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Permit - h e CITY OF TIGARD MECHANICAL PERMIT 11111 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00174 Date Issued: 04/21/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S1110604000 Jurisdiction: Tigard Site address: 10415 SW LADY MARION DR Subdivision: Lot: 0 Project: Gustafson Project Description: Gas furnace change -out and install a /c. Owner: FEES GUSTAFSON, DEAN S & GLORIA J Description Date Amount 10415 SW LADY MARION DR Air Conditioning or Heat Pump 04/21/2009 $14.00 TIGARD, OR 97224 Furnaces < 100K BTU 04/21/2009 $14.00 PHONE: 12% State Surcharge - Mechanical 04/21/2009 $8.70 Minimum Fee Adjustment - Mechanical 04/21/2009 $44.50 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 • • • • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility • ification Center. Those ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules I-sued By: K 446, 444 VI LS C Permittee • Signature �,�i / • Call_ 503.639.4]7.5_by- 7:00_a.m. for an inspection .that.busin ss 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. • APR -21 -2009 TUE 09 15 AM ROTH HEATING FAX NO. 5032663478 P. 02 P' Mechanical Permit Application ' roR earl I(ii: (. Sl ONLY ° „ f . 11 ; ,:si • .City of Tigard • ) Received Date/By: y it G9 4y Pei,mi( . IYCea2:9f • 13175 SW Hall Blvd., Tigard, OR 9722�3 p FL, Roviow • Phone: 503.639.4171 Fax: 503,598,1+ ant /hy: Other Permit: 1 I 0 A R I) Inspection Line: 503.639.4175 p9" ss n ` Date Ready/By: Junin. Ii Sec Page 2 for Internet: www.tigard- or.gov n°9 Notified/method. 4. supplemental Information AS R , ,TYPE 'OF ,WORK • ".' r , ; y . t � ct �� , ' COMMERCIAL• FEE" SCHEDULE, — ,11SCCIIECKCLIST in 11 • / t ., Mechanical permit fees* arc based on the value of the work © New construction [S Addition /alterali. - ,� . yt .., 0 ��t `i performed Indicate the value (rounded to the nearest dollar) of all © Demolition ❑ Other: 1 mechanical materials, equipment, labor, overhead, and profit. ' ' CATEGORY OF • • CON1 tiUJ Value • • . 'RESIDENTIAL, I(O1;11P.MENT /SYSTEMS.FEES* ' f7,1 1- and 2- family dwelling © Commercial /industrial ❑ Accessory building For special ire formation use checklist. 0 Multi family ❑ Master builder ❑ Other Description Qty. Ea. I Total JOB, SITE INFORMATION 'AND LOCATION, .' Heating /cooling Job site address: ! Air conditioning or heat pump ! • )11 �aV1 r� (' ( �l� (requires site plait r,hnwing placement) I 14.00 I i • W — City /Stale /ZIP: Ti 0 olerd Lie •"1 1 !,7 -y Furnace 100,000 BTU (chietidvents) ( '14,00 (y ••(X) Suite/bldg. /apt, no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90 Gas heat pump 1 14,00 Cross street/directions to site: Duct work 10.00 .. ydronic hor 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 Subdivision: Lot no.: Flue/vent for any of above 6.80 Other: 1 0.00 Tax map /parcel no.: Other fuel appliances • DESCRIPTION OF WORK .. Water heater 10.00 r1 ' Gas fireplace _ 10.00 QS , ILL . LL� Flue vent for water heater or gas a fireplace _ 10.00 . Log lighter (gas) 10.00 Wood /pellet stove 10.00 • Wood tircplacc /insert 10,00 - ?'PROPERT..Y OWNER ' ,' himncylliner /flue/vent 10.00 • ' � . 0 • TENANT Other: 10.00 Name: .'f-'t CkA(1 4 el Ori GI 01 cr( -V' QJ/, Environmental exhaust an d ventilation Range hood /other kitchen Address: �m �, equipment , 10.00 City /State /ZIP: Clothes diver exhaust - 10.00 - Single -duct exhaust (bathrooms, Phone: (503) J(2/ ( -- 0 S Fax: ( ) toilet compartments, utility,rooms) 6.80 ', APPLI(AN'I'.. '.• . 7 .,' f • C ONTACT Pti:RSON Attic /crawlspace funs 10.00 Other: 10,00 Business name: l'uel piping Contact name: 1 5540 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /StalelZlP: Wall /suspended /unit heater Phone: ( ) Fax: : ( ) Water heater . Fireplace E -mail: Range CONTRACTOR Bar ccuc .-� 13u5incss name_ oi Clothes dryer (gas) Other: Address: .. MECHANICAL PERMIT FEES*: City /State /ZIP: C c k. ` 7 6 l3 Subtotal 2g . l7E) (p � l 'yyt � l Minimum permit fee ($77.50) 12 .. Phone: ( ��� ( L( ) . Fax: ) .p 6r . -- 4 � \ill ) Plan review (25% of permit fee) CCB lie.: \ li D 6 _ r _ State s (12% of permit fcc) g . 1 (7 r' TOTAL PERMIT FEE , I I .7 . Authorized signature: • �ACL 1 W This permit application expires if a permit ix not obtained within 180 r days after it has been accepted as complete, Print name: At , x /-11 Mr Date: -• tp --0 ` Fcc methodology mit by Tri- County Building Induatry Service Board I. \Podding \Permit: \MeC.PermnApp,dot; 0 I /1 WO +40- 461'7(11 /02 /COM/WF,P) -- APR -21 -2009 TUE 09:15 AM ROTH HEATING FAX NO. 5032663478 P. 03 df2 N 1 • • bo‘l „...... • ,' I--lDU DIEEL.7-164 • • • STRErTU • • • 10 rD