Permit CITY TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES
PERMIT #: MEC2005-00737
'�' '' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/7/2005
PARCEL: 2S 103BB -11500
SITE ADDRESS: 12165 SW 123RD CT ZONING: R -4.5
SUBDIVISION: YE OLDE WINDMILL LOT: 034 JURISDICTION: TIG
Project Description: Gas furnace.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
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
SUSAN BAXTER Description ' Date Amount
12165 SW 123RD CT
TIGARD, OR 97223 [MECH] Permit Fee 11/7/200f. $72.50
[TAX] 8% State Surcha 11/7/200f. $5.80
Total $78.30
Phone: 503 - 590 -9439
Contractor:
GAROKEN ENERGY COMPANY
3565 SW 182ND AVE
BEAVERTON, OR 97006 REQUIRED ITEMS AND REPORTS
Phone: 503- 848 -3838
Reg #: L I C 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 OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: -0 �S Permittee Signature: \p\ \,
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.
NOV -4 -2005 14:33 FROM :GAROKEN ERGY CO. IN 5033569002 TO: 5035981960 P.1
.4 1 \NEB
M n: echa cal PF pl cafloll FOR OFFICE USE ONLY
City of Tigard • Received ��
0 4 2005 Davy: -6 : _ , . O k
13125 SW Hall Blvd., Tigard, OR Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 p , , p
Date Ready/By: Other Permit:
Inspection Lane: 503.639.4175 4 h 41 1 ®S Page 2 far
Internet: www.ci.tisard.or.u;ITY OF TIP _ �! '' y g
Notified/Method:, Supplemental information
I DING DIVISION •
F - i -.H � �T � J i -C '17 1 3'v".�TI i Y 1 S - f ! f �L 1'M ^ i.r:..ir4 ..
Y r f i r i tleiA;ltfsi '�x "t:;;.!{ L Wu t.t?ai ..''AtWi... r i , ' . ^ CL U 11 1 il0 fl∎' + ; t` "='� .. �'jQ:IS`I'
ew construction . Addition/alterationJreplacement Mechanical permit fees* are based on the value of the work
Li Demolition ❑Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
,. :i 'i0 7 '.: t T t ! q , t t xi t y i t'� .1)s., iii r ",3 Value: $
•�fL.,. � 5 _;1 .. ._ ,,_,?M� ` .";i� `emu ^ �'i-^n t 4�.a�. - ___._ 1 7' 4x1 [ O i 1-+ y :W! , •.a ,
,-
A. , 4 �, i .",,... `.ir�nJ '" 4 _ • - was w. .- -,V s ,' ;;;`,- t
I ,
`� , P ,; p 111 s VI pt: r pk y gip, ! tp!hR icy . , S•
and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building
❑ Multi -family ❑ Master builder ❑ Other: _ For special information use checklist.
y I Qry. I E I Total
fT ; y P""'�S, 47P TI - (o 1 C'1 ieM' 4t 7 :45^Vl u 04fo w 41':4_? i A l k + f ' . 1 + . �, f i l 'l Heating/cooling '
Job site address: / � L,) / y„,„4 Air conditioning or heat pump
/ (requires site plan showing placement) 14.00
City/State/ZIP: .D c . �J 41 ) Furnace 100,000 BTU (duets/vents) / 14.00
" � � )^' / �' Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 1 .
Oas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
' / -t � Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above G 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
.,.....e..1411' W,rk - s,.7s:. o �t11 i - 1 t, ^" D 4 D 3 42/ l. ' 4 1. 14i+r kt t
- _ Xs...esiz' iii Water heater 10.00 ;
, Gas fireplace 10.00
as C- - (L y i eLe__Q__, Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
1,0 i' T Y : ? _.r 7 •ii ° ,)y ° " ti , t ? , '
'' � ' 'rlt` Ot Chimney/liner/flue/vent 10.00
- Other: 10.00
Name:
Lt-St/Y1 4 .Q Environmental exhaust and ventilation
Address: geinr Range hood/other kitchen
equipment 1 0.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (S63) 'r _40 4. Fax: ( ) toilet compartments, utility rooms) 6.80
" �
., � E . •: 4:vhJ " J*r" l r .> r . ' r32
,�:-is+x*
'.' t• ~ 3 K & • kleoL Cr �,' .¢ L.'�y, 1°
« i p,1,,_,. ,p"1. _.. �ai x.'s 0 � , "a Attic /crawlspace fans 10.00
Other: 10.00
Business name: -
Fuel piping _
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: WalVsuspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail:
Fireplace
lw ,', Range
i rv � $ r��" ? i'i ''Y`�'�y ` i .'. a ` d ' a T- "et PyT' '?. lT� :� .
t. {r¢ r 1 y u ira "s +aol•` a \yC. e 1 :�` >�id .1. .) ,•t' Barbecue
i.1.1
Business name: (rarr O C�eiv t � Clothes dryer (gas)
� 3/ � Other:
Address: - S ` 16 ) O a. t ` ' , trl r6 ;'EOM " ; 5 .
City/State/ZIP: Q a ji e��tsr DR CII Subtotal
Phone: COQ) g � .. -
� 35 Sp �
Fax: ( � /1 Minimum permit fee ($72.5
r ��p - � D(, 1- Plan review (25% of permit fee)
)
CCB lie.: iy 3 \ a L- Y e? (/ -/,,e `_n 7 State surcharge (8% of permit fee)
l TOTAL PERMIT FEE 776
Authorized signature' ,8 e. 4 This permit application expires If a permit Is not obtaine within I80
%..."'....,.
days after it has been accepted as complete.
Print name: Wh. ��J Y c] \ G � L � Date: 1 • Fee methodology set by Tri- County Building Industry Service Board
L
, . \ Guild ing\PermmVYIBC.PCmutApp.doe 12/03 440.4617T (11/02/CCM/WEB)
CITY OF TIGARD L - BUILDING DIVISION a ar PERMIT #: MEC2005.00737
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/7/2005
Phone: (503) 639 -4171 i Inspection Requests (24 Hrs.): (503) 639 -4175 W:_..
INSPECTION WORKSHEET FOR DATE: 11/23/2005 TIME: 7:00AM PAGE: 63
SITE ADDRESS: 12165 SW 123RD CT CLASS OF WORK:
SUBDIVISION: YE OLDE WINDMILL • OT #: 034 TYPE OF USE:
PROJECT NAME: BAXTER
DESCRIPTION: [ furnace.
OWNER: BAXTER, SUSAN PHONE #: 503 - 590 -9439
CONTRACTOR: GAROKEN ENERGY COMPANY PHONE #: 503 -848 -3838
Inspection Request Scheduled For: Date: 11/23/20055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 022305 -01 03- 848.3838
Corrections /Comments /Instr ctions:
�,� '15l 7
A
Ce7i_
g PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: I • Date: l,(, t2 Phone #: (503) 718- 270