Permit CITY OF TIGARD MECHANICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit #: MEC2012 00672
T C G ARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 12/19/2012
Parcel: 1 S135DD04600
Jurisdiction: Tigard
Site address: 8865 SW CENTER ST
Project: Anderson Subdivision: LOMITA TERRACE Lot: 9
Project Description: (1) gas furnace installation
Contractor: ROTH HEATING & COOLING Owner: ANDERSON, ROGER F
PO BOX 1265 10120 S W KABLE ST
CANBY, OR 97013 TIGARD, OR 97224
PHONE 503 - 266 -1249 PHONE: 503 - 475 -6588
FAX 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/19/2012 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 12/19/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/19/2012 $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: xRagy kc.-d Permittee Signature: oa A PPL / C 0 1D0
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 -18 -2012 TUE 01:00 PM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Application 1 OR OFl 1( l: t I. ON1,1
City of Tigard • CEIVED d P annii Ho � 1( 13125 SW Hall Blvd., Tigard.OR Utn �� �a s� tMfi �— csV /,� - t��y
Plan Review
Phone: 503.718.2439 Fax; 503.598,1960 D Other Permit:
Inspection Line; 503,630.4175 DEC 18 2012
l I G .R It U Internet: www.tigard- or.gov Notified/method: f ( R upp em Page 2 for
ntsl Information
CITY OF TIGARD
TYPE .O WING DIVISION • .: COMMERCIAL: FEE ":.SCHEDULE USE CHECKLIST
Mechanical permit fen* are based on the value of the work
❑ New construction LSI Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials labor, overhead, and profit
.. , . Value: $
CATEGORY.' OF CCQNSTRUCTION ; : ,
. .RESIDENTIAL EQUIPMENT /.SYST.EMS FEES*. ' ..
® I - and 2-family dwelling ❑Commercial /industrial C] Accessory building Far apci1 Informiulon use dice/disc
❑ Multi- family E] Master builder ❑ Other: Description I Qty. F Ea. I Total
JOB SITE. INFORMATION AND LOCATION ' • Heating/cooling: ,
' Air conditioning
Job site address: 8865 SW Center St (requires site plan allowing placement) 46.75
CitylSlute/ZIP: Tigard OR 97223 Furnace 100,000 BTU (ducts/vcnts) 1 46,75 46,75
_ Furnace 100,000+ BTU (duels/vents) 54.91
Suite/bldg. /apt. no.: Project name: Anderson/39475 Heat pump
(requires site plan ahowingplacement) 61.06
Cross streeldirections to job Site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
- - - Unit heaters (fuel -type, nut electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: J Lot no.: Flue/vent for any of above 23.32
Other 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION • OF ,WORK • : :.: W heater 23.32
installation of gas furnace Gas fireplace/insert 33.39 ,
Flue vent for water heater or as
-
fireplace 23.32
Log lighter jags) 23.32
Wood /pellet stove 33.39
-
Wood tircplace/inscrt 23.32
Chimney /liner /flue/vent 23.32
® 'PROPERTY OWNER ' 1 • '' : ❑: TENANT _ ' Other. 23.32
Name; Roger Anderson I Environmental exhaust and ventilation:
Address: 8865 SW Center St Range hood/other kitchen
equipment 33.39
City /State/ZIP; Tigard OR 97223 Clothes dryer exhaust 33.39
Phone: (503)475 6588 Fax: ( ) Single -duct exhaust (bathrooms,
_ toilet compartments, utility rooms) 23.32
,.. n APPLICANT Q CONTACT' PERSON ,:;: , Atlic/crawlspace fans 23.32 _, „ ,
Business name: Roth Heating and Cooling Other; 23.32
Fuel piping:
Contact name: Angela McGraw _ 514 -IS for lust four; $4.03 for each additional
Address: PO Box 1265 Furnace, etc.
City/State/ZIP: Canby Or 97013 Gas heat pump
Wall /suspended/unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater ,
Fireplace
E -mail; angelam(Jroth- heat.com
Range
CONTRACTOR I : ; , arbecue
Barbecue
name: Roth Heating and Cooling Clothes dryer (gas) ,
Other:
Address; PO Box 1265
MLeCHANICAL,PERMITFEES•
City /StaterLtr: Canby Or 97013 Subtotal 46.75
Phone: (503) 266 -1249 Fax: (503) 266 -3478 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee)
CCR lie.; 14008 /y State surcharge (12
of permit lee) 10,10
V� f l � TOTAL YERMIT FEE 100.80
Ibis permit a p Authorized signs )dicarino expires if a permit Is not obtained within 1/30 days after It has been accepted as complete.
Print name: A eta raw Date: 12/18/12 • Fee methodology set by Tri- County Building Industry Service. beard
1 :113uildinAPermn.MEC- PawltAppdue 03/07/12 440.4e17r(II/02/COM/WEB)