Permit CITY OF TIGARD MECHANICAL PERMIT
II
s - COMMUNITY DEVELOPMENT Permit #: MEC2012 00320
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
TIGARD . 9 Parcel: 2S 103DB10400
Jurisdiction: Tigard
Site address: 13205 SW GENESIS LP
Project: Rollins Subdivision: GENESIS NO.3 Lot: 71
Project Description: (1) Heat Pump ductless split system
Contractor: ROTH HEATING & COOLING Owner: ROLLINS, SHARON
PO BOX 1265 13205 SW GENESIS LP
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 702 -5917
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Heat Pump 06/19/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 06/19/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/19/2012 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
__221_____Af
Issued By: Permittee Signature: V AT`f'N( ►vOL
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jun 11 2012 11:56AM ROTH HEATING 5032632513 p.1
Mechanical Permit Application
City of Tigard i V �, Aeaived
.� __--- 13125 SW Hall Blvd., Tigard,OR 97223 Detcna la 4 1 ! a- i 'io 1 4 /� OD 3
Phone: 503.718.2439 Fax: 503.598.1960 lea Review
Inspection Line: 503.639.4175 JUN 19 2012 P
Date/By: omen permit.
l l c, t: t> �c
Internet: www.tigard•or.gov l3 L Date Ready/By: see Page 2 for
C OF TIGARD Notified/Mehod: Tic- Supplemental information
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❑ New construction ® Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
❑ N e w on on performed. Indicate the value (rourded to the nearest dollar) of all
❑ Other: �3y mechanical materials, equipment, labor, overhead, and profit.
L - ut - +?:: -. ___:�.�'__ •; ,r`.: l'5.'- ••.,�,m g; q+`_" y `: � « FP�..iu'_��.`Y_r. ; , ?.,,:= :.::._!• =-__i - Value:$
T ``.:: : - - 1 a n 1I.. I@4fi�l+ : v- '_ i{ " :d x:4 li._ ;'-fh4 =. „ . , ; 17_ _ ��pg ._ -,
u„- Y�lulc#uut �loamlt l(i__'�- '�ii� ulrrsiiu'.Y_.� :, `_".: lii:_:.�y'
/ --,- -:
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ A •ry building For speclallsforntatlon use checklist
❑ Multi - family ❑ Master builder ❑ Oth r: Description
z _ =ii 4 _ Qh • Es- � Total
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:m = er. ; .._ : �;::_ Air conditioning
Job site address 13205 SW GENESIS LP I (requires site plan showing placement) 46.75
City/State/ZIP: TIGARD, OREGON 97223 Furnace 100,000 BTU (ducts:vents) 46.75
Furnace 100,000+ BTU (duets/vents) , 54.91
Suite/bldg./apt. no.: I Project name: ROLLINS i 3908 Heat pump
(requites site plan showing placement) I 61.06 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic 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: I Lot no.: Flue/vent for any of above 23.32
_Other . Other 23.32
Tax map /parcel no 1 - Other feel appliances: :
.. u - (p�T'= =' 1C�z i - l !nu�r_.-.?1i'._--Oc__a 2 '-. "tF�';
•- `;thta� -� -= vl'rc:_,a,.,.- .,a:, --_ �,,,,..._ y.F = - =�.� Wa ter h eater 23.32
INSTALLATION OF A DUCTLESS HEAT PUMP SPLIT SYSTEM.
Flu lu vent 33.39
Flue vent tar r w wale ater heater or gas
fireplace 23.32
1 Log lighter (Ras) 23.32 _
Wood/pellet stove 33.39
Wood fireplacermsert 2332
G`�:=_ _Fi �i�i c i x :re i ,..- ._,„ t Chimney/liner/flue/ vent _ 2332
.3 'i2 �, � � _ - � m uE� --' sit :? ���_ _.� �,'� =tip � • Name: SHARON ROLLINS Other: 23.32
Environmental exhaust and ventilation:
Address: 13205 SW GENESIS LP. Range hood/other kitchen
equipment 33.39
City/State/ZIP: TIGARD, OREGON 97223 Clothes dryer othaust 33.39
Phone: (503)702-5917 Fax: ( ) Single-duct exhaust (bathrooms,
�_�, =•: 'o - '• �_.° v = _ •c PT:: - y � Y - _ ,•: - -= , . ... . f. s toilet. compartments, utility rooms) 23.32
. ham'' : .'. 3 ,; r�••1 F • " � s ce fans
- .i •'.o4s n-=� -si ]'" i _ y i AtIiC/CttiWl p8
-'�'' � 23.32
Business name: ROTH HEATING AND COOLING Other. 23.32
Fuel piping:
Contact name: STEVE MERRILL $14.15 for first four, $4.03 for each additional
Address: PO BOX 1265 • Furnace, etc
City/State/ZdP: CANBY, OREGON 97013 Gas heat pump
Wall/suspended/unit heater
Phone: (503) 266 -1249 I Fax: : (503) 266 -34781 Water heater
E -mail: STEVEM @BOTH- HEAT.COM Fireplace
:91f- �t
y x11041 E; . Ulu[ L7 ,i _••y -_ F= _ 1 - Barbecue
Business name: ROTH HEATING AND COOLING Clothes dryer (gas)
•
Address: PO BOX I265 Other:
City /State/ZIP: CANBY, OREGON 97013 : '= •6 L +'tL K A J '` :
Subtotal
Ph ne: (503) 266-1249 I Fax: (503) 266-3478 Minimum permit fee (890.00) 90.00
Plan review (25% of permit fee)
CB tic.: 14008 State surcharge (12 %ofpertnit fee) 10.80
r te- TOTAL PERMIT FEE 100.80
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
I Print name: STEVE MERRILL I Date: 6/6/12 • Fee methodology set by 7N -County Balding industry Service Board
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Jun 11 2012 11:56AM ROTH HEATING 5032632513 p.2
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Outdo r Unit Site Plan
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City, State Zip: - 1 ►GA�o aQ
Front
Street