Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00397
T WA . R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/30/2012
Parcel: 2S109BA05100
Jurisdiction: Tigard
Site address: 13785 SW MISTLETOE DR
Project: Briggs Subdivision: HILLSHIRE SUMMIT NO.2 Lot: 33
Project Description: (1) replace A/C Must be within 5 side yard setback and approved rear yard setback
Contractor: ROTH HEATING & COOLING Owner: BRIGGS, VALERIE
PO BOX 1265 13785 SW MISTLETOE DR
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 - 579 -3437
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Air Conditioning 07/30/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/30/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/30/2012 $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. /�/�
Issued By: J `�.S4 .8 Permittee Signature: ox‘ \ pp / 64T70�
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. • 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.
JUL -26 -2012 THU 12 :05 PM ROTH HEATING FAX NO, 5032663478 P. 01/03
Mechanical Permit Apolicatio> C D i ou ilh't'u i Hsi,: ONl,,
City of Tigard Received Date/By: 1 30 12. 54— Permit No.: A.L �t 4 ) O f ?. _ ' ,
N.,_ u 13125 SW Hall Blvd„ Tigard, OR 97223 JUL 2 6 2012 Plun Review
•_ Phone: 503.718.2439 Fax: 503.598.1960 oote/By: Other Permit:
,. i ; A , t Inspection Line: 503.639.4175 auk Re rrlylay: turi RI Sec Page 2 for
Internet: www.libwd -0r,gov CITYOFTiGARID Notifi l � Supplemental Information
BUII.DINGDIVISIO r ••
• • .TYPE OF WORK ' . . • • COMMERCIAL FEE" SCHEDULE USECHECKLUST.'.
Mechanical permit fees'" are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, tmdprofit.
Value: $
CATEGORY'. (3P CONSTRUCTION •• •RESIDFN TIAL EQUIPMENT / SYSTEMS FEES" . .
El 1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building For spade! information usecheck&1.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total
•
• • JOB SITE •INPORMATION, AND LOCATION . . Heatiag/eooling:
Air conditioning
Job site addresu 13785 SW MISTLETOE DRIVE (requires site plan showing placement) , 1 46.75 46.75
City / State/ZIP: TIGARD, OREGON 97224 Furnace 100,000 BTU (ducts/vents) 46,75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no,: I Project name: BRIGGS # 33349 Heat pump
- (requires site plan showing placement) 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: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK . Water heater 23.32
• INSTALLATION OF AN AIR CONDITIONER C Q Gas fireplace/insert 33,39
r�a La, v-L4) 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
:® ?PROPERTY OWNER .' Chimney/liner/Sue/vent 23.32
. • : CI :TENANT
Other, 23.32
Name: VALERIE BRIGGS Environmental exhaust and ventilation :_
Address: 13785 SW MISTLETOE DRIVE • Range hood/ocher kitchen
equipment 33.39 •
City /State/ZIP: TIGARD, OREGON 97224 Clothes dryer exhaust 33.39 _
Phone: (503)579 -3437 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
,®• 'APPLICANT . • : . :[] CONTACT. PERSON' Attic/crewlspace fans 23.32
Business name: ROTH DATING 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.
Gas heat pump
City / State/ZIP: CANBY, OREGON 97013 Wall /suspended/unit heater
Phone: (503) 266 -1249 J Fax: : (503) 266 -3478 Water heater •
Fireplace
E -mail: STEVEM@ROTH- fEAT.COM Range
• • . ' CONTRACTOR ' . • . . . Barbecue •
• ^
Business name: ROTH HEATING AND COOLING . Clothes dryer (gas) •
Other.
Address: PO BOX 1265
M)Ji3lAIYCCAI:,PERfYiIT GEQS•
City /State /ZIP: CANBY, OREGON 97013 Subtotal
Phone: (503) 266 -1249 Fax: (503) 266 -3478 — Minimum permit fee (590.00) 90.00
Plan review (25% of permit tee)
/
-
CB lie.: 14008 • State surcharge (12% of permit foe) 10.80
4,___-, TOTAL PERMIT FEE 100.80
Authorized signature: This permit application expires if a permit is net ubfaioed v.tdrta 180
days after it has been accepted as complete.
I Print name: STEVE MERRILL I Date: 7/24/12 I • Fee methodology ear by Tri•County Building Industry Service Board
1: 18ulldlnalremtalMEC- PemdrAlryr.dne 05/07/12 4404o17T i /:/COM/Wea)
II
2 ° Building Division
Development Code Provision Review
TIGARD Residential Projects
Building Permit No:
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑
Routed Plans:
Original Plan Submittal Date:
1st Revision Submittal Date: ❑ Site Plan Only
2 Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact C k c'd C. c " - at 503-718-J-43 7 or c.>^ e ' y I c- @ tigard- or.gov)
Land Use Case No. Name
❑ Zoning
fi Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
Notes: A, e �lru.R 4 ' t ekb Act( b( c- et P 1 4t,e v F r•-� o-C e y i S .(.; .• 1 �v...
Original Plan: Approved N O Not Approved ❑ Date: — I - 30 - I
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope: %
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @ tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2
JUL -26 -2012 THU 12 :05 PM ROTH HEATING FAX NO. 5032663478 P. 02/03
A/C OR HEAT PUMP SITE PLAN
HOUSE lcC.fr �
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FRONT
ADRESS:
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