Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 00185
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/28/2011
Parcel: 1S 134ACO2623
Jurisdiction: Tigard
Site address: 11185 SW BOXWOOD CT
Project: TARIKU Subdivision: ENGLEWOOD NO. 3 Lot: 180
Project Description: Gas furnace replacement.
Contractor: GAROKEN ENERGY COMPANY Owner: TARIKU, DANIEL
3565 SW 182ND AVE YEHDEGO, SEMHAL
BEAVERTON, OR 97006 11185 SW BOXWOOD CT
TIGARD, OR 97223
PHONE: 503 - 848 -3838 PHONE:
FAX: 503 - 356 -9002
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/28/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/28/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/28/2011 $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 Permittee Signature:
/O
Call = AL is
_
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.
APR -27 -2011 14:12 FROM:GAROKEN ENERGY CO. IN 5033569002 TO:5035981960 P.1
Mechanical Permit Application 0 FUld Utl-I( I. I tit. U. \1.1
City of Tigard s' Received , Permit
SW Hall Blvd., Tigard, OR 97223 OC) � e ` 1 ,, Date/By. '' v g -1 i (, y � Phone: 503.639.4171 Fax: 503.598.1960 le o � a Other Permit
1 1 , ., 1 1 , Inspection Line: 503.639A175 95 � '` l • , � See Page 2 for
t' w
Interneww.tigard- or -gov p, Q < Supplemental Information
TYPE OF WORK C % 1110 COMMERCIAL FEE* SCHEDULE .7 USE catc I IST
\ Mechanical permit fees' are based on the value of the work
❑ New construction Addition /alteration/replacet
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. Value: S
CATEGORY, OF CONSTRUCTION
- and 2-family dwelling RESIDENTIAL EQUIPMENT /SYSTEMSFEES*
y g ❑ Commercialindustrial ❑ Accessory building
For special information use checklist
❑ Multi-family 0 Master builder ❑ Other: Description ] Qty. I Ea. I Total
JOB SIIT E INFORMATION AND LOCATION Heating/cooling
t r p Air conditioning
Job site address: 1 l �' (� B0)(,..-1,..A. eYx CT
« wi res sito-.:o.nu•.:vul:l tip ct ,vn, 46.75
City/State /ZIP: — ��d C i 1 2-a-3 Furnace 110,000 B _ ' . 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: —1-1^t_■(-: v Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
- Hydranic hot water system 23.32
CO k ,,,,,I. Lis-) Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in - wall, in - 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
DESCRIPTION OF WORK Water heater 23 -32
/+ Gas fireplace 33.39
n . r \pc�- Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/lfiner /tlue/vent 23.32
,,.? OWNER 0 TENANT
Other: 23.32
Name: O0 AU0.c -- rQ , <-- t. Environmental exhaust and ventilation _
Address: Range hood/other kitchen
SGt Itr-e equipment , 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (SU-29 35 - a_ 5-761 6 1 Fax: ( ) , toilet compartments, utility rooms) 23.32
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: ( z rou€.ln eiti. -ma Fuel piping
Contact nam �� N S14.15 for first four; S4.03 for each additional
11 y� A
Address: Furnace, etc.
-
Gas heat pump ,
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
Fireplace
E -mail: ' 41..Nc'aKel" e_.Vker , () t.) e. Nr • 2-4, In• eN --4 Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: �a, r p K ev1 ex- c4.i.i C,,,, . J•.N C. Other.
Address: 354,5 s 651 r+ 1- A MECHANICAL PERMIT FEES"
City / State/ZIP: g zl.0 e.t CD C� �'-� 0 Subtotal
vv �'� _ Minimum permit fee (590.00) g
Phone: (5'6 , 3%353 Fa x: (5 O ) '3 J Y __ Plan review (25% of permit fee)
CCB lie.: Lk Z ‘,,P... i4 State surcharge (12% of permit fee) /0. TO
� TOTAL PERMIT FEE /pp ga
Authorized signatur s7L ` . !�-4• �' Thu permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: bp wy , a 'S ar c - \ [ Date: r'[ 4 t ` r • Fee methodology sal by Tri-County Building Industry Service Board
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