Permit � k CITY OF TIGARD MECHANICAL PERMIT
'°1 I' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00654
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2012
Parcel: 2S 111 CC 18700
Jurisdiction: Tigard
Site address: 10385 SW GREENLEAF TER
Project: Fah Subdivision: SUMMERFIELD NO.5 Lot: 246
Project Description: Installation of furnace and gas piping to furnace and fireplace.
Contractor: ROTH HEATING & COOLING Owner: FAH, ROBERT E FAMILY TRUST
PO BOX 1265 10385 SW GREENLEAF TER
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/12/2012 $46.75
Type of Use: SF Fuel Piping 12/12/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/12/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/12/2012 $29.10
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 Signature: en/ 117
Pr
ff i�/� cri 6/770^1
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.
DEC -11 -2012 TUE 04:54 PM REGENED FAX NO. 5032663478 P. 01
Mechanical Permit ApplicatiotEC 1 1 2012
City of Tigard KCeelvrd �/ '^ p� Date/By: •/ i- /.1. II N9416-C.2942 e9S
O�
III 11
13125 SW Hall Blvd., Tigard, OR 972;�IT 1 of TIGARD Plan Review
u Phone: 503.718.2439 Fax: 503.59 ft.DING Oa111SI0td Other Pencil;
Date I G A RD
Inspection Line; 503.639 Date e Ready/By: nab: sec Pace .2 for
Internet; www.tigurd or.gov Notified/Method: Supplemental Information
•
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees• are based nn 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 'rout,
Value; S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I - and 2- family dwelling. ❑ Commercial /industrial ❑ Accessory building For special information use checklist,
❑ Multi - family 0 Mttster builder ❑ Other Description Qty. Eir_ 1 Total
JOB SITE INFORMATION AND LOCATION Heatin• coolin_: ..
Air conditioning
Job site address: 10385 SW Greenleaf Terrace 46.75 .
Furnace t I 46.75
City /State/ZIP; Tigard, OR 97224 _
_ Furnace 100.000+ BTU ducts/vents)
Suite/bldg. /apt, no.; Project name: Ruff Heat pump
Cross street/directions to job site: Duct work _
- Hydronic hot water system
Residential boiler (radiator or
h dronic)
-- ---- -- Unit heaters (fuel -type, not electric), .
in -wall, in -duct, susEnded. etc.
Subdivision: Lot no.: Flue/vent fur any of above ■
Other:
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater
installation of gas furnace, gas piping to furnace and fireplace (ins tire lace/insert
y// fIt }/ T /e72 , g - � �
Wood/ ella stove 3339
Wood fireplace/insert 23.32
. ® PROPERTY _OWNER I ❑ TENANT
Other;
Name; Dian Rutz Environmental exhatufit sod ventilation: -
Address: 10385 SW Greenleaf Terrace Range hood/other kitchen
City /State/ZIP: Tigard, OR 97224 Clothes dr er exhaust 33.39 -
Single -duct exhaust (bathrooms.
Phone: (503)432 -1657 Fax: ( ) toilet corn • .rtmcnts, utili moms 23.32
® APPLICANT ❑ CONTACT PERSON, Attic/crawlapace fans 23.32
Business name; Roth Heating and Cooling Other: 23.32
-.- Fuel piping:
Contact name; Angela McCraw S14.15 for first four: 54.03 for each acditioual
--
Address: PO Box 1265 Furnace, etc. ) 4• I J
Gas heat . um •
City /State/ZIP; Canby OR 97013 Wall /sus• ended /unit heater _
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater
Fire lace E
E -mail: angelam(aroth- hcat.com I M-
CONTRACTOR Barbecue
Business name: Roth Heating and Cooling Clothes d et (. , a - �~ _,
Other:
Address: PO Box 1265 MECHANICAL PERMIT FEES*
T
City/State/ZIP: Canby OR 97013 Subtotal La). l•
Minimum permit fee ($00.00) • fr .,
P. • e; (503) 266-1249 Fax: (503)266-3478
Plan review (25 %of permit fee) _
A CCB lie,: 14008 i State surcharge (12% of permit fec) I Z), . r
I .._ l/
TOTAL PERMIT FEE 11:X:),..710
Authorized signu l i , 1 �� , _ This permi : J yt after has been ac as template, within ISM Aka_ Print name: A McGraw 4 Date: 12/11 /12 • Fee meihodology set by Tri- onnty Redding liuduatry Service Oeanl
1 :1Buiidina\Purmiiu)MEC- PamilApp aloe 63/07/I: 440.4617T (1 1 /D2/COM/WED)