Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00322
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012
T [ G A.R. D Parcel: 2S111AD05100
Jurisdiction: Tigard
Site address: 8840 SW PINEBROOK ST
Project: Flora Subdivision: PINEBROOK TERRACE Lot: 74
Project Description: (1) installation of gas furnace
Contractor: ROTH HEATING & COOLING Owner: FLORA, DWAINE
PO BOX 1265 8840 SW PINEBROOK ST
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 -620 -2305
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/25/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/25/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/25/2012 $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 by calling 503.232.1987 232.1987 or 1.800.332.2344.
Issued By: /� y p . 1 Il x J. Permittee Signature: D 11 y A Qa/ . / -� \ ok
��� ///III � by 7:00 a.m. for the next available inspection date.
1 [ -/ F r
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 13 2012 1:56PM ROTH HEATING 5032632513 p -1
Mechanical Permit Application RE i ''
City of Tigard Received
:� ° 13125 SW Hall Blvd Tigard OR 97223 JUN eBy: to _ y- Sf Permit No.j ., olo a - too 3A
Phone: 503.71 8.2439 Fax: 503.598.1960 J U N � j plan Review
I I G :, 1: 1-, Inspection Line: 503.639.4175 p� Date/By: Other Permit:
Internet www.tigard or.gov pC� CITY Q. T I�:AR 1I N o a tifi Re Y/BY: Judi ® See Page 2 for
V IL'.l]Il� - ��1�� J � �i . /c i c, Seppkmental Information
, --ibI • i :: `��Sr'�' , - 'l I Sv�i�'6 �� , -� •w ent _
,rsa - I did a :��i� �','�'�'ur ;J:�','�� -�c:. � =n Y � `_�_ ..
>� I. - !� u�� �yT= �i- •in'3:€ -�= t =f R;;r�j' :.u�. '�,�'�i :� ,' Tom`( - u :� ;�.:_�� ,�
El New construction Mechanic .._.. T t r ' � r- �1't .
® Ad dition/alteration/repl . • .+1, �, per pamtt fees are based a the value ar s work
❑ Demolition ❑ Other: Perform indicate Uu value (routdod to the nearest dollar) of all
�u mechanical materials, equipment, labor, overhead,
>=r �. r! ie �- I w 'lei' =_. := t ^ _ Value: and profit
tszs+�e�r�t� - , . � :.. ,_ .., :.._ ._ slue:
® 1- and 2- family dwelling ❑ CommerciaUlndustrial ry :; ' ' I �_ -i
❑ A. essory building - sue'• -ti
• Foe fRlar checklist
❑ Multi - family 0 Master builder
��j�--- -�r_ Ig'x: . �.a-'� . f m � Description - I Qty. 1 a. Total
r::_ : ? - 17 -3 ti's" I Eiiil-,Ln - - _ - Hllea pdon
- a - ,_ - I � _ �=� � rl�lcoolinS:
Job site address: 8840 SW PINEBROOK ST. _ Air conditioning
(requires elite plan thawing elacement) 46.75
City/State/ZIP: TIGARD, OREGON 97224 Furnace 100,000 BTU �iuocvlvanta) 1 46.75 46.75
Suite/bldg./apt. no.: Furnace 100,000+- BTU (ducts/vents) 54.91
- I Project name: FLORA 0 32413 Heat pump
Cross street/directions to job site:
(requires sae plan showing placement) 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
6ydrocic) 23.32
Unit heaters (fuel - type, not electric),
in - wal l, i n-du ct, s uspended etc
Subdivision: I Lot no.: Flue/vent fbr any of above 232
Tax mad /parcel no.: Other: 233..32
23.32
Other fuel appliances:
-'. _ irk_ ,+ -, �.
� - . r ..:. l - = .�, ;til -L - - 1'-i 9 rat .; " :1 !� _ : - ' ?` € Water heater
INSTALLATION OF A GAS FURNACE 2332
Gas fireplace/insert eplace/insert 33.39
Flue vent for water heater or gas
fireplace 2132
Log lighter ( R as ) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert
����'�-� '�,��r�a - rteer�.- : = y -� 23.32
t .�'•)Et `ir,> •. _,. , ` ` I�as'S' r .t ; if, . i .«°il:c� Chimney/liner/Hue/vent 2332
Name: DWAINE FLORA omen:
23.32
Environmental exhaust and ventilation:
Address: 8840 SW PINEBROOK ST. Range hood/other kitchen
Chy/State/ZIP: TIGARD, OREGON 97224 equipment 33.39
Clothes dryer esheust 33.39
Phone: (503) 620 -2305 Fax: ( )
Single-duct exhaust (bathrooms,
Sin e-dua athro
pper�`. �p = : r � }, r , - �. _. toilet eartmen utility lr- r?!! - - cCA - i. .�iiii 7s &i MI :ri.. :.'�: LORI t3, ttY rooms) 23.32
' 1 AWe/crawispam tires 2132
Business name: ROTH HEATING AND COOLING Other:
2132
Contact name: STEVE MERRILL Fuel piping:
514.15 for lint flour, S4.03 for each additional
Address: PO BOX 1265 Furnace, eta
City/State/ZIP: CANBY, OREGON 97013 Gas heat pump
Phone: (503) 266 -1249 Wa Water heater
beater
I Fax:: (503) 266,3478 Water heater
E- mail: STEVEMOROTH- HEAT.COM Fireplace
k� i? ivuce,�� _.-- _ _ -. Range
...!j- . ...� , ..� r i.'I�r4itthLRS�E�,1` ''�, -= �?'4;- L -4iiwc e l ; ---- " 411 ".1 7 =- 7 :4 4- � Ce-: Barbecue
Business name: ROTH HEATING AND COOLING Clothes dryer (gas)
Address: PO BOX 1265 Other
City/State/71P: CANBY, OREGON 97013 ^' -` - I '° =' 1 t � .,a :.
Subtotal
P , one: (503) 266-1249 I Fax: (503) 266 -3478 Minimum permit fee ($90.00) 90.00
CCB lic.: 14008 Plan review (25%of permit fee)
State surcharge (12% of permit fee) 10.80
Authorized signature: TOTAL PERMIT FEE 100.80 (/
This permit application expires ifs permit beet obtained within 180
L Print name: STEVE MERRILL days otter b has been accepted as amide%
Data: , 1/12 I • Fee methodology set by Tii- Coenty Building Industry Service Board
1 : -P p.doe 03/07/12
-07r 01/1:=074/M10)