Permit CITY OF TIGARD MECHANICAL PERMIT
111 11 COMMUNITY DEVELOPMENT Permit #: MEC2013 -00346
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2013
Parcel: 2S102DD01604
Jurisdiction: Tigard
Site address: 8860 SW EDGEWOOD ST
Project: Lasniewski Subdivision: EDGEWOOD Lot: 7
Project Description: Installation of NC. Placement of A/C or heat pump units must comply with the manufacturer's clearance
requirements.
Contractor: ROTH HEATING & COOLING Owner: LASNIEWSKI, WILLIAM L
PO BOX 1265 8860 SW EDGEWOOD
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 887 -8291
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount.
Air Conditioning 06/25/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/25/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/25/2013 $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 OUN b calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: C5A7 e9 ' /���� jrJ/✓
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.
JUN -21 -2013 FRI 01:57 PM ROTH HEATING FAX NO. 5032663478 P. 01
I
Mechanical Permit A licati FUR OFFICE t,SI: ONLY
City of Tigard ; r:n:fv '
i 13125 SW Hall Blvd., Tigard, OR 97223 `� /
1 • Phone: 503 718 2439 Fax: 503.598.1960 JUN 013 Plan Review
Inspection Linc; 503 639 4175 "` ���"' “ “" Date/By. Other Permit;
TIGARD P
Dote d/1f e thy; ii ad• • ;� gee rap rap upplementu I b
ormation
Internet: www,tjgard ^eLgoV
CITY ®FIGARD Nont
T - 1ed/Mth 9tlnf
t'!i •'i ., i, �, `141 '1i � , , .,, 1f ..,, .,1, a''Y'r � i t dJ � � „
1 .in ' i l i ; i j� 1, I',i ! . � vl � jili;'r� IS A L L'_ elji'i�t�Jlji:. l l' gypp `.IQry jj I 'I 01 l irli ' ,- ,r'!Ir1��**E1i. C , -• � -, �
i . :: 1..,.i,,. F'Il l lli,t „ �1.r''I'il';3I•I:;i '''' `n!!' * i cai , ,T P- ees .. ;
'I 415' ,.., th il?J�SI � !• �h
❑ New construction [El pemut fees arc bused on the value of the work
® Ad dition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit.
!; b! is l,, ;r . •;l„ ;, ;, t,, , .. ;I't „1 ; Ir i ; . , Valuer
i . i il, i,l'I. 4 . i',, ` ,;,, ; i ?b ?�;1 .P „, 5�1yy}} � r!+' i ' 1 , , 1 ' 1 i 1` i b 1 ; 1 i $
r„ .� t10:00 ,iii,--,'— � I- , h I'i' �1. I il� ii i l4.7:1",10 P n., y .. PR to i 1 ,
® I - and 2-family dwelling Commercial/industrial �I'�h; � �hl'J' , 'I i��j,Q .,� ,�(�$"� t j ' �� � ' I '; �;�'�I
Y g 0 nmercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi -family ❑ Master builder ❑ Other:
Description I Qty. [ Ea. Total
Iillt l'� {I'; j; �' I,I111 ��I; I,I I,li i' i' l "d h{ �r ��i,,� �•, i �di r i ,q.�,� „ n, ', " r l i; 'til lrC l' ', ,1`1f , '1f;; , 1:1,V Heating/cooling:
i ^i 'nbl e R,I'.1 l i! OttK,i3.10 ?h , (,� � jh`i 0 I1;, 1 t Irhi 'i'!'' rn
I, t °� �'i��''YBttq PIT11A1'"�'rll, o�rltl,, I I,Illr, i :1! :,
Job site address: 8860 SW Edgewuod St Air common 1 46.75 46,,75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,00 BTU (ducts/vents) 54.91
Suite /bldg,/apt. no.: Project name: Lnsniewslci/46606 Heat pump 61 06
Duct work 23.32
Cross street/directions to job site: Hydronic 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
Flue/vent for any of above 23.32
^Subdivision: I Lot no.; Other: 23 32
Other fuel appliances:
Tax map /parcel no : Water heater 23.32
' :r iitt, I'I ii i;l!:'„ •rY':''i''�', 1 . �,;
I '� I(Jh i'l 'F „L' 'r r' I;;'j i
1'i�' Ii I S ' �'�o 7. "111'1
,�
t ''„ ' - ':1' -'1” t I•.i ,,y � ii,ip,lt; *'i+44. 1 Hl�'}31�C ,i�l�l4' "1�1'i!I'Y1 I' 1, Flue ;
r ,�'� ,,�'1!1I,�',.,,.III.I.I II,I',til i�� {i II'',�
T Flue vent for water banter or gas 33.39
installation of air conditioner fireplace 23,32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
_ Wood fireplace /insert 23.32
Chimney/liner/flue/vent 23.32
"� li��„�P,T41I'rl'' I1,`' „.1.c,i 11x„ ;Ip )! n „ , ''jall;i;ll;i 'i�',r,;,;,; ' °1-4”: 23.32
dI ,; J,;, ; i19! ,7 ! I,r a ., 1 ;+il,I lj', IIIIi:,11i 'It,�J'Iii:11 jt'11:0l�.lr', 4 / 11,11,11'�li�ul','0,- 011'i'I.i, •
' " ' Tnvironmeotnl exhaust and vcntiltttion:
Name: Bill Lasnlewski Range hood /other kitchen
equipment 33.39
-
Address: 8860 SW Edgewood St Clothes dryer alma. 33 39
City /State /ZIP: Tigard, OR 97223 Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (503)887-8291 Fax. ( ) Auic/crawlspecc fans 23.32
i ii � I ,ii 'r � � i II: �11,�h ,I i 0 ,,P r �,}rt; '•i rn T ,r ,,, r I I
' ' . ;:1.' 0'! iiiiioC ire I ' ' r :1 I '�,. , c ; I I r ' ; 0CI i.,a 1'' Other. 32
,., ; . i l' � ; f " '�: � ;;.. I I,; il, I l`gi�i�,1�v';l'�G!ij , ,�i•Pi�I 1�, i,,�l e aa.
Business name Roth Heating and Cooling Fuel piping:
$14.15 for first four: £4.03 for each additional
Contact nume; Angela McGraw Furnace, etc.
Address: PO Box 1265 Gas heat pup r
Wall /suspended /unit heater
City / State/ZIP: Canby OR 97013 Water heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Fireplace
E -mail: angelam@roth-licat.com
Range
„ ''I' i itl %11(:; is ,l ' {I NI; i rpl�l: # }i'L tl )r ,.rm , � ..r „ d'T!;r�'7 1� I rrr rr _ I r Barbecue
,i�'jri,, 1 I'; ' �'1 i t. " i?A i " • i;•�Ill 7 . �
,,, ''. r l ,',I , , ,li�l:�:Y1 � R '• � 1 t , I .�i' :� , 1
,, ;.1„ „i.,' :,1 �I�I -"nl�! , pr , r•t; , ii'ia l , 111 „a;':1�,�i�I�i;,L',i,l;;,'l ; i �r. I, wl''r,l'i @�S�i',r� : ?;I,f;, Clolhas "
Business name: Roth Heating and Cooling Other.
.
Address: PO Box 1265
. 1 .,i 1 :F 1 1 ;1.1ig ll iti' ' iNi i I4rg#,1� 00.i#Irltf4`# IIihl:0g0Si t i'i ilil it l i r l'll„;iiii ; cl
Subtotal 46 75
City/State/ZIP: Canby, OR 97013 Minimum permit fee ($90.00) 90.00
/Phone: (503) 266 -124 I Fax: (503) 266 -3478 Plan review (25 °/, of permit fee)
State surcharge (12% of permit Fee) 10.80 tJ
Xi CCB lic.: 14008 TOTAL PERMIT FEE 100.80
- This permit application expires if a permit Is not obtained within fan
A 4, MA dap viiii
after it has been accepted as complete.
Authorized ci y.. y, C Poe Ihtllhodnlogy set by To-County 8u114101 Indaslry Service Board
Print name: 6 Date: 6/21/13
I'VHmldrny \ PurmrnlMilt_Pci tld1App I I)aloe 44a-1e '71 (I I /a: /COM/WM