Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00652
Date Issued: 12/11/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 2S1146C04200
Jurisdiction: Tigard
Site address: 10452 SW BONANZA WAY
Project: Smith Subdivision: RIVERVIEW ESTATES NO.2 Lot: 79
Project Description: (1) gas furnace installation and (1) water heater installation
Contractor: ROTH HEATING & COOLING Owner: SMITH, MARK H
PO BOX 1265 10452 SW BONANZA WAY
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE. 503 - 806 -1594
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/11/2012 $46.75
Type of Use: SF Water Heater 12/11/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/11/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/11/2012 $19.93
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 or 1.800 332.2344.
Issued By: c /� / A L O Permittee Signature: au 4f / (CA- �'76K'
Call 50 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.
DEC -10 -2012 MON 04 30 PM RO FAX NO. 5032663478 P. 01
Mechanical Permit Applicati IVE t FOIROFFICE USE ONLY
City of Tigard DEC 10 2012 rtataivia I 1 0 0.... `3C Pomo Nd l A,« - 00 (4 0--
1 g N 13125 SW Hall Blvd., Tigard, OR 97223 Date/ay
Plan Review
Phone: 503.718 2439 Fax: 503.59,196 CITY OF TIGARD Dare/By: Other Permit
_
T IGARID
Inspection Line. 5036 39,4175 Date Rae y/1 y: Juris: see rni c 2 far
Internet: www.tigard- or-guv BUILDING DIVISION , t ' Notified /Mathu4; - Supplememutlnrornwtion
TYPE OF WORK COMMERCIAL FEE* SCHEDULE -. USE CHECKLIST
Mechanical permit fees" are based on the value nl' dte work
❑ New construction Ej Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other; mechanical - materials, equipment, l_ubur, cive1'ltcad, and profit.
Value $
CATEGORY OF CONSTRUCTION RESIDEN'T'IAL EQUIPMENT /SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty, Ea. _ Total
_ - •1OB SITE INFORMATION AND LOCATION Heating/ cooling: cooling: ..m
,,,,- - Air conditioning
Job site address: 10452 SW Bouanaza Way (ruquires site plan showing placement) 46,75 —
Furnace 100,000 BTU (dims/veins) I 46.75 46.75
City/State/ZIP: I'i Tigard, y g' _ Furnace 100,0On+ 1310 (duels/vetns) 54.91
Suite /bldg. /apt. no.: Project name: Smith /39095 Heat pump
4
(require. site plan shawinphwelnenl) (i 1
Cross street/directions to job site: Duet work _.. 23.32
^- Hydrunie hot water system 23.32
w ,., Residential boiler (radiator or
hydronic) _ 33.32 —
- Unit heaters (fel -type, not electric),
in -well, in -duct, suspended, etc, 16.75
Subdivision - Fol. Flue /van[ for any of above 23.32
- Other; _ 23.32
Tax map/parcel no.: : u Other fuel appIientees:
DESCRIPTION OF WORK Water heater I _ 23.32 2332
installation of gas furnace and water heater Gas vv ce/ins 33. 39
Flue vent for watt er er heater or gas
fireplace 23.32
I,ng lighter (gas) 23,32
�� Wood /pellet stove 33.3`0__
y Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT •
Chimney/liner/flue/vent 23.32
--- - Other: u 23.32
Name: Mark Smith E nviruti mental exhaust and ventilation:
Address: 10452 SW Bananas Way Mange hood /other kitchen
equipment _.._,. 33.39
City /State/ZIP: Tigard OR 97224 Clothes dryer exhaust 33.30 _
Single -duct exhaust (bathrooms,
Phone: (503)806 -1594 I Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON • Attic/crawls ace a funs 23.32
Business name: Roth heating and Cooling Other. _ 23,32
-..^ - Fuel tpinR:
Contuet name: Angela McGraw $14.15 ram first fnq: $4.03 for rich ndditian;rl
Address: PO Box 1265 _ Furnace, etc. _
Gas heat pump
City /Stale/ZIP: Canby OR 97013 — _-
Wall/suspended/unit heater
Phone: (503) 266 -1249 J ^ � fax; ; (503) 266 -3478 Water heater
Fir place
E -mail; angeIumG ±broth- hcat.cotn Range
CONTRACTOR Barbecue _
Business name; Roth Heating and Cooling _Ctotlies dryer ((;as)
Other:
Address: PO Box 1265 MECHANICAL PERMIT FEES*
City /State /ZIP; Canby OR 97013 _ _Subtotal 70.07
- -- -' T Minimum permit fee ($00.00) 90,0(1
Pho11e; (5U3)266 -1249 Fox; (503)266-3478 ...
Flan review (25 %ol'permit toe) _
CCB tic,; 14008 _ I Suite surcharge (12% of permit fee) 10.8_0
--• \ TOTAL PERMIT FIE 100.8(1
Authorized signature: r I' A. This permit application expires if a ae
permit is not obtained within t
1 �L J days after it has been ucceptal as complete,
Prim name; Angela ` 'aw ( .)ale; 12/10/12 I • Fee methodology eel by'I'ri- County Building Industry Service Board
I :lauildinuU'urmiielMi - Perinioppeoc 01/u7/12 4.10.451 Tr(I1iovcosiiWia)