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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00169 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009 Parcel: 1 S136AB03701 Jurisdiction: Tigard Site address: .01� 031-SW 7:1ST PL— Subdivision: LOCUST TERRACE Lot: 4 Project: Sander Project Description: Replace gas furnace. Owner: FEES SANDER, LEO ROBERT REVOCABLE Description Date Amount LIVING TRUST, 10031 SW 71ST PL Furnaces < 100K BTU 04/21/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 04 /21/2009 $8.70 PHONE: Minimum Fee Adjustment - Mechanical 04 /21/2009 $58.50 • 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 $81.20 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 Issued By: ..jt! latt lX Permittee Signature: S at, AppU eaRO n 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. .•PR -1 009 14:54 FROM :GAROKEN ENERGY CO. IN 5033569002 T0:5035981960 P.1 Mechanical Permit AnnlicatiR EC E I ED . I i,u t,l t,l , i •i 1,. i., 111 • City of Tigard Received r i -� 0q 13125 SW Hall Blvd., Tigard, OR 97223 APR 17 2009 t e/BY: , Permit No.: ,, , `it , 401 . ( 46 p ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: By: Other Permit: Inspection Line: 503.639.4175 Dat "" Internet: www.ti CITY OF TIGARD Data a Ready/By: tiD ae -oor. BUILDING DIVISION Nutifcd/MeLlwd: NM s°P See Pae°°2 " for formadoa TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees' are based on the value of the work ❑ New construction _ �Addition/alteration/replacement ❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: S - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES* _ r. For special information use checklist ❑ Multi - family 0 Master builder 0 Othe Description 1 Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling ^ � ) Air conditioning or heat pump Job site address: 6 Q Stv / / S taLa �.e �r eou ' R ohm:ement) 14.00 City/Stete/Z P: ! 1 3 p ,,,/a 4 t , aD-� Furnace 100,000 B (ducts/vents) / 14.00 - ace ruCcOliFF13TU (ducts/vents) , Suite/bldg./apt. no.: Project name: ti dal/ heat pump 14.00 Cross street/directions to job site: � Duct work 10.00 Hydronic hot water system 14.00 /X-C L1 , Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: no.: Flue/vent for any of above / 6.80 _ Other 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION 01? WORK Water heater 10.00 /� r Gas fireplace 10.00 C-O Q- 6'15. y . � Flue vent for water heater or gas l I fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood frreplacciinsert 1 0.00 I ❑ TENANT Chimney/liner/flue/vent 10.00 ROPERTY OWNER Other: 10.00 Name: / _ © Set- 4e-, Environmental exhaust and ventilation Address: (� Range hood/other kitchen equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 Single -duet exhaust (bathrooms, Phone: 7 JL j eg Fax: ( ) toilet compartments, utilitrrooms) , 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other. 10.00 Business name: p ArC) r w \ Fuel piping Contact name: v" S5.40 for first four; SI.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: Wall/suspended/unit heater Phone: ( ) I Fax: : ( ) Water heater 1) Fireplace E -mail: Q�Yb c t QMI- r�,..� vdiv i 2.a n . v.A Range CONTRACTOR - Barbecue V Business name: �� ]rt/� Clothes dryer (gas) Other: �� G�0'� �l r. _ Address: �sl�� J 1`� . �r� o MECHANICAL PERMIT FEES' City/State/Z1P: eP--C )?'r ^ n 4100 Subtotal Phone: (b) . L. „� R Fax: 4p3 )356 _.Ct 0j .Q. , Minimum permit fee (572.5 ' f� Sc7 CCB lie.: 4 4 Plan review (25 % of permit fee) `'L -j ■ D. State surcharge (12% of permit fee) Cf�1') 1. w TOTAL PERMIT FEE Authorized signa4: Thos permit applicadoa expires if a permit is sot within 180 n+ days after it has been accepted as complete. � Vv \V.p� D Ycl�� 1 i/ I • c..— ..ti_a�._...�.. Tin. .- «.o.. :u :___j.....c__ :_.o__..