Permit ' CITY OF TIGARD MECHANICAL PERMIT
:!t. ;;; ;. 1 ',- COMMUNITY DEVELOPMENT Permit #: MEC2010 00587
_.: Date Issued: 11/17/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S104AB07700
Jurisdiction: Tigard
Site address: 13112 SW KATHERINE ST
Project: Wildermuth Subdivision: MORNING HILL NO. 4 Lot: 106
Project Description: Install gas furnace.
Contractor: GAROKEN ENERGY COMPANY Owner: WILDERMUTH, DENNIS
3565 SW 182ND AVE 13112 SW KATHERINE ST
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503 - 848 -3838 PHONE: 503 - 849 -7059
FAX: 503 - 356 -9002
FEES
•
Specifics: Description Date Amount
Furnaces < 100K BTU 11/17/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/17/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/17/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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: � � � � f _ � J
Permittee Signature: e-A)
�O�O e . 7C )
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.
NOV -15 -2010 14:10 FROM:GAROKEN ENERGY CO. IN 5033569002 T0:5035981960 P.1
Mechanical Permit Application F of r c 1 t t t,�'t. i
City of Tigard
NO R e ceived
�-'
�o Date/By: ' Permit No..
13125 SW Hall Blvd., Tigard, OR 97223 ' 1iate/By: w w / 7 A/, Er ! / -, / ��
' ® ` Phone: 503.639.4171 Fax: 503.598. i w
Other Permit:
1 1;..,,11 1') Inspection Line: 503.639.4175 \ , X :ate Read lB Jurir
Internet: www.ti ardor, ov t� Ready /By: See Page 2 for
g g ��� ,c) _ li °tined/method: • I Supplemental Information
. - _ TYeE. OF WORK C� * �`l l \4 °`COMMERCIAL tie* SCHED'W USE CIIIECt Jt`tSi
❑ New construction ,gAddition/alteration/re 0 ent Mechanical permit f based on the value of the work
.4, performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
..
Value:
CATEGORY OP CONSTRUCTION
and 2-family dwelling RESIDENTIA1.,EQU PMDI�7 /SYS7rE1► SFEES °;
y g ❑ Commercial /industrial ❑ Accessory building
❑ Multi- family 0 Master builder ❑ Other. For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
,, JOB SITE INFORMATION "AND I,OCATION Heating/cooling
address: / Air conditioning
Job Site address: 3 / / SW L( -F) eir--1 ktsz 54 46.75
City /State/ZIP: - 7 - 7 5 a . r � p� 4i-7 D ' ] -3 Furnace 100,000 BTU (ductslve 46.75
Jl�� �-� Fu - 1 s e :: c 1 (ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: J /CALF e _ vi.. J Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
f Hydronic hot water system 23.32
?` Residential boiler (radiator or
hydronic) _ 23.32
Unit heaters (fuel - type, not electric),
in -wall, in - duct, suspended, etc. 46.75
Subdivision: l Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCR WORK Water heater 23,32
/^ Gas fireplace 33.39
l ' a S Rai / w Flue vent for water heater or gas
f fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23,32
.
ya PROPERTY OWN R -' E' TLNANT' 23 32
Chimney/liner/flue/vent 23 32
L: Other:
Name: I).Q_l/1 V1(5 L- � , ( 1 p�,/ , I Environmental exhaust and ventilation
I) 6 f ' ` L'1 Range hood other kitchen
Address:
,$'Ll/4,c... equipment , 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust K
Phone: 6/15 3 �j 705 e) Fax: ( ) toilet comp ments, rooms) 23.32
4 c APPLICANT � '. [] ,CONTACT PERSON
Attic /crawlspace fans 23.32 ,
Key. Other: 23.32
Business name: c y lJ rte\ L Fuel piping
Contact nam )A.y $14.15 for first four; 54.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater ,
Phone: ( ) I Fax:: ( ) Water heater ,
Fireplace
E -mail: �el.`C'e, K €X1 •�� cs c5 t ^ U €v s 7--40 • e -e--'�•- Range
CONTRACTOR Barbecue
Business name: ,e t('^p K 2N �� e`C Clothes dryer (gas)
- �� Other:
Address: 35 4„6" s t / ^ , 4.-1 MECUANICAL PBHMIT` ? ES'
City /State /ZIP: r0 4 U (X- - _ �C7 91006, Subtotal
Phone: (�D' = �+-F�. ex---0.6 , (S ` - o 31 '3 J U Minimum permit fee ($90.00) 9/",0,00
3s3� Fax: 42' tom; Plan review (25% of permit fee)
444 CCB lie.: Lk.." `,�, i. f State surcharge (12% of permit fee) _ /O. y•0
�j� —,� TOTAL PERMIT FEE /QQ,'Q '-i
Authorized signature'�'�M.R "— " ` �a^ �' This permit application expire if a permit is not obtained within 180
J / days after it has been accepted as complete.
Print name: i p vA �_' 0rcVt,
a., r1 f Date: L 1 / c 1 . Fee methodology set by Tri•County Building Industry Service Board
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