Permit MECHANICAL PERMIT
CITY OF TIGARD
a COMMUNITY DEVELOPMENT Permit #: MEC2013 -00158
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2013
Parcel: 2S104CAl2000
Jurisdiction: Tigard
Site address: 13260 SW ESSEX DR
Project: Caliebe Subdivision: HILLSHIRE Lot: 120
Project Description: (1) gas furnace installation
Contractor: ROTH HEATING & COOLING Owner: CALIEBE, RALF
PO BOX 1265 13260 SW ESSEX DR
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 530 -1470 •
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/21/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/21/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/21/2013 $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 lOUkaht/ NC by calling 503.232.1987 or 1.800.332.2344. ,� `
Issued By: f Pe rmittee Signature: n&J 4PPU(i%f O&L 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.
MAR -21 -2013 THU 08:51 AM ROTH HEATING FAX NO. 5032663478 P. 01
Mechanical Permit Applicatio. 1+412 OFI'ICI; IISE ON I,Y
City of Tigard RECEIVE Date/Sy: p-i 13 9( Permit No. eC x13 ' o f 5 O
13125 SW H all Blvd., Tigard, OR 97223
i ti � Plan Review
Phone: 503.718.2439 Fax: 503.598,1960 MAR 2 1 2013 PlunRe: Other Permit:
- r I G A RID Inspection Line: 503.639.4175 Dots Ready /By: 1sris: El See Page 2 for
Internet: www,tigurd•or.gov crr ' OFTIGARD Notilied/Mothod: 1G, Supplemental Information
t 1R
TYPE OF. W 1 : DING ANI ..
N. .. ,. • • :. ; n'1M co RC[AL PEE *',SCHEOULP� —'1 O CHECKLIST ,
Mechanical permit tees* are bused on the value of the work
Li New construction ® Addition /alteration /replacement portbrmed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit. -
CATEGORI','OF CONSTRUCTION',..,'.
Value;
_ �, � a R1CS1D�1![ 1' II�U; EQt111 '1,y}1%NT� /.Sl!b'T
El 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Far special lrrlormrt don use dteckllsk
❑ Multi - family ❑ Master builder ❑ Other; Description j Qtyj >u J Total • - Heating/eoolial;:
• dQB SITE.. INFORMATION.. AND; L'OCATIOIY
Air conditioning
Job site address: 13260 SW Essex Dr (requires site plan showinpplacemenf 46.75
City /Stalx /ZIP: Tigard, OR 97224 Furnace 100,000 BTU (ducts/vents) 1 46.75 46.75
Furnace 100.000+ BTU (duelslvenrs) 54.91
Suite/bldg, /apt. no.: Project name: Caliebe/43192 Heat pump
(requires site nlan showing easement) 61.06
Cross street/directions to job site: Duct work 23.32
- 1-1ydronic hot water system , 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in-wulldn -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:
— 1
' DDSCRI[PTION. ;OIr w[Iltk.' Water heater 23,32
installation of gas fu
Gas fireplace/insert, 33.39
furnace Flue vent for water heater or gas
fireplace _ 23.32
-- - Log lighter (gas) 23.32
Wood /pellet stove 33,39
Wood fireplace/insed 23.32
ner /tlue/vent
, Chimne /li 23.32
• • , : : ®' 'PROPERTY OWNER .. : ' ::. []; ;TENANT;..; , •, -
h CAlicbe Other: _ , 23.32
Name: Ralph environmental exhaust a nd ventilation: _
Address: 13260 SW Essex' Or Runge hood /other kitchen
_ equipment 33,39 ,
City/ Stale/ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
Phone: (503)530-1470 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, util y rooms) 23.32 •
... • Ej APPLICANT ' ,. , 0. CONTA('.I'..PERSON • Attic/crawlspacc fans 23,32 •
Business name: Roth Heating and Cooling Other; 23.32
Fuel piping
Contact nume: Angela McGraw $14.15 for drat four, $4.03 for each_ a dditional
Address: PO Box 1265 Furnace, etc.
Gas heat pump
City/ State/ZIP: Canby, OR 97013
WalUsuspendcd/unil heater
• Phone: (503) 266-1249 Fax: : (503) 266 -3478 Water heater
Fireplace
E -mail: angelam ®roth- heat.com Range
:''CONTRAC TOR
• • Barbecue
Business name: Roth Heating and Cooling Clothes dryer (pis) _
Other;
Address: PO Box 1265 MEPLOICAL ALRMIr FE1CSa.'. . , .. . •
City/State/ZIP: Canby OR 97013 Subtotal 46.75
503 266 -1249 Fax: (503 266 -3478 Minimum permit fee ($90.110) 90,00
Phone:
(503) ) plan review (25% of permit fee)
CCs lic.: 14008 State surcharge (12% of permit ace) 10.80
j TOTAL PERMIT FEE 100.80
Authorized signature'
C' This permit application expires if n permit is not obtained within 180
� � J . / _ to 0_ days after i1 has been ateepted ns complete.
P name: Ang la 1/ -. .. raw • Date: 3/21/13 ' Fee methodology set by Tri -Comity Building Industry Service Board
1:1BuildIng \Penniu \MSC- Pcrml[App.doc 03/07/12 440.4517r(1110JcoM/wna)
I