Permit ,, CITY OF TIGARD MECHANICAL PERMIT
`1. " COMMUNITY DEVELOPMENT Permit #: MEC2009 -00307
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009
Parcel: 2S112BD05900
Jurisdiction: Tigard
Site address: 14714 SW 76TH AVE
Subdivision: PROSPECT MEADOWS Lot: 2
Project: Carl
Project Description: Add on heat pump. Maintain 3' side and rear yard setbacks.
Owner: FEES
CARL, THOMAS W Description Date Amount
14714 SW 76TH AVE Air Conditioning or Heat Pump 06/24/2009 $14.00
TIGARD, OR 97224 12% State Surcharge - Mechanical 06/24/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/24/2009 $58.50
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 $81.20
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.
r -
Issued By: , al Permittee Signature: �2 / [ � �
C
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. T �
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.
JL1N-24-2009 WED 02:28 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application • • . ‘ jr , volt officE usr, oNi,y
• .14, .- .,
City of Tigard ,. :' / 117LESIIIEEM Permit No A.te-e... c ,). UV? — cr0 307
.1 13125 SW Hall Illvd„ Tigard, OR 97223 ',
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '1 JUN 2 4 2009 Date/By: Other Permit:
Tici A it i) Inspection Line: 503.639.4175
Dam Ready/By: lurk: El See rage 2 for
Internet; www.tigard-orgov
CITY OF TIGAR I. Notified/Method: Supplemental Information
ILDING DIVISION .., . . . . . . . . ... •-• . ... ••.. • ,. . , , .
;.•,...:,.:.,.:::,',:.;...,..•:,.:•,••:•,.. .......:: :•,., : ,..,....,,, I ..i Typploy ,virjr,:n A . , ,, ,: .:::. „ • • •:' ','. .!. • ';', .,' liSeCIIRCICOST:
D New construction a Addition/alteration/replacement Mechanical permit foes" are based on thc value of the work
pertbrmed. Indicate the value (rounded to the nearest dollar) of all
I: Demolition 0 Other:
mechanical materials, t . labor, overhead, and profit.
CATEGOAY:'OF' : :.' ... : '.. ,: . : ::. . '. ..., .. .,. , Valu:$
,. '.....RESIDENTIAlkQOPM VtE114
" E
,,.1ES
■,
12) 1- and 2-family dwelling 111 Commercial/industrial 0 AcceSsory building • " • • • •. • ..• . . • . .• . .. . . . .
For special information use checklist.
D Multi-family 0 Master builder 0 Other:
Description Qty. Ea. i Total
•••, ...•::-. -::'•'' :: ..t ',!' '...ij013 SITE INFORMATION : it :,' , ; ," ::, ' ':. '''': ' .., : • ' — Heating/cooling
_ .
Job site address: LI 7 } LA S W - 1 Lp Th 1 t Air conditioning or heat pump
(requires sire pian showingoincement) \ 14.00
/Strle/Z J 2 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
•
14ydronic hot water system 14.00
• _
— Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric).
in-wall, in-duct, suspended, etc. 14,00
Flue/vent for any of above 6.80
Subdivision: I Lot no.
— :
Other; 10.00
Tax map/parcel no.:
Other fuel appliances
....'•'• ,'. . ... ',.... .: ..!...,•::',.! :. ': DES RiPTIOSI 0F :.• • ' ',. •:, : ' ;': ',.. :! ;::•:,..:;: . .'•.:';', ' Water heater 10.00
Gas fireplace 10.00 •
OVI ii P Cbf ft-t_/4p . — Flue vent for water heater or gas
Culplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove ' 10.00
Wood fireplace/insert 10.00
t 'faiNiNt ::•. ::'...;.• ::h...: I:,. ' :'. ...,...:, i.J r., 11:LTNA ,,:..sii,., :.. , ::,:.. , --.:. Chimney/liner/flue/vent 10.00
• . . . . , .. .. i . . . ,.. ., .
• Other: 10.00
Name: - TbrY1 Q Al 1 Environmental exhaust and ventilation_
Range hood/other kitchen
Address: Sckx e ct, G000.11t. — equipment 10.00
City/State/ZIP: Clothes drycr exhaust 10.00
Single-duct exhaust (bola
Phone: (aG) 1 0 ( f - - 1 13 \ Fax: ( ) toilet compartments, utility rooms) 6,80
:.• ' , ' : :,1 ::':?'‘;,.::: APP1,. :•''. .r .:,..:::::. 1 ::...,::: , .' ; ;•," : ':::::•:1:116:iilirtiOr . prf,lisoi . iy '; . .... .:•':,: Attic/crawlspace fans 10.00
.. .. . .
Other: 10.00
Business name:
_ Fuel piping
Cornet. name:
S5.40 for first four: $1.00 for each additional
Address: Fr p
, e t p
— Gs
City/State/ZIP:
Wall/suspendcd/unit heater ..
Water heater
Phone: ( ) Fax: : ( )
Fireplace
E-mail:
1 e
,'''::: :, .,7,',:::.:••;.,•!:'' .: •1:1,1 .:•., ••l., '::i::.;•:CONTRACTOIR ' ::::..:•;:';''-:',.,.'':,:.,' : .:"'!: ::;1:.':::;':': :,.:. ,' Barbecue _
• Business name: Clothes dryer (gas) RI 111 _ Other: .
Address: ° D Un-. _ S ;,.,.. ''.,..Ji: rp*tirtioi:,:,,,y.i.::.;..:!..
City/State/ZIP: 2=k.1 6 13 Subtotal ILA . 00
Minimum permit fcc (S72.50)
Phone: (aF ) 2_,k ( (_
iniF ).
__L _c: 63> ) .(1) ( .1 --)
Pl 1 2-, CVO
an review (25% of pertnit fee)
CCB lic.: \ 8 441Aft _ _ State surcharge (12% of permit fee) e .1 0
_
TOTAL PERMIT FEE S 1 ' 2.0
Authorized signature: \ At-IA(406C 1 lil . This permit appticarlan expirrai if a permit is not obtained within 180
days after it bib Mien accepted ne complete.
,
Print name: kykt3 -k• l a k li,fr Date: LO -2(../ - 0 (.,) 1 . Fee Methodology set by Tri-Ceiinty Building Industry Service Board
1:Natiitaiiioeriiiiis■mEc-pffmanpp 01/19/07 , 44046171' (11/02/COM(WEB)
.= • JUN -24 -2009 WED 02:28 PM ROTH HEATING FAX NO. 5032663478 P, 02
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