Permit CITY OF TIGARD MECHANICAL PERMIT
Permit #: MEC2011 -00021
COMMUNITY DEVELOPMENT Date Issued: 01/12/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S104AA07100
Jurisdiction: Tigard
Site address: 12790 SW KATHERINE ST
Project: Stert Subdivision: Lot: 0
Project Description: Replace gas furnace.
•
Contractor: ROTH HEATING & COOLING Owner: STERT, JOHN & CHANDRA
PO BOX 1265 12790 SW KATHERINE ST
CANBY, OR 97013 TIGARD, OR 97223
PHONE:
503 - 266 -1249 HONE: 503 - 590 -0431
FAX: 503 - 266 -3478
FEES
Specifics:
Description Date Amount
Furnaces < 100K BTU 01/12/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/12/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/12/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
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
on
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon requires you to follow the rules adopted by the
the Oreg
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through h OAR 952 - 001 -0090. You may obtain a copy
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ; �r - Permittee Signature: U,/ [,/eej 770
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
JAN-11-2011 TUE 03:34 PM ROTH HEATING FAX NO 5032663478 P. 01
Mechanical Permit Application RECE t! .
,, OFFICE USE ONLY
City of Tigard Received
PriteM.Y7 -
IN
II SW 1-lati Blvd., Tigard, OR 97223
°
I: • Phone; 503.639.4171 Fax: 503.598.1960 4f 12"--PPF 1 - NUR byte " f/ Ne
'Dntelty: other Permit;
InspectiOn Line: 503.639,4175
TIGARD
earl/ OF T - , .y/By: 1,,,. • _ 0 Sec Page 2 for
Internet: wwwAisfird-or.gov
. , .g .. 'i hod: .'- / Supplemental Information
BUILDING 1; , ; A
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0 New construction IA Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
n Demolition 0 Other;
mechanical materials, c In Inept, labor, overhead and n•ofit.
Oriltel0 hv••'=iiiii V,Yiiii Yalu': $
T..!!
zi I- and 2-family dwelling lij Commercial/industrial 0 Accessory building
Fur spech21 irlformution use cimcklIst.
0 Multi-family D Master builder 0 Other:
Description Qty. Ea. Total •
,4 * : */ ' . : W*,F 0 #. 4 #tPXY*0„it,:; 415 . i 4,.10,1,i; : ',1:0k : O. 1 ,1 ! . : .4::;:J : ,•;1 ; .‘ib Ilea tIng/conl ing
Air conditioning
Job site address: 1 e70 tSGIJ 4K-a4--iii-'yine ('S (requaos site plan showilia placement) 46.75
City/Statc/
i5 .r 0 k C- 1_ Z-Lt12) Furnace 100,000 BTU (ducts/yenta) \ , _ 46.75 I -4015
— Furnace 100,000+ BTU (ducts/vonbi) 54.9i
Suite/bldg,/apt, no.: Project name;
- Heat pump 61.06
Cross street/directions to job site Duct work 23.32
livdronic hot water szstem 23.32
Residential boiler (radiator or
Ii dronic) 23.32
Unit heaters (fiet-type, not electric),
in-wall, in-duct, sus )ended, etc, 16,75
Flue/vent for any of above 23,32
Subdivision: Lot no.:
Other; 23.32
Tax map/parcel no.:
Other fuel a ilia„,„
'' :. : ; - ;: ' ,.: ; ;;'..: : : ' , : ! .' ' ' :', ' ;' ', ;;.:i:■':!.. !.. . ;' , : ! . ! ! ::' ' : :‘1 :,3gP"F' ' 0 $.-rlirt.'.140.*.l'..' Water heater 23,32
G fireplace 33.39
— as
A,' - .1 1 . ' ( 4 f :.• (1 Pluc vent for water heater or gas
fireplace 23.32
— Log lighter (gas) 23.32
_ iklil 11 Wood/pellet stove 33.39
Wood fireplace/insert 23.32
•,::•.: .: ;•! :; . ,.. ::1‘ Chimney/liner/flue/vent 2332 • 23.32
Name: ■ ) 0 h 11 / Qiit er—riLtrol, 6:1 Environmental exhaust and ventilation
Range hood/othcr kitchen
Address: — La, /nil- equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (a43) al 0 --- 0 Li S I Fax: ( ) toilet compartments, ul:ilitv rooms) 23.32
i'.,•:%;..i!,9:::1T.',:ti4i■iii:i41;ititil::iltpqAT,!,1;6[•:iii•:;D,t.•:.',ii''Fa.;.er,Of;47tAiev6(tiSi:..i;:;!.;,'01;':' Attie/crawlspace fans 23,32
— Other: 23.32
Business name: \:._ 6u.a
Fuel piping
.-2
Contact name: .. ip t,A \ \ if ti t),( $14.15 for first four: $4.03 for each additions!
I D
Address: , , s , 0 S\A) _ -Cr 1 f)() , GI-- Furnace etc.
Gas heat pump •
City/State/ZIP: ---- a_Arc, ) L. 9 1 42„:2-, Wall/suspended/unit heater
Phone: (6.2, ) i . _ -,... I s Fax: : ( ) Water heater
- 1?ireplace
T.i-mail: - a 1 4- Range
:.; ,r."':•••1:.q,iiii: . (k 1 i Barbecue
::' ,, til'tt:1t .0;t: t .
Clothes dryer (4as)
1314541CH name: 11 f .... c.cr i i 1 t L j_n 0
other,: ,,,
Address: PO P) x 1 2-L.,P (3 . et,..f,
City/State/Z1P: _Cwi 12) 9 ... 015 subtotal L _
Minimum permit fee ($90.00) Ci
I Flume: (5):3) at? to . I Z_L-1 , Fax: (5)3) 2, Le (n. 5/-/7 E Plan review (25% of permit fee)
CCB lie.: 1 0 g 47(0111- State surcharge (12% of permit fee) ris
TOTAL PERMIT FEE r )''' .r -(-)
4 This permit application expires if a permit It 110i obtained within 180
Authorized signature: / (,) Ai l - .e
(0_4,6 -
0 'VI 0 . any); after it has been accepted as complete,
Print narnc: ...., ( 4i 2 r ( & fa f u ifr, Date: 1 .--1 i - 1 " )ce methodology set by Tri-Counly Building Industry Sol Board
imuilaina‘PcornbAkric-Perrai io/olioo 40-461T1" (1 I /02/COIWWRB)