Permit III CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00047
TIGARD DATE ISSUED: 1/29/2009
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103AD -05800
SITE ADDRESS: 12680 SW 111TH PL ZONING: R - 4.5
SUBDIVISION: WILDERNESS LOT: 004 JURISDICTION: TIG
PROJECT: CRANDALL
Project Description: Replace gas furnace with like kind.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
CLIFF CRANDALL Description Date Amount
12680 SW 111TH PL
TIGARD, OR 97223 [MECH] Permit Fee 1/29/200E $72.50
[TAX] 12% State Surchar 1/29/200E $8.70
Phone: 503- 639 -4919
Total $81.20
Contractor:
GAROKEN ENERGY COMPANY
3565 SW 182ND AVE
BEAVERTON, OR 97006 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 848 -3838
FAX 503- 356 -9002
Reg #: LIC 43124
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center.
Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OU NC by
calling 503.246.6699 or 1.800.332.2344.
Issued y: : i_,p 4 1 . , . i Permittee Signature ,_s..__ —
Call 503.639.4175 by 7:00 a.m. for inspections 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.
JPi -28 -2009 15:14 FROM:GAROKEN ENERGY CO. IN 5033569002 TO:5035981960 P.1
Mechanical Permit ApplicatiRECEIVED _ Date/By:
City of Tigard Rweiv erg oq y Penttit rI Ct 9.000 y
13125 SW Hall Blvd., Tigard, OR 97223
j Pion Review
Phone: 503.639.4171 Fax: 503.598.1960 2 8 2009 Other Permit:
JA Date/By:
I 1 e, A R t_) Inspection Line: 503.639 Date Ready/By: Iuris: I pJ See page 2 for
Internet: www.tigard- or.gov Notified/Method: ^ I Sa
Cr '''''r.: TrI R / V . p tatormatioo
. q W try .D
TYPE OF ORK -• i \/ : t:•+ •. , , 4 COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
12 New construction ddition/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 OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES`
01- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Air conditioning or heat pump
1 9.10200 1,t1-4, P L . (requires site plan showing placement) 14.00
City /State /ZIP: � a ° I. 1 -3 Furnace 100,000 BTU (duets/vents) / 14.00
^ ` Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: C.�Q v�A� \ Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Fr) W V1.Q� Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: l Lot no.: Flue/vent for any of above / 6.80
Other. 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK ' Water heater 10.00
/� � w Gas fireplace 10.00
�-s�I S C1743 --ut { n �.� L Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
1 Wood fireplace /insert 10.00
- ❑N
Other: PROPERTY OWNER l Oter: Chimney/liner/flue/vent 10.00
llff 10.00
Name: a \ .c a(`� t- e,,,• aM,LL\ Environmental exhaust and ventilation
Address: Range hood/other kitchen
Ca-W1 P - equipment 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (6 3 ct_ { Q Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT l t ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: a ^�� ��
Other 10.00
L"� (� Fuel piping
Contact name: 1� )n to v� z"...4. by 1->!!w� S5.40 for Perot four; SL00 for each additional
Address Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax :: ( ) Water heater
1J Fireplace
'GL - mail: yvrip,r eAV - r�v ) L j-e r Z.a n . v Range
CONTRACTOR Barbecue
Business name: rWn v„ t � "[' • Clothes dryer (gas)
'� `�"V \ Other.
Address: -t5, 4� 1`14 'a. r�. x.v MECHANICAL PERMIT FEES"
J
City/State/ZIP: e3sPrlt.t )P ■[, , l7f!)ta / Subtotal �
Le Minimum permit fee (572.50) 7 2 /
Phone: (5b3) - L -7, 47'3 C. Fax:
a I 3 0 � ) 35 " op Q. Plan review (25% of permit fee) 1
CCB lie.: 44, '3 \a y State surcharge (12% of permit foe) �/) t• (.)
TOTAL PERMIT FEE Dl i
Authorized signatt • This permit appliatioa expires if a permit Is not obtained within 180
(N " �� �� ' ` days after it has beta accepted as complete.
..9%, V \". \•^401..._ ` O V 61"1—■ I — r a i -39
CITY OF TIGARD 410 7
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BUILIDING DIVISION A _ PERMIT #: 1EC2009-000-47
13125 SW Hall Blvd.,,Tigard, OR' 972234 DATE ISSUED: 1129/2009
Phone: (503) 639-4171
ze
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2111/2009 TIME: 7:00AM PAGE: 22
F Z
SITE ADDRESS: 12680 SW 111TH K. CLASS OF WORK:
SUBDIVISION: WILDERNESS LOT #: 004 TYPE OF USE:
PROJECT NAME: CRANDALL
DESCRIPTION: Replace gas furnace with like kind.
OWNER: CRANDALL, CLIFF PHONE* 503-639-4919
CONTRACTOR: GAROKEN ENERGY COMPANY PHONE #: 503-848-3838
Inspection Request Scheduled For: Date: 2/11/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Messa e
699 • Mechanical final 080479 503-639-4919
Corrections/Comments/Instructions: -
6.1—c 16 3 79
•
PARTIAL APPROVAL . LIJ CANCEL n NO ACCESS
4r4
1111 AIL if CALL FOR INSPECTION Ei ADDITIONAL FEES ASSESSED
-
2_6
Inspector: 4_A Z_ 11 0
Date: Phone #: (503) 718-