Permit •
'R
1f .4!'''' ` CITY OF TIGARD MECHANICAL PERMIT
., Permit #: MEC2009 00575
; r :: COMMUNITY DEVELOPMENT
" ` '"" 13125 SW Hall Blvd Tigard OR 97223 503.639.4171 Date Issued: 10/30/2009
r 9 Parcel: 1 S134DB01100
Jurisdiction: Tigard
Site address: 11045 SW 114TH PL
Subdivision: WINTERS ADDITION Lot: 5
Project: Conner
Project Description: Replace gas furnace
Owner: FEES
CONNER, STEVEN L Description Date Amount
11045 SW 114TH PL
TIGARD, OR 97223 Furnaces < 100K BTU 10/30/2009 $46.75
12% State Surcharge - Mechanical 10/30/2009 $10.80
PHONE: 503 - 552 -5366 Minimum Fee Adjustment - Mechanical 10/30/2009 $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:
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, 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: / p t— Permittee Signature: e-yt---- (,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 -29 -2009 THU 10:17 AM 7 a CPIV ED FAX NO. 5032663478 P. 01
Mechanical Permit Applica ' rOI( ()1.1F1(1I1(Isl.: (tmi
City of Tigard �� 2 9 2009 nose ed Permit No ec q- t 7_5
;
" • ! 13125 SW Hall Blvd., Tigard, O A F TIG Plan Review
Phone: 503.639.4171 fax: sQ3 4 G DIVISION Date/Ely: Other Permit:
i t , i A t , 1 , Inspection Line: 503.639.4175 1 1 � Data Ready/By: gEgi Gil See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental information
TYPE OF WORK COMMERCIAL . F121 *` SCHEDULE USE CHECKLIST
❑ New construction EN Addition /alteration/replacement MechanicpJ permit fees` are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of ell
❑ Demolition ❑ Other: mechanical materials, equipment. labor. overhead, and profit.
' CATEGORY OF CONSTRUCTION Value: $
® 1- and 2-family dwelling ❑ Commercial /industrial ❑ Accessory - RESIDENTIAL' EQgIPMENT /,SYSTEMS FEES*
y g ry For special irI/ormarlon use checklist.
CJ Multi - family 0 Master builder 0 Other: Description p 1 . Qty. Ell Total
JOB SITE ; INFORMATION AND LOCATION Reefing/cooling
Job site address: 1 ` 0 Li. j l o I 1 L.1 .j'1' P G1 0 e_ (requires site e Ian plan
rc sshowing placomont ) 46.75
City /State/ZIP: 1 G)-� 1 l; 9 -1 Z 2_, Furnace 100,000 BTU (ducts /vents) ( 46.75 4 p.'15
�} Furnace 100,000+ BTU (darts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: 1 L At no.: Flue/vent for any of above 23.32
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • . • Water heater 23.32
,~ Gas fireplace 33.39
G(.s ... 1.,x,1' ici cua. tct'> :out Flue vent for water heater or gas
C Rc PLPr C., ,. J fireplace 23.32
- Log lighter (gus) 23,32 _-
Wood/pellet stove 33.39
Wood fireplace /insert 23,32
la .PROPERTY OWNER l - ❑, TENANT Other: 23.32
Other: 23.32
Name: SN-C_ : , 1 ,-- Environmental exhaust and ventilation
Range hood/other kitchen
Address:
rn e,. GlA O.-b e_-. equipment 33.39
City/Statc /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (,53) ,752- 53(, L , Fax ( ) toiletcompaltmcnts,utili� rooms) 23.32
. 0 CONTACT" PERSON !..-
`. ' ';'0 APPLICANT , , Aldc /cmwlspace fans 23.32
Other 23,32
Business name:
pi
Fuel ni
Contact name: 514.15 nA for first four; 54.03 for each odditlonol
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) ` I'ax :: ( ) _ Water hcetcr
Fircplacc
E -mail: Range
,'CONTRACTOR '' Barbecue
Business name Clothes dryer (gas)
Other:
Address: ? 0 fjcrr (•2 L s .. : MECHANICAL PERMIT FEES* .
City/State/ZIP: e_ air , , iv_ 17 0 �
. . S ubtotal 1 .1 e, . `1 r'7
r Minimum perm C>
hone: (5Q3) ( p (p . ) Li 7 rux: (5 ), ( - &L) 7 t . Plan review (25% of permit fee)
CCB tic.: ) Lj G D F ,7 State surcharge (12% of permit fee) ) 0 .&0
TOTAL PERMIT FEE I QQ • gO
Authorized Si atu o: / f This permit application expires Ira permit Is not obtained within 160
�I.G -r , ��'ti 1� b �� X� days afer It has been accepted as compleir.
Print name: C�I'l c. -.Q ,( li V -c. fi't / - lr' Date: 1',A Q.C\ l p • Fee methodology set by Tri.County Building Industry Service Board
MUuilding\Pennilel 4 C•PeridtApp.doc 10/0l/09 4404617T(11 /02C0M/WEB)