Permit CITY OF TIGARD MECHANICAL PERMIT
• a • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00446
T [GA.RL) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 1 S125DA03500
Jurisdiction: Tigard
Site address: 6524 SW WALNUT TER
Project: Henson Subdivision: KINGS VIEW Lot: 20
Project Description: (1) gas furnace change out
Contractor: ROTH HEATING & COOLING Owner: HENSON, DONALD
PO BOX 1265 6524 SW WALNUT ST
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 246 -7880
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Minimum Fee Adjustment - Mechanical 08/27/2012 $43.25
Type of Use: SF Furnaces < 100K BTU 08/27/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 08/27/2012 $10.80
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: U fj Permittee Signature: Di 4 !'p/� U e Arok I
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.
AUG -24 -2012 FRI 01:46 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechani'ca1 permit Applica (.�' Y ( { J
City of Tigard
l'OIZ O1+'1
Received '1('1: u.51? l)N1.1'
N___-. 13125 SW Hall Blvd., Tigard, OR 97223 Date/lly: . , '] N Permit No, :_ EC .20 _ D0 0, _
Phone: 503.718.2439 Fax: 503.598.1960 AUG 2 7 2012 Plan Review
T 1 i; A It D Inspection Line: 503.639.4175
Date/By: Other Permit:
Internet www.ligtud�r.gev CI�OFT Nate : Jain: Page 2for
I D �1 4i � pplemeoml Information
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❑ New construction Addition/alteration/replacement
Permit fees* era based on the value of the work
El Demolition performed. Indicate the value (rounded to the nearest dollar} of all
?rD r 'os tion t 0 r mechanical atcnals overhead, profit
- ui
• �� f-� �+ "'.;� - equipment, labor.
:L i.li - �'' 1; t . irk . 1. r } {C 47 �1� :G D _I h �-• n m m lu r cad and f
�.. �L . t.. - tl a `,;, f a �l ; 5 ' • , ' �� ty � � Value $
IS 1 - and 2-family dwelling 1 14 2 ;in'1 1 , r L1 Ar4 "f r '1Y) °' �� t n
y g ❑ Commercial /industrial ❑ Accessory building hl t o ,us ° ` = fi
❑ Multi orspedal/ryJamrorf
❑ Master builder F on use check/!st
`� i ° =ll r,- �` ,+Ir�,, I("- +.%.r -w � •.� ... -,- .. Other: Description QtY. Ed 1 H., - 2. ' 71:a �' ._ ,, ,1:. l dl (•1 y 7.-r t ! r r iA.1 /-D' ,1 - -^ Ir
_ sw . , � ;) 77 . 1 1 H.,. , 1 1 r, 4 . r lf� J ) ! .,' r' ' Y I� cond /cu n in :
Job site address: / . � r `1 Air conditioning
W 1 - I - r'�' ra Ge., (requires site plies showing placement) 46.75
City/State/ZIP: ( • n = �27 Furnace 100,000 BTU (duels /vents) 1 46.75 LI b.'1,'
Suite/bldgJapk no.: U Furnace 100,000+ BTU (duct,+/venta) 54.91
Project name: Heat pump
Cross street/directions to job site:
,..(require:. aim plan showing piecemeal 61.06
Duct work
Hydronic hot Water system 23.32
Residential boiler (radiator or i
hydronic) 23.32
Unit heaters (fuel -typc, not electric),
in -wall, in -duct, suspended. etc. 46.75
Subdivision:
_ I Lot no.: Flue/vent for any of above
23.32
Tax map /parcel no.; Other:
', " r"-t �y u' ,€ ;' s'� 4 ? �>a Other fuel appliances:
, : ,7 _ ,ti IlL4 a l �ti �t 1 1 ti / ± ; ' **"'•r io 7 1, Water heater 23.32 i
CA. s l A_.1 Q;CJ.. V14.71.0 • . C - Otis fireplace /insert 33.39
Flue vent for water heater or gas
fireplace 23.32
_Log lighter (gel 23.32
Wood/pellet stove 33.39
to +l }� 4 1,�y_ ! ry Wood ftreplace/insert 2332
_x ,174 , Fil a nit� 4 rut Ti, 1'I x i
.. :G... , ._.` 4 .. r l ,° , -r F „ .,, -, .1 ' tka l : yl .1 'Q ;,-r; Chimncy/liner /tlue/vt:nt 2332
Name: p on .F�`� :.�. .n. a.; ^ Other: 23 3
rti �� 23.32
Environmental exhaust and ventilation:
Address:
I Z Range hood/other kitchen
City/State/ZIP: - equipment 33.39
Phone: Clothes dryer exhaust I
' I 3339
�3) 2`7 (Q � Fax: ( )
Single-duct exhaust (bathrooms,
w µ i �q� ey- t a.�,n , ^r s toilet let compartment', utility rooms)
R
i' r - .F_,k-i ,r + uS`/'� I a_ "1. 4 i ...,, • w c 23.32 '
.. e,�lf,1_ a. :.,uzLi'�f q °, 4 : sit ; r.., % ..` t . , Attidcrawlspaccfans 23.32
Business name: �° `'
Other: 23.32
Contact name: - Fuel is :
514.15 for first four $4.03 for each additional
Address: Furnace, etc. r-
City/State/ZIP: Gas heat . um 1�
-
Wall/sus . nded/unit heater
Phone: ( ) r Fax; ; ( ) Water er heater
E-mail: Fire,laco
I1 ,:1:,Kra'- ti�i3�11. .T:1;'.. i_ -lira W�� e 4 tl el; T,a .p• 7 . '... - - Ratt_e
�'' -+ 6o.r �. r -_ - ; � , N� , W " m_., 1 it '� - ' � y � ` ; �' t..:^ Barhoctn:
Business name: t O f� 1 J ,',-)e- Clothes dryer -:
Address: PO L Other
City/State/ZIP: �{,/')� D k, 2, t T- t ` • ,11D ei E(_4 U IJo ,grr
subtotal L'
Phone: (,� j 2. Lp (p. 2_4 Fax: (C ) Minimum permit fee ($40.00) '1 0 ..611
1 0 - - 3 0 7 (
CCB lie.: l i.moy Plan review (25% of permit fee) MIN
State surcharge (12% of permit fee)
Authorized signature: I �j�{}�j This cress a TOTAL PER IIT FEE • 0. '1 N
p pplicatlon expires if n permit is not obtained within ISO I
Print name: �'�, "n�-� days after It NO been accepted nm
as cplate,
�� - IC�i / � =11 Date c ®IM • Fee Me thodology set by Trl -County Building tnldusny Service Boon)
1 : 1 BunclieracrmftalM$C.rermitA den 03/07/12
44D - 4417T (I 1 /07/C0M/WPJi1
CITY OF TIGARD MECHANICAL PERMIT
• a • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00446
T [GA.RL) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 1 S125DA03500
Jurisdiction: Tigard
Site address: 6524 SW WALNUT TER
Project: Henson Subdivision: KINGS VIEW Lot: 20
Project Description: (1) gas furnace change out
Contractor: ROTH HEATING & COOLING Owner: HENSON, DONALD
PO BOX 1265 6524 SW WALNUT ST
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 246 -7880
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Minimum Fee Adjustment - Mechanical 08/27/2012 $43.25
Type of Use: SF Furnaces < 100K BTU 08/27/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 08/27/2012 $10.80
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: U fj Permittee Signature: Di 4 !'p/� U e Arok I
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.