Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009-00236
Date Issued: 05/27/2009
T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S133AD03800
Jurisdiction: Tigard
Site address: 12,7_50 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: Mitchell
Project Description: Install heat pump and air handler.
Owner: FEES
MITCHELL, JOHN EDWARD AND Description Date Amount
KAREN KAY, 12750 SW SPRINGWOOD DR Air Conditioning or Heat Pump 05/27/2009 $14.00
TIGARD, OR 97223 Furnaces < 100K BTU 05/27/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 05/27/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/27/2009 $44.50
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503 - 266 -3478
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue
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Total $81.20
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 -0100. You may obtain a copy of the rules
Issued By: L1i. �tjQjjj Permi ttee Signature: 1Q �d JI l a .
Cali 503.639.4175 by 7:00 a.m. for an inspection that business day.
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-22-2009 FRI 12:39 PM ROTH HEATING FAX NO. 5032663478 P. 02/03
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Mechanical Permit Application- ' ' -- . 1 - '''_ ' - 1 volt orFicl.: 1181... ONLY
A
City of Tigard Itausived
- 1 1 Voi.. .11 - '■ ,
!p - . 13125 SW Hall Blvd., Tigard, OR 97223 .,. MAY 2 2 2009 p .
■ . io Date/Oy. n Review
59
03
0
Phone: 503.639.4171 Fax: 503,598.1960 '1 her Pomit:
Datc/By: Ot r
Inspection Line: 503.639.4175
TiGA I
tto Cr S '. - I ,- ,..ii - , : .',0 Dm ' 4"154133• RI see Page 2 for
Internet www.tigard-or.gov Notified/method: IM Supptementat Information
Di VIS101.,
tv.Pt . ..:OCAVamc: ''' • '.' •.! -, --.,•.'• '. :'''''', ..-`:', . ,-. ' t.'ciiiiimiiieWi . icilibutl:tigi
0 New construction :7•0". Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 1 0 Other mechanical materials, equipment labor, overhead, and profit.
Value: S
' '. ' :.:''':•-•: ''''! . ' .,- -• :: ;.- CATEGORY '9F:.c9NSTRUCTIOTSI , . ; •::: : ....? ,''' :::: ' , . ..„
f p 1 - and 2 dwelling D Commercial/industrial 0 Accessory building . ,.
For special Information use checklist.
U multi-famil 0 Master builder 0 Other;
Description 1 Qty. ! Ea. I Total
: ::: ,: ; :; JOB SITF 'INF.ORIVIA.TIEIN•TNp .LocATIoN:::. .:,. : i .:. ,... ::-..:. ... Heating/coaling
_ —
Job site address: 1 9_7 50 5 co cogl 1,0 (ld.- t 6 R Air conditioning or heat pump
(re_quiroN shy plun showing placement) I 14.00
City/State/ZIP: -_,,,,, ,?...,, 1 , 3 Furnace 100,000 BTU (ducts/venis) 1 14,00
•
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Furnace 100,000+ BTU (duets/vents) 17.90
Swte/bldg./apt.no.: 0 Project name: *-/ 5' 7 5 6, 2., — AS
Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct. suspended, etc. 14.00
,
Subdivision: Lot Flue/vent for any of above 6.R0
L10.*.
- . Other 10.00
Tax map/parcel no.: Other fuel appliances
pE se t o p tib r , / . dt,' w :. , .- , s . ' ... ..: • .z. -::- • !. Water heater 1 10.00
—
Gas fireplace 10.00
Flue vent for water heater or gas
.
h_13e74-19vnip fireplace 10.00
Log lighter (gas) 10,00
(A/2_ kviAta Wood/pellet stove 10.00
t2A
•
Wood fireplace/insert fireplace/insert
10.00
11 C imney/liner/Iluelvent 10.00
''..& ••;::." i';•; : 13::11701■41,f4: : ::: : E . ' . :i: : !: . 1 ::::,...
Other: 10.00
Name: 0731k,_ Environmental exhaust and ventilation
Address: ' Range hoocUother kitchen
k
equipment 10.00
...5. Cj... ..,,
City/State/Z1P: Clothes dryer exhaust ,. 10.00
Single-duct exhaust (bathforims,
Phone: ( ) " 70( Fax: ( ) toilet compartments, utility rooms) _ 6.80
1 ' ""' - " " •-• k jiiPAVPCICANT '-‘• ','...- ••••• '. :. ' -:. - , . • - ID: c oNTAcT • pErgs0::.. . .. ,::,‘ , Attic/crawlspace fans 10.00
_ _.__ . .. .. ,
Other 10.00
Business name:
Fuel piping _
____
Contact name: $5.40 for lint four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater _
Phone;( ) Fax: : ( ) Water heater
Fireplace _
E-mail:
l'r Ben
CONTRACTOR' ' .' • - •.•• ''' ''''' ' : . ' ". • '' . '; '' .f ' ' ' . ' , —
Business name: 1 ,..I.SHAA--64.41 . C 1 :0 C_DE 1) Clothes dryer (gas)
Other:
Ad4re$8: C) lb tn- )...4..5 •
0.2.
City/State/Z1P: C ok 6 v3 Subtotal
Minimum perrni ' ($72 50 gii,""
Phone: 6)3. ) 2_,A (. L(9 Fax: 6c5 ) ) 6. 4 -)d) • .
Plan review (25% of permit ee
CCB lie.: \ 1.11(1) 8 State surcharge (12% of permit fee)
TOTAL PERMIT FEE 'It( i 2:0
Authorized signature: AAVyte Ck_ KO& 1.9ir / ) 04 i c E no%,
— 'This permit application aspires if a permit is nnt obtained trii in ISO
days after it has lasso accepted ns complete.
Print name: I 4 r se Date: j • Fee methodology sot by TN-County Building Industry Service Board
—
1:V.Buildina1Perrnits\MEC.Peram.spp.dac 01/19/o7 . 440-4617T ( I 1/02/COM/WEB)
1AY =22 -2009 FRI 12:40 PM ROTH HEATING FAX NO. 5032663478 P. 03/03
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