Permit ill CITY OF TIGARD MECHANICAL PERMIT
: '' COMMUNITY DEVELOPMENT Permit #: MEC2009-00474
Date Issued: 09/09/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S133AD08200
Jurisdiction: Tigard
Site address: 12860 SW CHICORY CT
Subdivision: Lot: 0
Project: Stolz
Project Description: Installation of furnace and A/C. Unit must meet 3' minimum side and rear yard setbacks.
Owner: FEES
STOLZ, RANDY Description Date Amount
12860 SW CHICORY CT
TIGARD, OR 97223 Air Conditioning or Heat Pump 09/09/2009 $14.00
Furnaces < 100K BTU 09/09/2009 $14.00
PHONE: 503 - 524 -8888 FlueNent For Any of Above 09/09/2009 $6.80
12% State Surcharge - Mechanical 09/09/2009 $8.70
Contractor: Minimum Fee Adjustment - Mechanical 09/09/2009 $37.70
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:
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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: lir441-7/ Permittee Signature: &k pP ( //
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.
• SEP- 13:58 FROM: GAROKEN ENERGY CO. IN 5033569E02 TO: 50359819621 P . 1
••
. . .
Mechanical Permit Application
1.014 01-1.1(1.., 1 l()\ l.
. .,---.:-
City of Tigard r - r..- ,‘,, , 1 I Received .
il 7 „ ,. ',, , ,,.,, ?,
,. ,-. 13125 SW Hall Blvd., Tigard, OR 97223 C" p i' ''. ! '
Date/By: 09 *A Permit
' I Phone: 503.639.4171 Fax: 503.598.1960 'i :: -I " ' "
74
Plan Review
Date/By: Other Permit:
fIGARD
Inspection Line: 503.639.4175 4 0 0 2.
Date Ready/ 'uric la See Page 2 for
Internet: wvAv.tigard-or.gov SI 1 Notified/Method: ' Supplemental Information
TYPE OF WORKTA 1 ''' °--' -. -;',`' : Yk ' 1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
1:1 New construction 5•Addition/alteratio ' . Mechanical permit fees* arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION . . Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2-family dwelling El Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family El Master builder 0 Other:
Description I Qty. I Ea. Total
. ' . JOB SITE INFORMATION AND LOCATION -. ,' , • Heating/cooling
Air conditioning or heat pump
Job site address: i aeg ( St CAT\ t C.0y eA (requires site plan showing placement) / 14.00
City/State/ZIP: 1 ey1_, •A_ q a ,-3 - Furnace 100,000 BTU (ducts/vents) / 14.00
Furnace 100,000+ BTU (ducts/vents) 1 7.90
Suite/bldg./apt. no.: Project name: Si.... t -
Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
On t 6.de_...(2....._ Hydronic hot water system t 4.00
. Residential boiler (radiator or .
9-
hydronic) 14.00
Unit heaters (fuel not electric),
in-wall, in-duct, suspended, etc. 14.00
Flue/vent for any of above / 6.80
Subdivision: Lot no.:
Other 10.00
Tax map/parcel no.:
Other fuel appliances
-
. . . . DESCRIPTION OF WORK . ' - ,, , . Water heater _ 10.00 _
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
c) k 4 7° 1r 6 Pr - Lk.I L - ,-- .r , afs..9 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
/ PROPERTY OWNER I . ., - 0 TEN.Otr • ' I ," r : , Other: ther: 10.00 10.00
i
Name: g et, v. c\--t.) ¶ 4 - 7- Environmental exhaust and ventilation
. Range hood/other kitchen
Address:
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
, Single-duct exhaust (bathrooms,
Phone: ( 511)6,2 g. S Fax: ( ) toilet compartments, utility rooms) 6.80
• 0 APPLICANT 1:1 CONTACT PERSON Attic/crawlspace fans .... 10.00
Other: 10.00
Business name:
(--;niv-v Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
, Furnace, etc.
Address:
Gas heat pump
City/State/Z1P:
Wall/suspended/unit heater
Water heater
Phone: ( ) Fax: : ( )
Fireplace
E-mail: ( -&-"ic-' V....0-0 e.41.8-•-,C,,,;..i v-e.-Ar i ?...cav-■ . NI- \-_a__.. i ! Range
,
CONTRACTOR • • ' ' • Barbecue
Clothes dryer (gas)
C
<-- rilv 49-4A .. ji , v2r..C1C-11-> • N C Other:
Business name:
Address: ---,5,://7 MECHANICAL PERMIT FEES*
,
Subtotal
City/State/ZIP: 4 (e-4
Minimum permit fee (S72.50) "20Z , 5(")
Phone: (511 < L..g.,...7...)ez _ Fax: 1.53 )35(0 --ct cc) a . I Plan review (25% of permit fee)
/ CCB tic.. 4 -- 6\ak-i- qii;- II ,, State surcharge (12% of permit fee) r 70_,
TOTAL PERMIT FEE i 9,6
Authorized signat. \(A.0:5L-,----.. This permit application expires if a permit is not obtained thin 180
days after it has been accepted as complete.
a."
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SE'P=4 -2009 13:59 FROM:GAROKEN ENERGY CO. IN 5033569002 TO : 5035921960 P.3
(GEN.
GARCIKEN ENERGY CCI. INC.
SINCE 1 979
3565 SW 182ND AVE • BEAVERTON, OR 9707 • TEL (503) 848.3838 • FAX (503) 356-9002 • CCB# 431 24
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