Permit '. :', CITY OF TIGARD
MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2010 -00132
OR 97223 503.639.4171
Tigard Hall Blvd., SW H
13125 Say., Date Issued: 03/31/2010
T Parcel: 2S104CC07500
Jurisdiction: Tigard
Site address: 13530 SW ASCENSION DR
Subdivision: HILLSHIRE WOODS Lot: 94
Project: Coffelt
Project Description: Install gas furnace
Owner: FEES
COFFELT, DALE R & LINDA G Description Date Amount
13530 SW ASCENSION DR Furnaces < 100K BTU 03/31/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 03/31/2010 $10.80
PHONE: 503 - 524 -1062 Minimum Fee Adjustment - Mechanical 03/31/2010 $43.25
Contractor:
GAROKEN ENERGY COMPANY
3565 SW 182ND AVE
BEAVERTON, OR 97006
PHONE: 503 - 848 -3838
FAX: 503 - 356 -9002
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4 .' op, Permittee Signature: o AJ / G / r!'4-% /b4
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 -29 -2010 14:19 FROM:GAROKEN ENERGY CO. IN 5033569002 TO: 5035981960 P.1
Mechanical Permit Anplicat � i � I )R till l('r. I l% (1\1,1
City of Tigard Date/B ' . Permit No.
; � 13125 SW Hall Blvd., Tigard, OR 97223 Received � '/ ; � t20/0 - 40/3�-
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit:
l t ` l , t Inspection Line: 503.639.4175 MAR 2 9 2010 Date/By:
Date Ready/By: IN S See Page 2 for
Internet: www.tigard- or.gov Notified/Method! Supplemental information
CITY OF TIGARD
_ .. .- _TYPi. a a 1'4 TENGNEERING _
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❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
_ .. CATEGORY Oif 'CONSTRUCTION. value: $
- and 2-family dwelling . '' i 0EQMbl i rt0.4,53441r . V STEVA,
Y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑Master builder
❑ Other:
Description 1 Qty , 1 Ea. 1 Total
JOB •SITE INFORMATION, AND - LOCATION,
Job site address: ) 3 530 s'w r t SC t° vi Air conditioning
r j "-u- f'7- , (respires site plan showing placement) 46.75
City/State/ZIP: —t " G� 7 . �umace 100,000 BTU (ducts/vent l 46.75
/ J Fumacc 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: G d,c.):P / y
Heat pump 61 06
Cross street/directions to job site: / Duct work 23.32
Hydronic hot water system 23.32
g, .-1r' 'O 14) S 4- /4- 01.- 1 z �-v,- Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
" D R+Oj2K Water heater 23.32
/ Gas fireplace 33.39
(c /.L S 1"' l t,Y el G. C_ Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove 33.39
23.32
Wood fireplace/ insert
Chimney/liner /fue / vent 23.32
/ Other: 23.32
/
Name: _ 1 ,. . 4( .. L a ) e /Y� "� ( � - F J� Environmental exhaust and ventilation
Address: �-�� Range hood/other kitchen
Sa equipment 33.39
City/ State/ZIP: Clothes dryer exhaust 33.39
/ Single -duct exhaust (bathrooms,
Phone: f�®�j) `'7" /O Fax: ( ) toilet compartments, utility rooms) 23.32
. 0 AP PLICANT Attic/crawlspace fans 23.32
.:a:.:• ,. CO�CONTAGT FERRO r= Other: 23.32
Business name:
� t�r 0 K� \e-kr \ Fuel piping
Contact name: n , G 514.15 for first four; 54.03 for each additional
Address: � Furnace, etc.
Oas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: CQNra Kesr1 •_Vve.u. gt,,t 0 a e• . z-0v1. n -€.--A— Range
A; ° CONTRAcrTO12 ' Barbecue
Business name: �Q, , f-es K e� �N t.,t, �� C--
Clothes dryer (gas)
o - Other: • Address: 364,5 s a5, r,k t ^1• . MECA A 64I0iPRM1<I%Fl:E3ii.
City/ State/ZIP: l;:) tt?„613,) ex- O() p�. -� Subtotal
Phone: { 5D ) 1~ r549- Minimum permit fee (590.00) C�• p - �1 p
'a 4z. 3�, 3� F ax: (5 * 3 cif , Plan review (25% of permit fee)
r 1
b CCB lie.: �'.`� l { State surcharge (12% of permit fee) /D• TO
L TOTAL PERMIT FEE /op .,g',0 L./'--- Authorized signature:: l* Q> p-4∎v ■- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: . v 1/4 w0. DX —a-CIA" Date: 3 /�� 1 0 • Fee methodology set by Tri-County Building Industry Service Board
1.1Building \PermitrlMEC- PermitApp.doc 10/01/09 177 (11 COM/WErn