Permit CITY OF TIGARD MECHANICAL PERMIT
1114 12 ' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00124
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012
Parcel: 2S109AB02900
Jurisdiction: Tigard
Site address: 13477 SW MOUNTAIN RIDGE CT
Project: MIZE Subdivision: THREE MOUNTAINS ESTATES Lot: 22
Project Description: Gas furnace replacement.
Contractor: GAROKEN ENERGY COMPANY Owner: KITTLE -MIZE, CANDACE C &
3565 SW 182ND AVE MIZE, ROGER F
BEAVERTON, OR 97006 13477 SW MOUNTAIN RIDGE CT
TIGARD, OR 97224
PHONE: 503 - 848 -3838 PHONE: 503 - 579 -1312
FAX: 503 - 356 -9002
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/07/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/07/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/07/2012 $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: Permittee Signature: r
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.
MAR -6 -2012 16:49 FROM :GAROKEN ENERGY CO. IN 5033569002 TO:5035991960 P.1
Mechanical Permit Application r • Olc 0 1 . 1 . 1 ( I.: (;SE O.\ i .,
City of Tigard Received
13125 S W O Date/BY: _ t:�� - _LI
• Phone: 503.639.4171 Fax: 50 r ,11 Plan Review
r LO ��' Date/B N : Other Permit:
111 , A I; / t Inspection Line: 503.639.4175 Date Ready/By: RI See Page 2 far
Internet: www.tigard -or.gov MP. �`�O Notified/Method: j' Sopplamental information
._ - TYPE• OF:W • • 1 • . ^ ON \ .) - _ - • . . r
❑ New construction Addition/altera i. u ; element 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.
. . ^.. .- ., _.. 0ORV'ORi'CU Value: S
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building "'' tg,
use checklist.
For spec/a/ /
❑ Multi- family ❑ Master builder ❑ Other:
Description
_ Description I Qty. Ea, I Total
JOB- SITE ! NBORMATION: AN D LOC - Heating/cooling
/y ^ ^ L I- Air conditioning
Job site address:
/ 3 4/7 7 s43 / `' / T/J. ♦ - O . e re u' .- ; plan showing placement) 46.75
City/State/ZIP: 7'-1- q Nr . Z:),--. R 9,0- G� umace r,000 BTU (ducts/vents) 46.75 / �e.'7C
J T ace 1,11,000+ BTU (ducta/venta) 54.91
SuitelbldgJapt. no.: Project name; ^^ L Heat punt 61.06
Cross street/directions to job site: / '" L Duct wor 23.32
Hydronicfhot water system 2
Residenti'l boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall. iti -duet, suspended, etc. 46.75
Subdivision: Flue/vent!for any of above 23.32
Lot no.: Other: 1 23.32
Tax map /parcel no.: I Other fue. appliances
. . .. . . .. ,.. _ ; ... haste
DESCRIPTION "'OF• wow( • ` I Water r 23.32
Gas firepl 33.39
it S l.f . V" v... et i%� Flue vent for water heater or gas
fireplace t 23.32 o
Log lighter (gas) 23.32
Wood/peliet stove 33.39
Wood fireplace/insert 23.32
Chimnev/liner /fluelvent 23.32
;ra.og aRTY Q4111, R : -I _ 01'ENAKr Other. 23.32
Name: J Qtr' M r 7 v. Environmental exhaust and ventilation
Address: Range hood/other kitchen
S���A... equipment 33.39 ,
City/State/ZIP: - Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: () /79', 13 / Fax: ( ) I toilet compartments, utility rooms) 23.32
.-,-7.._. -``„''�. // 5 Q AP.,Pt K thr ��'J CO1440 Pzas011 • , . .' .. Attic/crawlspace fens 23.32
Business name: ( a.r0 �:{P.v. i✓i \ e-M Fuel 23.32
� � Fuel piping .
Contact name: n v.� a - ei 4 N 5(4.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: F WalUsuspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace ; ,
E -mail:
&'C lee In e, g Q u e V , mete elk-A. -. Range , ,
•` CONTRACTOR. Barbecue ';
K e tr a t F •-, a Clothes dryer
Business name: �Q r p 1 N � -o ga
Other -
Addres S w V . .
a ►� � J� � � i►�lHA�rtcAs� -, I1�>>;s .. .
City /State/ZIP: ; 13. , - w - mot t O j •- roa0 i Subtotal /,C4,
Minimum permit fee ($90.00) GQ -Op
Phone: (703) cis, 4 3$3$ Fax: ( 503 3 90t),2_ Plan review (25% of permit fee) _ 7
CCB Iic.: .2 � � 4 ? ' I3 , State surcharge (12%ofpermit fee) /D. ITD
t` TOTAL PERMIT FEE y/jO_EG
Authorized signature � Q.v-- This permit application expires if a permit is not obtained within 180
days after it boa been accepted as complete.
Print name: li,p y‘ , „.,,,0. ''S O fit,\ I Date: 3 ..../„ - / t I • Fee methodology ad by Tri- County Building Industry Service Board
t :\Buildlna\Permita C•PemnaApp.doe 10/01/09 440.4617T(1UO2/COM/WEa)