical 08/04/2009 $44.50
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503 - 266 -3478
( r
• J
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
•
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344
Issued By:
;3:44/1_e__ Perm ittee Signature: / G /e.w.7 jer( 7.
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.
•
JUL-30-2009 THU 04:53 PM ROTH HEATING .. FAX NO. 5032663478 P. 01/03
Mechanical Permit AnnlicatiaC- FON OFFICE 11SE ()NIA
City of Tigard z 0 '60 o rt i :; , z; . .ffigar r itrAll . ge
514 " 13125 SW Flll u Blvd., Ti -. gard, OR 97223 .. \ Illfa.■
,.., N DO Plan Review Perrnit No. 0etp 1,039A
Phone: 503.639.4171 FaX 503.598.1960 % 111,3 tvi.` , 1 k Date/By. Other Permit:
it I . ) Inspection Line: 503.639.4175 CY" V DIN ISIU Dale Ready/By: 1121 El See Page 2 for
Internet: www.figard Notified/Meihod: Supplemental Information
10 311.1)114G
7 .. z "1".. '; ..V :::-:'' : ;: ''.Y .', • . ' ''; : ,:r - TYPE- ilF . : ..:::'.. ......•,.•...., '...,-: :. 'cOmmeaci4L'tgkt; di Et •
0 New construction In Addition/alteration/replacement Mechanical permit fess* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
p Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
.• .. 4 • .-..':.• .'.'' ':''':- : - , •• OF. CONSTI1LICTION,.. '. . . • :. , . : f ,: •';'' ,-. Value: $
••,',
fZI 1- and 2-family dwelling 0 CommerciallinduStrial In Accessory building
Far special information use checklist
D Multi-family 0 Master builder 0 Other:
Description I Qty. I Ea. I Total
'.,- grrE; ANI.l.i..0eATION"... . : ,'.: , '.. ... " ''... Heating/ennling
Job site address: 1 ( 5 c : - - , 5 s c k , A ) ( A , ) 00 ci Cf .C.Si Air conditioning or heat pump
(requires site plan showing placement) 1 14.00 ii-1--
-
City/State/ZIP: — n 0\ . 01 ., /,--0/ , 0 le _ Furnace 100 BTU (duets/vents) I 14__LQ-:
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg./apt. no.: L ' i Project name:
Gas heat pump 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, sugiended. etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.:
-- Other: 10.00
Tax map/parcel no.: Other fuel appliances
.. • ...'::::'.`,"."':': , ''', . ',''''' : . OF,AVORK ',-.. ; ':. .:::'..... —...:`'.....::....e.•'...."' Water heater 10.00
10 00
, Gas fireplace
-R)Julcui and -tal
h- pump Flue vent for water heater or gas
QAADJR i,kt tiA,L79— fireplace
10.00
Log lighter (gas)
10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
10.00
. N , .•••:".;:' -: . - •• .YjEPIPROpEit : :; ‘ ... r :',.:••.:Ir,;:. ,:,-; • ... ... la, t ....,:,......-... '....., . Chimney/liner/flue/vent
Other: 10.00
... Name: eihaj ti SKtrij00001 Environmental exhaust and ventilation
Address: 3114 0 L O \2,--fil p a. cs_. Range hood/other kitchen
equipment i
10.00
City/StateJZ1P: ‘00 ( -1-1 art ( o(?... GI 1 2,251 Clothes dryer exhaust athooms, 10.00
Single-duct exhaust (bi
Phone: (50D LOCI 0 - .p. 3 Fax: ( ) toilet compartments. utility rooms) 6.80
eArPigAl,i " ''''' ,!: .: :CON11 :;, : .:.." Attic/crawlspacc fans 10.00
-
Other: 10.00
Business name:
Fuel piping
Contact name: SS.40 for first four: $1.00 for each additional
Address: _ Furnace, etc.
Gus heat pump
City/State./ZIP: WalUsuspended/unit heater
Phone: ( )
VI 1 Fax: : ( ) Water heater
Fireplace
E-mail:
Range
-„ -•:-:-..: . - • . ':'; .4 '.. " .... , .6.' •1 ;•,:::.-:..‘” CONTRACTOR , ...... , .. t '-.. , '[. ''' ' ..._,.' ! • : Barbecue
%
Business Clothes dryer (gas)
ss nume: II 0 lia. P. Other:
Address: I D +rs .DS .'-'!..',',". , ....'''AitimAsii6it'FiiirffkI.*;.',.N:
_
City/State/ZIP: Ca °k ( 13 Subtotal I, ---
Phone: 2.4). (-{'t 0
C'yn Fax: 65> ) )--(.10 Lie. 4 -it ___Plan review (25% of permit fee) .,.,
CCB lie.: \ 11/4t1 - ) 6 State surcharge (12 of permit fee) 14.
TOTAL PERMIT FEE 1 .1_4
Authorized signature: I a ettil This permit application expires if a permit is nut obtained within 180
' ' - K CA
days after it has been accepted as complete.
Print na.._..rltelfzLUKkt LQ,.it Date: *ri - ...0 Doi - Fcc methodology set by Tri Building Industry Service Board
lArluildmalPermia;MEC.Pereetwes doc 01/19/07 440 (1 IMVCONMVF.B)
JUL -30 -2009 THU 04 :53 PM ROTH HEATING FAX NO. 5032663478 P. 02/03
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