Permit .11 CITY OF TIGARD MECHANICAL PERMIT
° - :' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00494
Date Issued: 11/03/2011
T! GARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S1036D04101
Jurisdiction: Tigard
Site address: 11785 SW FONNER ST
Project: OCHSNER Subdivision: CARMEN PARK Lot: 1
Project Description: Gas furnace replacement
Contractor: GAROKEN ENERGY COMPANY Owner: OCHSNER, MICHAEL A & JOYCE
3565 SW 182ND AVE 11785 SW FONNER ST
BEAVERTON, OR 97006 PORTLAND, OR 97223
PHONE' 503 - 848 -3838 PHONE.
FAX 503 - 356 -9002
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/03/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/03/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/03/2011 $43 25
Occupancy Grp:
Stories:
Fuel
Fuel Types Natural Gas
Gas Pressure
Total $100 80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232.1987 or 1.800 332.2344.
Issued By: i / //. Ace, `Permittee Signature:
OP
✓.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV- 2 -2011 09:24 FROM :GAROKEN ENERGY CO. IN 5033569002 TO:5035981960 P.1
Mechanical Permit Application l OR Oi l It 1 ' t_4. O.
City of Tigard Received L
Date/By: //' i !Il /� Permit No : , ) fyi_ * 4
13125 SW Hall Blvd , Tigard, OR 97223 `� Plan Review r �l�
Phone: 503.639.4171 Fax: 503.598.196Q l� ` Date/By. Other Permit.
ii t.. F I) Inspection Line: 503.639.4175 �j t �A
Internet: www tigard-or.gov / �Q \\ Date Ready/By. ` @1 See Page 2 for
Notified/Mdhod: Supplemental Information
X3 0 . .
' , TYPE OF WO • , � A 1klss \11 'tOWIlkfE CIAL FEE ":�SCHEDU,t.lr: ,: t O a:iST +
NI IXo tit�p Mechanical permit fees' are based on the value of the work
❑ New construction IKAddition/alteratior
��` performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: i?, ON5) mechanical materials, equipment, labor, overhead, and profit.
' " CATEGOR Y 'OP CO1N$TItUCTION - •, Value: $
ItA - and 2 dwelling 1tA4..10 VR'IAtiE4AMIN EIV`S:SYS"1'EMS- f*F-$a '
y g ❑ Commercial/industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE- I FORMATION- AND LOCATION- Heating/cooling
Job site address: Air conditioning
( . ,/, � r - )� >v . a (requires site,plan showing placement) / 46.75
City/State /ZIP. —'— , � C, -3-_.3 1 7 `Furnace 100,000 BTU (ducts/ve l )' / 46.75
F urnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project e: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
/e'l Hydronic hot water system 23.32
5 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 23.32
Lot no.: Other. 23.32
Tax map /parcel no.: Other fuel appliances
' DESCRIPTION'O F WORK Water heater 23.32
' r Gas fireplace 33.39
_i . - // ,e Q — 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/liner /flue /vent 23.32
�• PROPERTY OWNER 0 TE NANT Other: 23.32
Name: M t (T ( c Environmental exhaust and ventilation ,
Address: l J Range hood/other kitchen
"' equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
// l Single -duct exhaust (bathrooms,
Phone:
qg /) / , Les • 0. L_ 3 g Fax: ( ) toilet compartments, utility rooms) 23.32
0' APPLICAN '0 'CONTACT PERSON - Attic/crawlspace fans 23.32
n Other: 23.32 _
Business name:
�c 0 K y.h 2r'' Fuel piping
Contact name: r, IA ". a , . N ed $14.15 for first four; 54.03 for each additional
Furnace, etc.
Address: .
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
` E -mail: t&'4€,v - VNe.V's s & u ev.zcl .
Y1. n -i- Range
- - CONTRACTOR- _ Barbecue
Clothes dryer (gas)
Business name:
QY'o e.v ,, 'e „, e , Y' rl` , t i C .---Z,v Other:
Address: 36 4 si,,, lz >". *
to MECHANICAL PERMIT FEES*.
City /State /ZIP: ?. � ex t _ _ o 910040 Subtotal
Phone: , e ��"� Y � !`° /_ -i Minimum permit fee (590.00) f ,c)_Oc,
(5 v"3J L , 3c Q Fax: ( S"D 5 3 5 ca - ci r Plan review (25% of permit fee)
CCB lie.: Lk 3 Ea- L4- State surcharge (12% of permit fee) /D. r
TOTAL PERMIT FEE h9e_ gQ
Authorized signature . --- -- o`c t -der- This permit application expires if a permit is not obtained within ISO
11 days after it has been accepted as complete.
Print name: \, p v „�Q ". or e it,. ]late: 9-L COMB C ( • Fee methodology set by Tri- County Building Industry Service Board
I V 3 mldinglPermitONEC- PermitApp.doc 10/01/09 44 l ITT (II )