Permit p CITY OF TIGARD MECHANICAL PERMIT
' • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00503
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 2S114BA11800
Jurisdiction: Tigard
Site address: 9550 SW MILLEN DR
Project: Lewis Subdivision: COPPER CREEK STAGE 3 Lot: 83
Project Description: (1) furnace change out from gas
Contractor: ROTH HEATING & COOLING Owner: LEWIS, RUSSELL D & PAMELA C
PO BOX 1265 9550 SW MILLEN DR
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503 - 620 -9707
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/03/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/03/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/03/2012 $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: ' /1 A, rn Permittee Signature: a 1 A pp Ci 4f'1 p LI
v Call 503.639.4175 by 7:00 a.m. for the next available inspection dat ' l
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.
OCT -03 -2012 WED 09 :31 AM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application ; a ! loll oFFicr. I1SE ONLY
City of Tigard O C T 0 3 2012 Date/By:
�/
D ve a e a- Permit No,: t x G a, -
Q�— oDs�
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
t C ` Phone: 503.711,2439 Fax: 503.598.1960,c Di lt Rev nv Other Farrah.
Inspection Line: 503.639 4175
TIGARD R /B , ' � r t �'. ;cuff '_{ Data Roa By: Juris;
121 Sec Page 2 for
Internet: www,tigard- or.guv !'1 ;1; ;-itb:f+, j,.r.iti'"• +; Notified/Method: T1 Cc, Supplemental Information
' • TYPE OF WORK ; , , ' COMMERCIAL FIhht 'SCittDIJLE tin 'CIII1CKLIST : .
Mechanical permit fees+ are hosed on the value of the work
❑ New construction ® Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ I)enlolition 0 Other: mechanical materials. equipment, labor, overhead, and profit.
Value: S
' • ' . ' , : ' .. ; ' ' ' • :; CATECQRY. OF:: CON
...., : � , � :: • : .
; . : ' 1 YA SYS?I'It1r5 :1 .105 ±.
® I- and 2- family dwelling [] Commercial /industrial ❑ Accessory building For special Information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: _Description Qty. I Ea. I Total
• JOB S1ITE •INFORMATION::AIVD;L0CA.T1014( . •• , entit acooling:
Air conditioning
Job site address: 9550 SW Mullen (reclaims site plan showing placement) , 46.75
City/ State/ZIP: Tigard, OR 97224 Furnace 100,(00 B'ft (ducts/waits) 1 46.75 46.75
Furnace 100 ,000+ BTU (ducto/venta) 54.91 _
Suite//bldg. /apt- no.: Project name: Lewis/31656 Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydmnic hot water system 23,32
. Residential boiler (radiator or
Itydronic) 23.32
Unit heaters (fuel -type, not electric), .
in -wall, in -duct- suspended. etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above _ 23,32
Other. 23.32
Tax map /parcel no.: _ Other fuel appliances:
' DESCRIPTION•..OIt WORK ' : :.::
Water heater
cha nging nut gas furnace Gas freplucrJinsert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 3139
Wood fireplace/insert 23.32
iner /flue /vent
'himney /I' 23 32
...... •� PROPERTY .OWNER • • ; :� ! ` .:. p. 'rENi#N'C .;. ...
Other: _ 23.32
Name: Russ Lewis Environmental exhaust and ventilation:
Address: 9550 SW Millen Range hood/other kitchen
equipment 33.39
City/ State/ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)620 -9707 Fax: ( ) toilet compartments. utility rooms) 23.32
: ® AP PLICANT : ; ° Ile,'CONTACT!:.PERSON : :' : „, Attic/crawlspacctans 23.32
Business name: Roth Heating and Cooling Other: 23.32
fuel piping:
Contact name; Angola McGraw 514.15 for first fuur; $4.03 for each additional
Address: 6990 S Anderson Rd Furnace, etc.
Gas heat pus,
City / State/ZIP: Canby, OR 97013 Wall /suspended /unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater
E -muil: ungelam@roth-hent.com Fireplace
•
,
Range
;CONTRACTOR B arbecue
Business name: Roth Heating and Cooling Clothes dryer (gas) _
Other: L___ Address: 6990 S Anderson Rd �
:. Mrcanr�ICAr : �P>i;1�t�tlrhanas*% ; .... ,.
City/State/ZIP: Canby, OR 97013 Subtotal 46.75
. Phone: (503) 266 -1249 I Fax: (503) 266 -3478 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee)
CC.B lie.: 14008 State surcharge (12% of permit fee) _ 10.80
TOTAL PERMIT FEE 100.80
Authorized signature: T his permit application minima if a permit is not obtained within 180
r ... days after it has been accepted as eoaq)loto.
Print name: An . . * cGraw Date: 10/3/2012 • Fee methodology set by Tri•County Building Industry Service Board
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