Permit gif CITY OF TIGARD MECHANICAL PERMIT
� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00487
V 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/21/2004
PARCEL: 1S136DD-01300
SITE ADDRESS: 06855 SW BAYLOR ST
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML.INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Extend ducts and grilles for TI.
Project Value: $3,500
Owner: FEES
MALCOLM ESLINGER Description Date Amount
11575 SW PACIFIC HWY [MECH] Permit Fee 7/21/200 $107.00
TIGARD, OR 97223 [TAX] 8% State Surcharl 7/21/200 $8.56
Phone: 503 620 - 9515 Total $115.56
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 Mechanical lnsp
Final Inspection
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 -00 -I I • through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
)246 -6699. A , 'm
%% < <..1 ,,
Issued By: , _ � ! � /1 ; 1 Permittee Signature: ��_.,_
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busine 1. ay
503 265 3478
lent by: ROTH HEATING 503 266 3478; 07/16104 2:15PM; JetFax #567; Page 1/1
Mechanical Permit Application - 1:01( 01 lii: Iltilil °NIX
. . . _
City of Tigard Reo.wva
ntit:rt3y: Fr nn:i No.:
13125 SW Hail Blvd., Tigard, OR 97223 Plan Review
Phonc• 503.639 4171 Fas: ti 503.5%.19Mi Oii.er Prrrnit.
. Dalt/fly:
inspecon Line: 50,3.639.4175 DEIc Rcady/Eiy: .. . 1 1 Scti rtigt: 2 lor ,
ltitcrnrt: www.ci ligard.nr.0 4 S Nonficd/Mtthoci. .... / t . Sttpplemorttitl Infurmatturt
---
Typg OF 'WORK . COMMERCIAL FEEv SCHEDULE - 11Sg. CHECKLIST
I 1vIcchanicai - it:mit fees* ale buytt the value o - • .
l Y Nei.). construction 11] Addition/Ow
. orincd. Indicate the VdlrIFITM nztari-tiq the nuarest dollar) n 1
B Demolition 0 Other, mechanical materials, c in mcni. labor cvarlicad. and profit.
. . -
.CATEG - .OF CONSTRUCTION ' Value: S GUI.
• .4 1 - 1 - I • v . : OS
■ 0 1- and 2-family dwelling Commercial/industrial 0 Accessory building
. Fey special information us,:- eiltitlist.
0 Multi-ilimily 0 NI aster builder D Other: -----
I . Descroion j Qty Ea. Total
i • JOB 'SUE ir.il'ORMATION:A79:11:OCATD1t4 tieutilutkoollng
i- -
Air conditioning or heat pump
1 Job site address: ..,, ,..e S 64,0
tiltsccincon 14.00
1 City/State/LIP: - 4 ., Arenffri • FUTTUICC 100,000 BTU (dun venial 14,00
r---- Furnace 100,000' I3TU (duets/vents)
[ Suitt/bldg./ant. no.: Project name: tinie Ow. wile, G
as hi pump 14.00
[ Cross street/directions to job site: 6 .,,; ,...., .03 / ®� Duct work 14.00 I
_Llydrunic hot water system 111.00
1 ) P.esidentinl boiler (radiator of
I bydronie? 14,00
I. 1 Unit heater % (fuel-type, not electric),
in-wall, in suspended. etc, 10.00 - —
I . . Floc/vent for any of above 10.00 _
Subdivision: Lot no.:
Other' 10 00
Tax map/parcel no.: Other fuel appliances
- '
i - • - ., . - • . : ,DESCRITTION OF WORK I -.. • . : , • • ,' . , Willer heater tout
i ...../' , _..
... ' - / ' Gas fireplace 30
1 .1 I Pi/ - .: i ' ' 4 -_1.41LAr -- ---- ,,,, ,I,..,4 , '%■2 Flue vent for water heater or gv
1 --- '
1 :
, / Ii) _4' .'e . I:
e ,ffisirmir • Anic Ili fireplaec 10.00
1 Az/lighter (uas/ 10.00
• z %
ttL
: 40 I '-f ' 'Dc_ e i 146 . - Woodipellet stove 10.00
Wood fireplaceinsert 10.00
. . Chimneyilinerifluv'yent 10.00
L• •.-- - cr 4P --...,-:...,.•• ,..,.• :•,;,.: P TENANT - • • ' L0th : 10.00
—
Name: 4;4 wc J t ,I4nM ti 1--C,C0 dlcg' 1- • , Environmentul exhaust and ventilation
/ Range hoodiother kitchen
1
Addr 1r dow ... I 741 Mira* ''' _...• 0 equipment 10.00
1 City/State/ZIP: - etes JPA-• ' .... 3 Clothes dryer exhaust 10.00
- Single exhaust (bathrooms,
I Phone: ( _,..,/‘ ) ( Fax 03) -, ZO
Airing.' ea . - ' 6 toilet compartments. utility rooms) (LBO
• ' :
4I2LICANT ;',..4.i i,... 1 :,:''.': :...': ';. ::•0 .:CONTACT PERSON :: : ' : ' Attizicawls ieLcc fans H000 ....,
Other 10.00
1 51.1airues s name: , do , "LA ' 1 .....tfl,„ _i_'
--. Fuel piping
I Contact name: Metido A4 • $5.411 for first four; $1.00 for each additional
_ 1
' Pumaceetc
1 , Address: ' . - e• t (C.... 1 ! p
City/State,ZW: ) I , , _____ Gus heatum
--T 07, ,p. 7 nci
:
Wall/sus eediunit heater
i --I-
1
I Phone: ) A0 .... 4 % 0 , --- Fax. : Water heater . -
`,P': 4 ...4' „, -Z5—. _ —
r — , A , A Fireplace I
E-mail Ii I .0 ,12RIMIr_ ... _te (/ i ::..-. i 0 t I V' 411' al.: •
1 -.. ,•.: .: • • , ..:t..' g - ••' • • .' -'..:•': ... IP R ,. !: • .. - . .. - ... _ . ., , • Barbaue
, Clothes dryer (gd
Address: r;) ,
Business name: Ofh /41-7 —
____Other
P-b O f-- &
L.. 1 2- A _ f - 5 11 _ ,, r if) . .
I: : • . . _ ; , .: • rviEcur!,..ritc4.1.,.rw■ft - : ,
.„ ' ' .:,'• s'
City/Stale/ZIP: a j./..ly ,/ c / / 4.,/ 3 Subtotal J&7. 00 I
M ini Frinit fee (572.50)
Phone. (_64) 2-Lc-.L --t 2:419 _ Fax: (5Z, . ) 24/47 - 34u. 7,
— Plan review (7.5% y rielailit fee )_
.... - --
CCB lic.r / . q DOI
/1 _.... State surcharge (% of TICTITIll fee) 57.75'd,
/
— TOTAL PERMIT FEE t ( /5. 5to k
' r
- e-d-CA-- / C _,,,,,t..4Aa\ Titii permit application expires ;( a penult is nut obtained within 180
Authonzed sibnature,/
dayb atm it bus been ACCOF11“1 ilt. carnriliriir.
Print name: IYOL Date:
C ) • ..
K . ( 40 / j • Fec incthodoloic set ey 10-C..uncy Btnie.in,; InciwAry Fter Board
L ' ,
• 4.1,,.4s17T ■' I 1,vi, 4)..4),.1 I,