Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00129
T I G A R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2012
Parcel: 1 S133CD02300
Jurisdiction: Tigard
Site address: 11790 SW SWENDON LP
Project: Lebeda Subdivision: COTSWALD MEADOWS Lot: 21
Project Description: Install gas furnace.
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Contractor: ROTH HEATING & COOLING Owner: LEBEDA, VLASTIMIL & SHARON
PO BOX 1265 15607 SW HIGHPOINT DR
CANBY, OR 97013 SHERWOOD, OR 97140
PHONE: 503 - 266 -1249 PHONE: 503 - 625 -3954
FAX: 503 - 266 -3478
FEES
Specifics: • 'Description Date Amount
Furnaces < 100K BTU 03/13/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/13/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/13/2012 $43.25
Occupancy Grp:
Stories:
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Fuel
Fuel Types: Natural Gas
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
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 -0090. You may obtain a copy of the rules
or direct • • - s ions • ' UNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: / ■ � ' / Permittee Signa re:� �,
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.
Mar 01 2012 11:59AM ROTH HEATING 5032632513 p.l
Mechanical Permit Application I ()It OiTli I: ( (1\s.,
City of Tigard Raerved 9
13125 SW Hall Blvd., Tigard, OR 9 � .c �� Dato/By: 7 42, All Pamir No.: �! /� 9 -664.1 ' Phone: 503.7182439 Fax: 5 to - 'Iii 600 O � . Plan Review
a O�
1 ; n s•, n Inspection Line: 503.639.417 $ `�, DatelBy: Other Perth
Internet wrvw.tigardor.gov P-O Date y*: lam: El See Pagel for
r � NatifiedtMetbed
Q� �v \ O � Sopplemeotal information
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r- P'' .1 -. � -jeli 1}„� 713 ,V'.f�4i'<74 -'_'r.:. . M. + {9 1a v� i� aMDZ:F}+vr T --
c1, f+�1a.� _ 1��`� = ..i� -t :��.ti �. �- �' - 7 .+rte
❑New construction ® Addidon/al :.: , , i .,eat Mechanical permit fees' are based on the value of the wort
N performed. Indicate the value (rounded tote nearest dollar) of all
❑ Demolition 0 Other.
^,` _ . �:i T
11 $ mechanical materials, equipment, labor, overhead, and profit.
_� 5: �>1 ;8 n "' ,r. .'.as � ^•Myc �`':ti? 'x
• e_ ` ' �P, n';' mss',, -- -- - Value: $
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Far • f or m e "a e des *1 ��
❑ Multi 0 :pedal fRl6rnratlwr are dYecirlt�t
Y ❑ Master builder Other: Description I Qty. I Ea. I Total
i 21"I rc-4 _ 1" irr"'. u 9i�°- a'.�� m>r s- ' 14f�h�lq�v�k?�:s Heatiag/0001in
sue f F !�= $,re,�i ! "drill iu has[ - ' A _,,t_ Air
Job
site address. 11790 SW Swendon Loop (requires eke elan showing placement) 46.75
City/State/ZIP: Tigard, Oregon 97223 Furnace 100,000 BTU (�au/veu) I 46.75_ - 46.75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg. /apt. no.: I Project name: Lebeda # 29193 Heat pump
Cross Meet/directions to job site:
(requires site plan showing pfeeemeot) 61.06
Dud work 23.32
Hydronic hot water system _ 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit beaters (fuel -type, not electric).
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above
23.32
Tax map/parcel no.: Other 23,32
R - ,� _ Other fuel appliances:
^lei -' � `y�l- I J 7 ei ' )w „ .F 3 _1-31 L ;_ntt �'1, �_ -li Water h 2332
�.� -�.__ `-- . - " --' _; r eater
Installation of a gas furnace. Gas fireplace/insert 33.39
Flue vent for water heater or gas
- fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
_ Wood fireplace/insert 23.32
I- FMK 6 M i c i r - Chimney/liner/flue/vent /liner/flue/v
�- - °- .- � ri'� : - _'� =�;- Y eat 2332
Name: Vlasti� Lebeda 23.32
Environmental exhaustand ventIlatIon:
Address: 11790 SW Swendon Loop Range hood/otter kitchen
City /State/Llp: Tigard, Oregon 97223 ere 33.39
Clothes dryer exhaust 33.39
Phone: (503)625-3954 Fax: ( )
Single-duct exhaust (bathrooms,
'?;� :: ; ', �'' ({ _ toilet compartments, util' .
-• A. _; µ a, q hty rooms) 23.32
... -.._. -, __ At6cJcrawlspace farts 23.32
Business name: Roth Heating and Cooling Other: 23.32
Contact name: Steve Merrill Fuel piping:
514.15 for first four, $4.03 for each additional
Address: PO Box 1265 Furnace, etc. I L
City/State/ZIP: Canby, Oregon 97013 Gas heat pump
Wall/suspended/unit heater
Phone: (503) 266 -124+9 I Fax: : (503) 266 -3478 Water heater
E -mail: stev • p Frepllace
`'_ '-.. h'1.4Y; ilCmiliF . ':'_., , :g%--1. 4 _. - t Barbecue
Business name: Roth Heating and Cooling Clothes dryer (gas)
Address: PO Box 1265 Other:
11 -3= -- .'f ;12,174---]
- ' w` ar.. J'�' - . 1- pe,A, 3 "^', i __ `, ':: 0
City/State/ZIP: Canby, Oregon 97013
Subtotal 46.75
Phone: (503) 266 -1249 I Fax: (503) 266 -3478 Minimum permit fee ($90.00) 90.00
CCB lice: 14008 Plan review (25% of permit fee)
r State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
Authorized signature: MU permit application expires if •permit fs not obtained within Igo -
Print name: Steve Me days after ft has been accepted as complete
I Date: 3/9/12 I • Fee methodology set by Tri•Cowity Building Industry Service Bard '
q: ml odY cant. App.doc 03/07/12 440- 46177(11/02/COMjWW138)
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