Permit 1 y n CITY OF TIGARD MECHANICAL PERMIT
1 1 Ilz , COMMUNITY DEVELOPMENT Permit #: MEC2012 -00522
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/10/2012
Parcel: 2S112CD03600
Jurisdiction: Tigard
Site address: 7700 SW BOND ST
Project: Lebeda Subdivision: BOND PARK Lot: 16
Project Description: Changing out gas furnace
Contractor: ROTH HEATING & COOLING Owner: LEBEDA, VLASTIMIL/SHARON
PO BOX 1265 15607 SW HIGHPOINT DR
CANBY, OR 97013 SHERWOOD, OR 97140
PHONE 503 - 266 -1249 PHONE: 503 -473 -5480
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/10/2012 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 10/10/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/10/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types. Natural Gas
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: Permittee Signat
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.
OCT -10 -2012 WED 02 :50 PM ROTH HEATING FAX NO, 5032663478 P. 01
Mechanical Permit Applica roll (!I i'l('+ USE ONLY
114 City of Tigard -- ' " Date/By; /� i Pennit No ���_�
Y 13125 S Nall Blvd., Tigard, OR 9722n
to Phone: 503 7182439 Fax: 503 598.1960' C T 1 0 2012 p Date/ lan RBy: eview Other Permit.
T I G A R U
Inspection Line' 503,639.4175 Dnie Ready /By: June' ia Soc Page 2 for
Internet: www.tigurd or.gov CITY OF ARD Notifed/Method: Supplemental Information
BUsi. L[ - • COMMERCIAL FEE" �SC11EDLt s!— US (CHECKLIST ,
IYI'L;OF WORK, _
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
❑ Demolition ❑ Other' mechanical materials, equipment, labor, overhead, and profit,
CATEGORY 'OF CONSTRUCTION. ' Value, $
, RESIWENTIAL EQUIPMENT/ I'`YSTEMS IMES *'
® 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For spednlln(fonnnllon use checklist. _
❑ Multi- family ❑ Master builder ID Other: Description — I Qty. I Ea. � Total
, JOB SITE INFORMATION' AND LOCATION Heating/cooling:
— — Air conditioning
Job site address: 7700 SW Bond (requires site plan showing placement) 46.75
City /5tatc/ZIP: Tigard, OR 97224 Furnace 100.000 BTU (diicls/vents) 1 46.` 5 46.75
Fumuce 100,000+ BTU (ducts/vent.) 54.91
Suite/bldg. /apt. nu.: Project name: Lebcda/36365 Pleat pump -
- (requires silo plan showing placement 61 06
Cross street/directions to job site: — work 23.32
Hydronic hot water sn 23.32
Residential boiler (radiator or
Imdronic) 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:
DESCRWPTION' OF WORK .. . ," , , ' _Water heater 23.32
changing out gas furnace Gas fireplace/insert 33,39
Flue vent for water heater or gas
fireplace 23.32
Lop, lighter (gas) 23,32
Wood/pellet stove 3339
_ Wood firplace /insert 23.32
' , • ' ,®, PROPERTY OWNER , %. " 0.'TENANT. ' : , Chimney/liner/flue/vent 2332
Other: 23.32
Name: Vlastitnil Leheda Environmental exhaust and ventilation:
Address' 7700 SW Bond Runge hooTother kitchen
equipment 33 39 -
City/ State/ZIP: Tigard, OR 97224 _ Clothes dryer exhaust 33.30
P)473-5480 - Single -duct exhaust (bathrooms,
Phone: (503 Fax: { )
toilet compartments, utility rooms) 23.32
ISI, APPLICANT', , El . COPITACT'PERSON Attic/crawlspace fans 23.32 -
Business name: Roth Heating and Cooling Other: 23.32
Fuel , Ilino
Contact name: Angela McGraw $14.15 fur first four; 54..03 for each additional
Address: 6990 S Anderson Rd Furnace, etc.
Gas heat pump
City/ State/ZIP: Canby, OR 97013 Wall/suspended/unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater _
Pir •lace
E -mail: angelam@roth- heat.com Ran .e
, ;CONTRACTOR " ' ' , , , Barbecue
Business name: Roth Heating and Cooling Clothes dryer (gas) _
Other.
Address: 6990 S Anderson Rd , ..• . ',.. '. ' ' ' '
,,.'' MI4IGHAN,[f.A,LPERMITTI'ES's; , .
City /State/ZIP: Canby, OR 97013 Subtotal 46.75
Phone: (503) 266 -1249 Fax: (503) 266 -3478 Minimum permit fee ($90 00) 90.40
. Plan review (25% of permit fee) _
CCB lie.: 14008 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100,80
This permit application expires If a permit Is not obtained within 18
Authorized signature: . 0
�(}� 1 days attar it has been accepted ae complete.
Print name: Ang Gra ale: 10/10/12 * Foe methodology set by Tai- County Building Industry Servleo Board
1 :\ building \Purnuts \MEC•PormlrAppdcc 03/07/12 I40- 4'17T(II/07JCOM/WtB)