Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2012 -00295
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 2S114AB04200
Jurisdiction: Tigard
Site address: 16430 SW 93RD AVE
Project: Adams Subdivision: KNEELAND ESTATES Lot: 29
Project Description: Installation of gas furnace
Contractor: ROTH HEATING & COOLING Owner: ADAMS, KEVIN
PO BOX 1265 16045 SW BULL MOUNTAIN RD
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 - 266 -1249
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/06/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/06/2012 $10.80 .
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/06/2012 $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
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /►T
Issued By: ��r^ Permittee Signature: cM AD4e,Fa I r Dld
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.
May 27 2012 9:06AM BOTH .
5 032632513 •
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Mechanical Permit Application ' 01.1..1( -I': ! �►� o:vL, 0et.„..„.
C JUN 01 4 201 4 ;
City of Tigard , � a
i 13125 SW Hall Blvd., Tigard,OR 97223 DaarJBy. �' Peed �'"`� �- -__I
_ a
03.718.2
Phone: 503.718.2439 Fax: 503.598.1960 CITY 0 TIGAR !'
Inspection : 5 Line: 439 F x: 5 ii'glitilimim Olfier Permit:
i i . A !: !, � !1!! DIN �JIVI , ; see Page 2 for
Internet: www.tigatdor.gov 4 Supplemeetallnfotmation
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❑ New construction ® Addition /alteration /re lacement Mechanical permit fees' are based on the value of the work
Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, end zroflt
Value: S
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® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory build For spedelInformadon uar obeeklta.
❑ Multi- family ❑ Master builder ❑ Other: Description
_ I Qty I Ea I Total
!_;�'�� _t!.e_` :Lim- _ �. _ = :':-5-,.‘.',:-.-,;-::::;,::,:•:;., Besting/cooling: .. W
�' " Air conditioning
Job site address: 16430 SW 93 (requires site plan showing placement) 46.75
Furnace 100,000 BTU (duenvvertts) 1 46.75 46.75
City/State/ZIP: TIGARD, OREGON 97224 Furnace 100,000+ BTU (doctsnems) 54.91
Suite/bldg. /apt, no.: I Project name: KEVIN ADAMS # 311616 Heat pump
(requires site plan ehowmg placement) 61.06
Cross street/directions to job site: Duct work 23,32
lyydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.:
Other fuel appliances:
_
: - _ -- _ ,:;.A es ;; = o �u i' "sic _ s._ := __ €:::: - =_;: ° Water heater
„ .... ...._... ��... _.. - _ � , - -
2332
INSTALLATION OF A GAS FURANCE. - s - ~ I Gas fireplace/insert 33,39
Flue vent for water heater or gas
I fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/ 2332 -,
.__ - „ . ,, .,_„x, - ;mss 7 -7 -• ; , i ,�:W _:__ ._ 7 Chimney
- Ainor/ lue/vent 23.32
; _': —��� , � -- -- - .:.-- x- , --- -. _ai!'a:;n+� �� Lp '� �-- '- '- ,�;= '== �:i;rziy 23.32
- other:
Name: KEVIN ADAMS Environmental exhaust and ventilation:
Address: 16430 SW 93RD Range hood/other kitchen
equipment 33.39
City/State/MP: TIGARD, OREGON 97224 I Clothes dryer ',disuse 33.39
Single -duct exhaust (bathrooms,
Phone: (503)869.4100 Fax: ( ) I toilet compartrneras, utility rooms) 23.32
aM =,., .i_._ R=,='- ii_R`:x _ Attic /crawls ace fans 23.32
Business name: ROTH HEATING AND COOLING F e l 23.32
' Fuel piping:
Contact name: STEVE MERRILL i $14.15 for first four; $4.03 for each additional
Address: PO BOX 1265 Furnace, etc.
i Gas heat pump
City/State/ZIP: CANBY, OREGON 97013 I Wall/suspended/unit heater
Phone: (503) 266-1249 I Fax: : (503) 266 -347(f Water heater
E-mail: STEVEM ®BOTH HEAT.COM Fireplace
Range
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Business name: ROTH HEATING AND COOLING Clothes dryer (gas)
Address: PO BOX 1265 I l.Othe�•-; ::,; -�__ g' ... 0 ;SE _--�='
u,
City/State/ZIP: CANBY, OREGON 97013 ; Subtotal
Minimum permit fee ($90.00) 90.00
Phone: (503) 266-1249 I Fax: (503) 266 -3478:
Plan review (25% of permit fee)
CCB lic.: 14008
Stara surcharge (12°Yo of permit tee) 10.80
TOTAL PERMIT FEE 100.80 V
Authorized signature: - T ab permit applic expires If a permit b not obtained within 180
days after it has been accepted as complete.
Print name: STEVE MERRILL Date: 6/4/12 ' Fee methodology set by Id- County Building Industry Service Board
rABailding1Permif EC.PermftApp.doc 03/07112 i440-46177(11/022COM/WEB)