Permit • 04;14/2006 14:13 15032632513 ROTH MECHANICAL PAGE 03
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CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00153
DATE ISSUED: 4/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134BD-02900
SITE ADDRESS: 12005 SW SPRINGWOOD DR ZONING: R - 4.5
SUBDIVISION: ENGLEWOOD NO.2 LOT: 117 JURISDICTION: TIG
Project Description: Gas furnace change out, 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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
SCOTT ALJETS Description Date Amount
12005 SW SPRINGWOOD DR
TIGARD, OR 97223 [MECH] Permit Fee 4/17/200E $72.50
[TAX] 8% State Surcha 4/17/200E $5.80
Total $78.30
Phone: 503 -590 -5627
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: °1 ;�� =, Permittee Signature: 5 4:.€
Call 503 - 639 -4175 by 7:00 a.m. for inspections that businessSa
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.
04/14/2006 14:13 15032632513 ROTH MECHANICAL PAGE 02
• CEIV ED
Mechanical Permit A.ppIica> t
1 OFFICE 1. l,til. f,ti'l.V
City of Tigard APR . 4 0 . Received . _ — • �U` Permit No.. 1 - A r
13125 SW Hall Blvd., Tigard, OR 97223 Pla
Phone: 503.639.4171 Fax: 503,598.1960 Plan n Review
°'- ' � � "� '�;� Date/By;
Other Permit;
Inspection Line: 503.639.4175 �Y ,s 'n „ ` % y;
P - 7 - D ate Ready /By; Sec Page 2 far
Internet: www.ci.tigard.or.us j fzo ! r . • Notffied/Mcthod; Supplemental Information
� ��
: • TYPE OF :WORK
COMMERCIAL FEE* SCHEDULE USE CHECKLIST
❑ Ncw construction ffi Acl i on /operation /reel A.x,E ^ Mechanical permit fees" are based on the value of the work
1 1 performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑Other: l i J J , mechanical materials. equipment, labor, overhead, and profit.
CATEGORY 'OF ;CONSTRUCTION • Value: $
-
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIAENTIAL EQUIPMENT /SYSTEMS FEES ".
❑ Multi- family ❑ Master builder ❑ Other, For special information use check list.
Description I Qty, I Ea, I Total
• i JOB SITE •INFORMATION AND LOCATION Heating/caoling
• w ,/I Air conditioning or heat pump
Z
Job site address: / e jyi irr t %�., (requires site plan showing placement) r 14,00 City /State /ZIP: - \ ...to. � Or 41 « Z2- _Furnace 100,000 BTU (duets/veats) ( 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suitefbldg. /apt. no.: Ai Project name: Gas heat Hump 14.00
Cross street/directions to job site: Duct work 1 4,On
Hydronic hot Ovate ystem 14.00
_ Residential boiler (radiator or
hydronic) 14,00
Unit heaters (fuel -type, not electric),
in-wall, in -duct, suspended, etc. 10,0(1
Subdivision: Lot no,: _ Flue/vent for any of above 10.00
_ Other:, 10.00
Tax snap /parcel no.: Other fuel aepliances
! ; : H ;;,.!:::, : '.. :. ;DESC.RIPTION OR WORK :. :. ., :, ..... :.., . ..: .. Water heater 10.00
Gas fireplace 10.00 _
�Q Flue vent for water heater or gas
__?_.)_11 6 - 4 u fireplace 10.00
Log lighter (gas) 10.00
_,__ Wood/pellet stove 10.00
a Ca-- 0-v7 Wood Hreplace/insett _ 10.00
:. '.: •i Ts .PROPERTY OWNER . .::..:' ::.:' ❑ TENANT : .
urn finer /flue /veal 10.00
- -. Other 10.00
Name: S� — Q. . 1 _ Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment _ 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
- Single -duct exhaust (bathrooms,
Phone: ( ) 1 b -- ( t 9. Fax: ( ) toilet compartments, utility rooms) 6.80
:! : '` : :i: :': ': ;
APPLICANT_.:: ": ON . •.: ' : CI CONTACT PERS .. ! Attic /crawlspacc fans 10,00
Other 10.00
Business name :
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: s Furnace, etc,
_ Oas heat .um
City /State /ZIP: Wall/suspended/unit heater .______
Phone: ( ) " Fax: : ( ) Water heater
Fireplace
E -mail: Range
Business ' , CONTRACTOR; ' Barbecue
■name: f 6/ . --- -42a / .1 Clothes ryer (
1 dgas)
J Other,
Address: At j
CHANIICAL P
CiCity/State/ZIP: ti t 1' y r7 9 / 0/ 3 Subtotal •
Phone: ( } Z(,71O .- (2 i . 1 Fax: (565) Z , 2 /
� Minimum permit fee ($72.30) 7'� �
�� Plan review (25% of permit fee)
CCB lie.: / Lf IV _ State surcharge (8% of permit fee) 0,
r TOTAL PERMIT FEE 7
Tide permit application expires If a permit Is not ob wain 180
Authorized signature: �� , • days aver It bas been accepted as complete.
Print name: L 1. -. Date: ` Fen methodology set by Trt.County building industry Service Board