Permit 1
C ITY OF T MECHANICAL PERMIT
IA DEVELOPMENT SERVICES PERMIT #: MEC2006 -00187
'' � ��' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/8/2006
PARCEL: 2S1 09 DA -06800
SITE ADDRESS: 15067 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 045 JURISDICTION: TIG
Project Description: Install A/C unit.
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
TREVOR & J BAKKE Description Date Amount
15067 SW GREENFIELD DR
TIGARD, OR 97224 [MECH] Permit Fee 5/8/2006 $72.50
[TAX] 8% State Surcha 5/8/2006 $5.80
Total $78.30
Phone:
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: __Le, chi
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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.
05/08/2006 09:53 15032632513 ROTH MECHANICAL PAGE 02
• ; Mec h anical Permit Application, /7 ''-', 1 ' IOR of R t: USE ()NI.V
l
CI Of Tigard Received �„� _ Permit No.
`J g Date/By: a • ■ �.! 6 C. '66 C 71 / , 4
13125 SW Hall Blvd -, Tigard, OR 97223 a
( �� Plan Review
Phone: 503,639,4171 Fax: 503.598.1960 �6' Date/By; Other Permit:
Inspection Line: 503.639.4175 ,� . . L Date Ready /By: Sr e Puac 2 for
Internet: www,ei.tigar'd.or s �/ , ' i ' Notified /Method: S upplemcntnl Information
' ) `-" ;7 i t7 i iii I S i o N. _
TYPE OF WORK COMMERCIAL REE* ' SCHEDULE USE CHECKLIST
/Oh 1--.. Mechanical permit fees" are based on the value of the work
❑ New construction AfTAddition /alteration /reph c:. • . ,/ performed. indicate the value (rounded to the nearest dollar) (Trail ❑ Demolition D Other: �� ✓ mechanical materials. equipment, labor, overhead, and profit.
CATEGORY • OF CONSTRUCTION Value; $
RESIDENTIAL EQUIPMENT /:SYSTEMS FAES'
`)2 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building - --
For special information use checklist -
O Multi - family ❑ Master builder ❑ Other Description Qty, Ea. Total
..... • ...1OB SITE INFORMATION AND LOCATION _Hcatin(t/conitng
O � . Air oon
Job site address; gg or heat pump
�, _ ,quires site plan showing placement) ( 14.00
City /State /ZIP: 1--i'ysd ? 9 Z-Z1 Furnace I00,000 BTU (ducts /vents) 14.00
F urnace t 00,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no -: Project name: Gas heat pump 14.00
Cross street/directions to job sire: 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/vent for any of above 10.00
.
Other: _ 10.00
Tax map /parcel no.: Other fuel appliances .
.WORK : . :...... :. Water heater 10,00
, I` ; :c. •, DESCItiPT10N..O1?. —
Gas fireplace _
10.00
Flue vent for water heater or gas
(% I fireplace 10.00
I Log.lighter (gas) 10.00
Wood /pellet stove 10.00
- - -- - - - Word fireplace/insert 10.00
ttnney lner
ue /vent 10.00
.:- : : .c712'PROPERTY OWN I El ;TENANT •:
Other. 10.00
Name: " [)� \ )i N i 1 � Environmental exhaust and ventilation
Address: �^ Range hood/other kitchen
Clothes 10.00
CiCity/State/ZIP: - Clothes es dryer exhaust 10.00 _
��� Single -duct exhaust (bathrooms,
Phone: ( ) (- Z. Fax: ( ) • toilet compartments, utility rooms) 6.80
. e/crawlspace fans 10.0(
: ,, PPIJCANT • • � .. . ... 0 ;CONTACT .PERSON :., .
Att
Other' 10,00
Business name:
. _ Fuel piping
Contact name: $5.40 for first four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump -47. _____
City /State /ZIP: . - -' Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater —
-- -- -- -- ---- Fireplace
E -mail: Range
Barbecue
Business name: f `• ? / /„QUr�` /"� Clothes dryer (gas) _
V
• Other.
Address: / '' �> _ / 2 CG
` ,, : ':'' MECIAANICAL PERNIIT.It?EE *: -
City /State /ZIP: ca `, ik / � .�r (3 .) 2P� Subtotal
/ Minimum permit fee ($72,50) / Z. .s U
Phone: („54/5) z . (0 ( 2./.41 ( t ) 2 ` Fax; (� - -3 ? ; Plan review (25% of permit fee)
CCB lie,: / `.. DOI ���_ r S tate surcharge (8% of permit fcc) 5 , gb
TOTAL PERMIT FEE -7C3n
417 This permit application expires ir permit k not obtained w tin 18))
Authorized signature: day■ ARer It hm bccn Accepted as complete.
Print name: �- Sl. Da1 J 1 • fee methodology set by Tri•Couttty Building lndaarry Service Board
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