Permit CITY OF TIGARD MECHANICAL PERMIT
$ • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00235
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2009
Parcel: 2S112CC22000
Jurisdiction: Tigard
Site address: __15671 SW 81ST AVE
Subdivision: GAGE FOREST Lot: 27
Project: Danbom
Project Description: Alter a /c.
Owner: FEES
DANBOM, JOSEPH A & Description Date Amount
DANBOM, CYNTHIA D, 15671 SW 81ST AVE Air Conditioning or Heat Pump 05/27/2009 $14.00
TIGARD, OR 97224 12% State Surcharge - Mechanical 05/27/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 05/27/2009 $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
Issued By: 4, Permittee Signature: I
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.
MAY-22-2009 FRI 12:37 PM ROTH HEATING FAX NO. 5032663478 P. 02
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Mechanical Permit Application0 -.17:p IvE I FOR OFFICE IISI.: ()NON
City of Tigard . - Received ..0 Permit No,. lk I • . .6 • . .,
Il .--- • 13125 SW Hall Blvd., Tigard, OR 97223 NAY 2 2 2009 Date/By
3 Plan Review
I Phone: 503.639.4171 Fax: 503.598.1960 1 Other Permit:
Date/By;
Tic A it 1 , 3 1nSpetti011 Line: 503,639,4175
Internet: www.tigard-or.gov CITY OF TIGARD Date Ready/By:
Notified/Method: LEI et Page 2 for
53 S
Supplemental btkrmatin.
3U1LDING DIVISIO
. ''• :i:' ..- ; .".:,- :;':' .:: : :...:;„; „ :.,; tiov'a.t:wonk7.7.7777- :.. ';'';:.-.:'',-;:-: ..,::-.,,,-.: : ... toinigtitut
Mechanical perrnit fees* are based on thc value ofthe work
E New construction tkPetddition/alteratiOn/replacemenl performed. Indicate tho value (rounded to the nearest dollar) of all
ID Demolition ci Other: mechanical materials, equipment, labor, overhead, and profit.
.....'A'"CATPOO/i: .:',' . ''1',.'.;:''':1: ' ' .:' . . , Value: $
I - and 2-family dwelling 13 Commcrcialrmdustrial 0 Accessory building
ig
Multi-family I:] Master builder CI Other; ,.;.,.'i&„',BES1BENT.IAL'Et*IeMk*./,';0(P#1■0:Ii#S.:.;;!..:.
Description For special information use checklist.
I Qty. I Ea. I Total
; :.1' . .'', - ..::;' . "•.'.: : ' '' '' ::::,,,.:,''.'::. '' '0.00.'sirig iixtOTirOt■li:.•::•;:;:::: ,.'.:,,.:.: '....' • Healing/cooling
Job site address: I 56/7/ 566 di ±co.v-e___ Air conditioning or heat pump
(requires she plan showing placement) ( 14.00
City/State/ZIP: — 1 — \ ^ (pflok,, Rts a l rr2 Furnace 100.000 BTU (ducts/vents) 14.00
_
Furnace 100,000* BTU (duets/vents) 17.90
Suite/bldg./apt. no.: Project name: 1 5 7 q 2„ 07 S
Gas heat pump 14.00
Cross street/directions to job site: _Duct work 10.00
l-lvdronic 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: Lot no.:
Other. _1 10.00
Tax map/parcel no.: Other fuel appliances
H.......: .;:,.:: '.'., ." - T.BEgeltlilliOROF;.VVEIRIC.:'': : : '::: :.:.'''' '',:).:''.;,-.•:::''', :-. le ' heater 10.00
- Gas fireplace 10.00
Flue vent for water heater or gas
a, vc- ad, a rr-vt fireplace 10.00
. Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood
„
fireplace/insert 10.00
. . (., , .. - : Chimney/liner/Rut/vent 10.00
:`' '.";:)at . .....::;t.: r ri.N.iiNT: 'i ,:;: :.i. :. L Oth , 10.00
Name: QA io.4(0a0___nq Environmental exhaust and ventilation
Runge hood/other kitchen
Address:
_., equipment 10.00
A 2 ' 414-• -
City/State/ZIP: 5 6= Clothes daer exhaust 10.00
Single-duct exhaust (bathrooms.
Phone: ( ) -- 7 47 ---7 D (,, Fax: ( ) toilet compartments, utility rooms) 6.80
:.'::: : ::4.:;.;;.T.,: '.'''';''..', le t01441 ..'„ MickravilsPa" fun. 10.00
Other. 10.00
Business name:
Puel piping -
Contact name: I S5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gras healpump
City/Slate/ZIP: Wall/susponded/tmit heater
Phone: ( ) Fax: : ( )
V Water heater
- __ Fireplace
E-mail: Range ,
_
l'.cPINTRAcTPIV:.:.'..:': .?' ''7-I.::.!:: :::. ;:',.. . r.:; ' ', I, :';., Barbecue
d er (las)
Business name: ( .. is f4,,,..4-64. 1 , 104 4 c A
Other.
Address : 0 iberk. ' •i::.;..,.1
City/State/ZIP: c
„A A (...--1 p v3 Subtotal ..„.."
Minimum permit fcc ($7_,
Phone: (r ) 2_L ( ,_ Fax: 6a) ) )4..r) 11..). '. 4 -. )ci> Plan review (25% of permit fee) Nv__.
CCB tic.: \ 1141)6, _ ,,,, State surcharge (12% of permit fee) . C)
- TOTAL PERMIT FEE I
I -.
Authorized signature: AtA r..,edri tzr-- This permit applicatn eaOres if a permit is not °Mai within 180
days after it has been accepted as complete.
1 _ _
Print name: CX wr Date: 5/ 2. 240 ' Fce methodology aim by Tri-County Building industry Service Board
1:\EulldlnOcunluAMEC-PcrimiApp.doa 01/15/07 , 440.4617T (11/02/COM/W613)
. MAY -22 -2009 FRI 12:38 38 PM ROTH HEATING FAX NO 5032663478 P. 03
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