Permit CI TY OF TIGARD MECHANICAL PERMIT
A DEVELOPMENT SERVICES PERMIT #: MEC2006 - 00265
��I DATE ISSUED: 6/9/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112CC - 02800
SITE ADDRESS: 08095 SW CHURCHILL CT ZONING: R -
SUBDIVISION: BOND PARK NO. 3 LOT: 056 JURISDICTION: TIG
Project Description: Replace furnace, add A/C.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
KEN DOBSON Description Date Amount
8095 SW CHURCHILL WAY
TIGARD, OR 97224 [MECH] Permit Fee 6/9/2006 $72.50
[TAX] 8% State Surcha 6/9/2006 $5.80
Total $78.30
Phone: 503- 351 -9147
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503- 266 -3478
PRI 503- 266 -1249
Reg #: LIC 14008
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: v � 4
Call 503- 639 -4175 by 7:00 a.m. for inspections that business da�j.
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.
06/09/2006 11:29 15032632513 ROTH MECHANICAL PAGE 02
Mechanical Permit A lication F(11z OFFIC V (ISE ONI.Y
City of Tigard CEIVED Received , ' Permit 6 C e21 1 -
Date/Hy; — 1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503,639,4171 Pax: 503.598.1963U 9 2006 � , 44 ; t. 1 t - ( I; { ;,
6 Dare/By. Other Permit:
inspection Linc: 503.639.4175 17 !: -'! I _, Date Ready /By: See P e 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING . •.T A VII M!!
• .. TYPE OF WORK ����Y_ _ .COMMERCIAL. FEE* .SCHEDULE - USE CHECKLIST
'Erin= r f� Mechanical permit fees* are based on the value of the work
performed, construction ddi [ion /alreratinn /r ' + ent performed, Indicate the value (rounded to the nearest dollar) of all
❑ Dolnolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
. .. .. . CATEGORY OF CONSTRUCTION i Value: $
" - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEMS FEES"
For special fnformalion use checklist.
0 Multi - family 0 Master builder ❑ Other; Description
1 Qty. L Ea. I Total
• • JOB SITE INFORMATION AND LOCATION Hcatia ooli
cng
-
Job site address:
.$,' 5 I \ I. , 1 `� c� , - Air conditioning or heat pump r J ► (requires site pimp showing placement) 14.00
City /State/ZIP: ' p 0 • p ► • 7-7-- Furnace 100,000 BTU Nu a /vent .. I 14.00
Suite /bldg. /apt. no.: Project Warne; Fumuce 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
` Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc, 10,00
Subdivision: Lot no.:
Flue/veni for any of above 10.00
- Other., 10,00
Tax map /parcel no.; Other fuel appliances
. . D1f8CRIPTION QF. WORK;':, :.: ...
Ater heater I p 00
Gas fireplace 10.00
• Flue vent for water heater or gas
tr, A vn 'ti,u' rn . i g ,/ fireplace 10,1x1
�G- Lc) 1ightc r(gaa) 10,00
p 0 �` L , Wood/pellet stove 10.00
Wao fireplacdi . 10,10
Chimney/liner/flue/vent 10.00
r PRO 'E' .. . OWNER. . TENANT: Other, 10.00
Name: r hi" i ri Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment (0.00
City/State/ZIP: Clothes dryer exhaust 10,00
Single -duct exhaust (bathrooms, ..
Phone: ( ) 3 ' (, I 14.9 Fax: ( ) toilet compartments, utility rooms) (1.80
.... . C fa
,_ APPLICANT' • • :., :. 0 CONTACT PERSON raw space
Attic/ fans l p
Other. 10.00
Business name :, , Fuel piping
Contact name: 55.40 for first four; $1.00 for each additiona
Address: ^" Furnace, etc.
,. Gas heat pump
City/State /ZIP: Wall/sus pcnded/u he aler _____r
W
Phone: ( ) Fax: : ( ) Water heate _ ___ __
_. - Fireplace
E- mail: Range
..,.CONTRACTOR . „ . • : Cles c
Business mime: a Ul h /T_QC)t / oth dryer (gas) _
Other.
Address: D 4 .. / 26,5 _ /1 / / .. '•'.: "'' :.MECHANICAL• FLEES*
A. ..l
City/State /ZIP: e k: t /0 . //' 4 o f 7 2 3 . • Subtotal
Phone: ( ) Z (�7(Q -(2 •� � +Fax: (�j) � _ . j ��r Minitnum pemtil fee ($72.50) 7 Z .50
5 Plan review (25 of permit fee)
CCB lit,: LID ( �' State surcharge (8% of permit fee) S so / )
TOTAL PERMIT FEE -71), 30
�, This permit appltcatlnn expire% Ira permit k not nhtntpetl wlthIn IRO
Authorized signature: ale! niter It has been accepted as complete.
[ Print name: / i ) (z.) t. - Oate: i f {.J�
ree methodology set by Tri•Cnunty Building 'Industry Service Board
06/09/2006 11:29 15032632513 ROTH MECHANICAL PAGE 03
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