Permit CITY OF TIGARD MECHANICAL PERMIT
-= = COMMUNITY DEVELOPMENT Permit #: MEC2011 -00343
Date Issued: 07/19/2011
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111 CA11300
Jurisdiction: Tigard
Site address: 9521 SW LAKESIDE DR
Project: Holland Subdivision: Lot:
Project Description: Install gas line to cooktop.
Contractor: GAROKEN ENERGY COMPANY Owner: HOLLAND, JO
3565 SW 182ND AVE 9521 SW LAKESIDE DR
BEAVERTON, OR 97006 TIGARD, OR 97224
PHONE: 503 -848 -3838 PHONE: 503 - 684 -9703
FAX: 503 - 356 -9002
FEES
Specifics: Description Date Amount
Fuel Piping 07/19/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 07/19/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/19/2011 $75.85
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. Q L
Issued By: 2-11 Permittee Signature: &A/ {�y / ( / /0" j
•
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.
JUL - 18 -2011 09:35 FROM:GAROKEN ENERGY CO. IN 5033569002 TO:5035981960 P.1
Mechanical Permit Applicatio � '� Ft,It c,hr li'1: a S! O l,l
3
Iv
City of Tigard ;� • comes! EZZEMINtr
13125 SW Hall Blvd., Tigard, OR 97223 i� Date/By: 19 ���
Phone: 503.639.4171 Fax: 503.598.1960 P Review
JUL 18 2011 Dale/By: Other Permit:
1 I t , .,, ,,, i) Inspection Line: 503.639.4175 Date Ready/By: Ei See Page 2 for /v
Internet: www.tigard or.gov CITY OF TIGA D Notifiad/Method:, , Supplemental Information Sct (3
TYPE 'OF WQ EQMME tl3A1.. E' SCFI. D...1114.' E 118E CHECIKL"IST
❑ New constructionAddition/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: $
- and 2- family dwelling ❑Commercial/industrial — RSWENTM"ZQU/PM / SYSTE M SF E 01.,
❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. ( Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: i Q ' n Air conditioning
/ 1• r�P'r (requires site plan showing placement) 46.75
City /State /ZIP: G� q Furnace 100,000 BTU (ductyvencs) 46.75
�� ��� L � Furnace Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt. no.: Project name: jib ` / Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
' -4 Hydronic hot water system 23.32
- 11 Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Flue /vent for any of above 23
Lot no.:
Other: 23.32 _
Tax map/parcel no.: Other fuel appliances ,
- 7 .. .: - DESCRIPTION' OF WORK
Water heater 23.32
J Ge�o n Gas fireplace 33.39
, ,4.s 1 / n� . 65 t� p Flue vent for water healer or gas
fireplace 23.32
• Log lighter (gas) - 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
• ." Chimney/liner /flue/vent 23.32 • R O WN E R - 0 TENANT Ocher. 23.32 ,
Name: � — f L-4-0 t, cI Environmental exhaust and ventilation
Address: �� Q Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33,39
, ( - Single -duct exhaust (bathrooms,
Phone:
C j T ) ' 1703 Fax: ( ) toilet compartments, utility rooms) 23.32
�. 0 APPLICANT I CONTACT PERSON Attic/crawlspace fans .23.32
z— Other; 23.32
Business name:
e. tr O b<el� rM 2+rC,� Fuel piping
Contact name: /, ei se $14.15 for first four; 54.03 for each additional
`' 1 l
Address: Furnace, etc.
- Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) ( Fax: : ( ) Water heater
• Fireplace I
E -mail: �Q,K'ep K@.vti �1n 84r gt..y � :J et, ■ ZC'l1 • n 42* R
� Range
- . . CONTRACTOR Barbecue
Business name: c,e p e- ,NAY. C C dryer (gas)
Address: 35� i / �� c� r� c,._ J j � . - ,11IECHANICi1L P RMrr FEES" .
City/ State/ZIP: R. �u ex-V-0.,1 c:9-, C ' C � Subtotal
■ � L Minimum permit fee ($90.00) 947.40
p V Phone: (503, 'S`6 3w-653. Fax: (5 D� -357a, r Plan review (25% of permit fee)
CCB lie.: 14 .. - 1.,.- t. State surcharge (l2 %ofpermit fee) /O. r 'O
G TOTAL PERMIT FEE /DD . SCi
Authorized signatur ` � ---0"1" --/"-- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: O v M.GI -y— w_ � w N. Date: $ • Fee methodology set by Tri -County Building Industry Service Board
J
1BuitdirePermiuUAEC "DpmitApp.de 10/01/09 4.40-401tr (11 /Os) • M/VEB)
•
! CITY OF TIGARD MECHANICAL PERMIT
M.1
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00344
Date Issued: 07/19/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111DB14100
Jurisdiction: Tigard
Site address: 15070 SW 92ND AVE
Project: Lacey Subdivision: Lot:
Project Description: Install gas fireplace and gas piping.
Contractor: FIRESIDE DISTRIBUTORS Owner: LACEY, THOMAS RICHARD
18389 SW BOONES FERRY RD 15070 SW 92ND AVE
PORTLAND, OR 97224 TIGARD, OR 97224
PHONE: 503 - 684 -8535 PHONE: 503 - 330 -3438
FAX: 503 - 670 -7285
FEES
Specifics: Description Date Amount
Gas Fireplace 07/19/2011 $33.39
Type of Use: SF Fuel Piping 07/19/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/19/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 07/19/2011 $42.46
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: Permittee Signature: to n / iee77 /O/\./
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.
07/18/2011 08:43 5036707905 WIDDOWS PAGE 01
Mechanical Permit Applicati s FOR OFFICE i ISE OM.V
Received Permit No.
City of Tigard 9 Date/By: °� /9' // a20 /l -- 00 3 f
IIII
r 13125 SW Hail Blvd., Tigard, OR 97223 JUL 18 2011 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Outer Permit:
T I G A 11 D Inspection Line: 503.639.4175 CITY , Tl Date Ready/Ely: Is: WI See Page 2 for Ar0
Internet: www.tigard or.gov `-�i t t" �D Notified/Method: 7 - � Supplemental Information r-t47
RIP LD!NG DiViSiuN ,ioc
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II i.:yt' . N i , „ t f' �i , °i',YC111 .f���„ ed j ` r . , a,Tf4'iTl{ � iAL.,,,,
Me permit fees* are bas ` on the value of the work
❑ New construction Addition /alteration /replacement performed. -ndicate the value (rounded to the nearest dollar) of all
El Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
(t f :') 1� ( ,! I I I i„r r �, 1 q fl all I�f { 1�4 T ;a l Il; I Ill I Value: $
' I C;t1;l I. ' ! III i �.a,; l 4 4: a tin { ' N rl�diti� x Ek I ,I I , . 11 li lt; 1 1 Ill!q �{ � �,I �{ t , �Y ' �I`'
y Ili, i I `I - �., t„;,. t , u1L, , , - I I , „ t . _ . ,I! _ L -. 0 µ 1 { \ I •iir y, It V1i, 4 yy 1 §i {1 ¢�t 7 ' i'r j � ' y� I �I II�11ill
4-a 2- family dwelling ❑ Commercial /industrial ❑ Accessory building •ri ` , i , "` , . h 1t I I; Il1I 1, I ti^ ry1.11, I I II't� , ^ •111'. "11. •
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
t ff � 1 1 1 t I _ ,�. „, ry I� i .
t 1 lih
11 l.tt. d; 1,1;' { I , 5�'i?,�il '1�0hI 11110141106 �`5' IIIII f . 111IIIiI!illi;..,41 {I�III II{ Heating/co,ding •Air conditioning
Job site address: \ 6 •'1 p S t....s SIP c' .\? e.. (requires site clan showing placement) 46.75
City /State/ZIP: t.V"G) G r , -1 2,2- L- 4 Furnace 10[',000 BTU (ducts/vents) 46.75
�. Furnace 1010,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: L A Le__,1 Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic h1 it water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heater (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
> ill!! + IVI II I 11 ' h 1 I ,i . ES m'rlryN `1W � ' I I 1 11 µt' I' - 0 ' Water hea
III heath 23.32
11, ,�„ n i t Iy l I �
I �- in t i�u� ,GP { „ll � . , t11 III ud1 t. �.> -.:
"'�''�' -- }} Gas ftreplat e 1 33.39
.T 15aL O(J` cvfe,e1e�G2 t•
• A- , t L� t C PS Flue vent ft 4r water heater or gas
I fireplace 23.32
1 "-a- Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
' 1 li A� iI' Mild i 1 ilgtO NFR' ii 111 ' ` , IuI i i C� ES C t 41- t W ilk ot ylli ler /flue/vent 23.32
23.32
{
� . t., l i i t I t i � If , .. : �: �. 1•I I•uil {.: - �.,
) Other:
Name: i, m L. s. C_Er 41 Environmental exhaust and ventilation
p "�� Range hood /other kitchen
Address: 9 SO 0 q 2. P li a equipment 33.39
•
City /State/ZIP: p rt.�1 D)- ,. 9 7 2.L-1 Clothes dryer exhaust 33.39
L Single -duct exhaust (bathrooms,
Phone: (SI ) 33.0 3 14 38 Fax ( ) toilet compartments, utility rooms) 23.32
fans 23.32 , + a I I I u I 1 1 , I ri P; A ttic/crawl Tam
1 !1;, I :r , i�' �!�CA;� I^ , ?11. ' . ,,, ''! : ...,. ;ill�f 11 I I �di�'�� Il�i�'l�t�u.lh i
:(! Ilo „,
Other: 23.32
Business name: Et9,:es t_ ,e, I ts t Y 0 LA" Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address:
\ b 3 5 3 S1/4,_1 - 60ane_ss 2YY (A P8 Furnace, et:.
Gas heat pump
City /State/ZIP: �Y-4- y\.eX C) r t 9.1 22--- Wall /suspeided/unit heater
Phone: (l 3 ) 5 31 3 a L Fax: : ( S y �-ZO ,_ S to oil Water heat. :r •
(� Fireplace /
Email + r \Ch1. -Cr cs -''�cl.(-,p$ °- \ �&s C,Q it' Range
i I liillil i lll I alt,k 11 s 1, IIIIIII , ll r. Iii ",Ill CO 1l r' bliillilli'IIIi1I1I'111(IIII I %I II II li 11 1111 II IIl Barbecue
1. , ;,iylIII,i,.; 4.t,i, -. 1,.,t:: �I�,11,l..If1 .. ikll _ ',1.1:.,.111,1 . , I I.I,I,IIIIIi... :,1,.. - . , -:
Clothes�dr er (gas)
Business name: .
Other:. I rH 1 I 41 n i t r 1 11 I
e OS t X 0 1✓ e i!1 11111111111 �i 1 ! 111111 , ,ti4 .f r0Y '1 i, 1 .�, S , 1 l 1111. - JiIIl,i��8, I
City /State/ZIP: Subtotal 33.3 a}
hone: ( ) Minimum permit fee ($90.00) o e ✓
/ ( ) Fax. Plan review (25% of permit fee)
' CB lie,: 4 0 C State surcharge (12% of permit fee) 1 ;. 0 . e 0
U TOTAL PERMIT FEE t 00 + - !V /
T his permit application expires if a permit is not obtained within 180
Authorized signature:
wfo days after it has been accepted as complete
Print name: } t t---V t,np err,2.r /- Dat 1 e ( 'LO Lt * Fee methodology set by Tri- County Building Industry Service Board
•
(:\Building \Permits \MEEC- PermitApp.dom ID /01 .• • • 440 -4517T (I I /02/COa1/WEB)
rr CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00400
Date Issued: 07/19/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S1 CA08000
Jurisdiction: Tigard
Site address: 9955 SW KABLE ST
Project: Subdivision: Lot:
Project Description: (2) branch circuits for garage
Contractor: CLASSIC ELECTRIC LLC Owner: CARRIGG, STEPHEN & SUSAN Y
P.O. BOX 1335 9955 SW KABLE ST
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503 - 259 -0459 PHONE:
FAX: 503 - 345 -0912
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/19/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/19/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 -00 0. You may obtain a copy of the rules or direct questions
e r mittee Signature: calling 503.232.1987 1.800.332.2344.
a� Issued By: /l/JJ// /?Gi �D'� v ,-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
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.
Fm:Classic Electric, LLC To:Electrical Permit Application (15035981960) 07:23 07I18/11GMT -08 Pg 02 -03
: 9 < i ! k a � r ;j igwfig r '�n. sriY =t v 1Rlr/S j � f✓ "% /a # r giv
Electrical Permit Apph EcENED ' r r : ✓ xf > FORO E:161. USE ) s� r �� is , r . Ur r.rwAvi ., ::a � . 3 .4.r;:l�s- . ,. i _7_ss t r'' . Fi{sSroi ..5. 1 <. a .s : �ftm. a...� :s � j 2 -
e i ts i \ Received a r City 01�'iigard 1 Datcfay. / `iii,. Permit .a� — 60 //
i °° 13125 SW Halt Blvd., Tigard, OR 9 223 � � �' r lan Review
Other Permit:
Phone: 503.718.2439 Fax: 503.598.1963UL 1 $ DarerB
T'1 G'ARI] Inspection Line: 503.639.4175 .• Date Ready/By: El Sec Page 2 for Aro
Internet: www.tigard-or.gov Notified /Method: Supplemental Information . TYPE OF : i"i(11 �l� it��`e PLAN REVIEW , �
❑ New construction ® Addition/alte: t o'n71eplacement Please check all that apply (submit 2 sets of plans w /ucuts alhcc,kedbelov):
❑ Service or feeder 400 amps or more [I Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
- CATEGORY' OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0Iloating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
ri Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
... .. : - . Emer system. larger separately derived system.
,
.JO13 SITP:: INFOR.MATION AND.: LOCATION • Q Addition ol'nc motor load of Q "A", "L" "1-2", "1 -r
Job no.: Job site address: 9955 SW Katlic St. 1001IP m more. occupancy.
Q Six or more naideniat units. 0 Recreational vehicle parks
City/State/ZIP:Tigard, OR
0 Health-care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE -SC: HEDULE
Cross street/directions to job site: Description I Qty. I Fee. f Total I *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 1 168.54 4
Ea. add'l 500 aq. f}. or portion 3:,`..02 1
Tax map /parcel no.: Limited energy, residential
2
>':D. SCR.II'.TION OF WORK (with above sq. it.) 75.00
Limited energy, multi - family 75.00 2
Add 2 20 Amp GFCI protected circuits in garage residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps 01 less 100.70 2
FROI'LR'Y Y O6 NER El <TENANT 201 amps to 400 amps _ 131o6 2
n 401 amps to 600 amps 200.34 2
Name. 19
i 601 amps to -1,000 amps 301.04 2
Address: S 091.7r- Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 40fi amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: - — Dat A. Fee for branch circuits with
ab , ove service or feeder fee
®APPLICANT:.: ®.C PERSON each branch circuit 1.42 2
Business name: Classic Electric, LLC 8. Fee for brawl circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Thomas Adams branch circuit
Each add'l branch circuit 1 7,42 _ 7.42 2
Address: PO Box 1335 or e ___ r n
Miscellaneous (service or feeder not included)
City/State/ZIP: Sherwood, OR 97140 Each manufactured or modular 67.84 2
tY dwetlin;, service and/or teeder
Phone: (503) 259 - 0459 Fax: : (503) 345 -0912 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: thomas@classicelectricnw.com
I Sign outline lighting 61.84 2
or ouui n
' .. `-CON TRACTOR j Signal circuit(s)orlimited-energy
Business name: Classic Electric, LLC panel, alteration, or extension. Page 2 2
Each additional ins etion over allowable in any of the abov
Address: PO Box 1335 , Additional inspection (1 hr lain) 66.25/ hr
City /State /ZIP: Sherwood, OR 97140 investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
one: (503) 259 -0459 / Fax: (503) 345-0912 / Inspections for which no fee is 90.00 / hr
✓ ✓ specifically listed (h/ hr min)
y CI3Lie.: 181851 Electrical Lic.: C414 Suprv. Lic.: 5339S I . : `` ELECTRICAUPEll MIT:4EES ' .' - ..:' :..:
Suprv. Electrician signature, required: "g _
a — Subtotal: 63.60
Plan review (25 /o of permit fee):
print name: Thomas G. Adam I Date: 7/18/11 State surcharge (12% of permit fee): 7.63 ✓'
TOTAL PERMIT FEE: 71.23
Authorized signature: T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Thomas G dams Date: 7/18/11
' Number of inspections allowed per permit.
—
1: 1Buil din{{,Permits \ELC- PermilApp.doc 07/01/10 440 4615T(t t /05 /CowwEls