Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 00168
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2013
T [ Cs'A.FtL� Parcel: 25111 CB00600
Jurisdiction: Tigard
Site address: 14820 SW 103RD AVE
Project: Shelley Subdivision: DEL MONTE SUBDIVISION Lot: 5
Project Description: (1) gas furnace installation
Contractor: ROTH HEATING & COOLING Owner: SHELLEY, SAMANTHA J
PO BOX 1265 14820 SW 103RD AVE
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 - 1249 PHONE: 503 - 707 - 9360
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/27/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/27/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/27/2013 $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 or 1.800.332.2344.
Issued By: talidejl ChLed— Permittee Signature: D AP /UC�fo4
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.
MAR -26 -2013 TUE 09:51 AM ROTH HE FAX NO. 5032663478 P. 01/02
Mechanical Permit Application RECE
City of Tigard Received cr Permit No.; / Qer X( 3 -a) / 0
y MAR 2 6 201 Date/Oy;
�� 13125 SW Hall Blvd., Tigard, OR 97223 Plim Review
Phone: 503.718.2439 Fax: 503.598.1960 llote/dy' Oilier Permit:
TI G A R D Inspection Line: 503.639.4175 Iuin: 83 See Pa e 1 fur
C ITY OF TIG )nln RaadylBy: S
Internet: www.tigard- or,gov BUILDING DIVISI Ni realMethod: ( n& Supplemental information
TYPE . WORK . ` . CONENERCIAI PEE*, 'SCHEDULE �= .1.1%C:1IECKLIST•.
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
[] Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Values $ _
' ., • CATEGORYO
;• F, :.CON 'R 4 T1ON ... „ „ y MiN'TISYSTPMS:REES"
Iid'1DEN FIAL.)LrQil[P
® 1- and 2- family dwelling ❑ Commercial /industrial [] Accessory building For spcclrhlluformalldn use checklist.
❑ Multi- faini1y C Master builder ❑ Other: Description j Qty. 1 Ea. I Total -
1fOB •SITE )NFORMATION AND„ LOCAT1ON .' Heating /cooling:
Air conditioning
Job site address; 14820 SW 103 " Ave he aims site 'Ian showin • .Incementl 46.75
Furnace 100,000 BTU (ducts /vents) 1 46.75 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+ BTU (ducts/veins) 54.91
Suite/bldg./apt, no.: I Project name: Shelley /43296 Heat pump
_ (re aims she plan sh placem 61.06
Cross street/directions to job site: Ductwork 23,32
Fronic hot water system 23.32
Residential boiler (radiator or
h onic) 23
Unit heaters (fuel - type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: l Lot no.: ,^ 23.32
Other. . -
Tux map /parcel no.: Other fuel appliances:
DESCKIPTION.OF WORK..., , •Water heater
Gas fireplace /insert 33.39
Installation of gas furnace Flue vent for water heater or gas
fireplace 23.32
- - Lo 1i hter as) 23.32
Wood/pellet stove 33.39
Wood lire i Iacc /insert 23.32
Chimney /liner /0ue/vent 23.32 •
® •PROPERTY OWNER ' ` 'f_N : . - Other. 23.32
Name: Samantha Shelley Environmental exhaust and vcnl lallon:
Range hood/other kitchen
Address: 14820 SW 103n Ave equipment 33.39
City/State/ZIP: Tigard OR 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone; (503)707 -9360 Fax: ( ) toilet compartments. utility rooms) 23.32
® APPFICAN'I' .. '
, " ID ' CONTACT. . PERSON:, . i : !; Attic/crawlspacc fans 2332
Other: 23.32
Business name: Roth Heating and Cooling Fuel piping:
- - Contact name: Angela McCraw $14.15 for first four; $4.03 for each additional
Address: PO Box 1265 Furnace, etc.
Gas heat Bump
City/State/ZIP: Canby OR 97013 Wall /suspended /unit heater
Phone: (503) 266 -1249 Fax: ; (503) 266.3478 r Water heater -
Pi • lace
E -mail: angelnincjroth- heatcom Range ,
,. ,,.CONTRAt:TOR ;; , ..,
Barbecue
Business name: Roth Heating and Cooling Clothes dryer (gas) _
Other:
Address: PO Box 1265 . '• • . Mji''C,HANCCAL.PERMI.T:FT.Fr :.. ; • •.
City/Stale /ZIP: Canby OR 97013 Subtotal 46.75
Minimum permit fee ($90.00) 90.00
Phone: (503) 266 -1249 Fax; (503) 266 -3478 - _ Plan review (25% of permit fee)
-
Cell lie. :140(18 State surcharge (12% of peniit fac) 10.80
TOTAL PERMIT FEE 100.80
This permit application expires if a permit is not obtained within 180
Authorized signs , 1 ^ i 1 i • (__ days after it has been accepted as complete.
Print name; Ant ' cGraw 11 Date: 3/26/13 • Fco methodology set by Tri -County Building Industry Service Board
h \OuildingI rrsiis\55 c rtnlhApp.doc 0716711. 415.1817T(I1 /n7./COM/WGB)