Permit y CITY OF TIGARD MECHANICAL PERMIT
= • - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00584
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2012
Parcel: 2S112CB14100
Jurisdiction: Tigard
Site address: 14845 SW KENTON DR
Project: Gornick Subdivision: ASHFORD OAKS NO.3 Lot: 150
Project Description: (1) gas furnace replacement
Contractor: CAVALRY HEATING & COOLING Owner: GORNICK, LEROY
7715 NE 33RD DR STE A 14845 SW KENTON DR
PORTLAND, OR 97211 TIGARD, OR 97224
PHONE: 360 - 423 -1966 PHONE: 503 - 968 -0796
FAX: 360 - 423 -1978
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/08/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/08/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/08/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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: wt Permittee Signature: vN (APL' CPT 0 Id-
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.
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Mechanical Permit Applicll CElVED FOR OFT! l L 1, `I•: ONLY
City of Ti and NOV 0 8 2012 Received • 13125 SW iiall Rlvd„'I'igatd. OR 97223
NOV I a PamitNo. :, KrLoZG1�. OD�I
Phone: 503.718.2439 Fax: 503.598. y>♦fj9- / V ti TIG� Plan Review
llll 1 i- I lu Date/By. Other Permit:
Ti c; it i
Inspection Line: 503 75 Date Ready/By r iris:
Internet: www.t(gard- or.gov L� I' i� ® See entr e2for
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t /, cditcdfinethaf; sapplementt Information -
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j � Mechanical permit bees* are b on the value of ncc work
❑ New construction el Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and P rofit.
fir .T Z I 7i L sp ; /tW 1 - er y .14...,. srr, I f ".h 4 r Value;
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® I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special inf' marlon use checklist.
❑ Multi- family ❑ Master builder 0 Other: Description I Qty. I I -a. I Total
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Job site address: 14845 SW KENTON DR. (reyuirea sile plan showing placement) 46.75
City/State/ZiP: PORTLAND OR 97224 Furnace 100,000 BTU (ducts/vents) I 40.75 46•75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt. no.: Project name: GORN1CK Heat pump
(requires site plan showing placemcnt) 61.06
Cross street/directions to job site: Ihtet work _ 23.32
Hydronic hot water system 2132
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (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:
1 t +r
i .__ts , t rt'i w p' tTl t' _
' 1 l yl lj 'i " :4'n 1. ',,`i�'pjj� f f" i vl ll ')1 r ,l,: i -I Water heater W 23.32
:_:, tti! 1 ' ilr: tl L[tit it 1. �}boyiiii t!1I I:t.r.I' if:, " r„ . _
REPLACE GAS Ft JRNACE Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33,39
Wood fueplace/in ert 23.32
i t qt' y Alp i umw 1 I! `J ? 1 1 W1 "!i f t Chimne Hiner /llue/ven
1 II -- ia 1 o >!, ! rt i t 23.'2
1 L,(i r l., e, t. o. 1l i rf4 :�lldr z t. 1), 4 Utter: 23.32
Name: LEROY GORNICIC Environmental exhaust and ventilat
Address: 14845 SW KENTON DLL Range hood/othcr kitchen
_equipment 33.39
- City/State /LIP: PORTLAND OR. 97224 Clothes dryer exhaust 33.39
toilet con
Phone: (503)968-0796 Fax: ( ) Single -duct exhaust (bathrooms.
1 artments, u tility roams 23.32
Wiz: lh 1 1 a >i "{{� r� I R t J M i:t r ;nom
I-7:4 ._,'lift h . t y 1 _ + 'f . 1 l I Nt' , " A i 1 i t• - il lI " V t�' it . 4. i : i Q r � vg. t Aric/crawls ace fans
•. i.ct..,., r, naiil;u. ,.,.h. :1(�!v�Jt tlt+tr :C1 :5. 1 P 23.32
Business name: CAVALRY HEATING AND COOLING Other: 23.32
es
Fuel piping:
Contact name: RON STRONG 514.15 for first four, 54.03 for each a dditional
Address: 7715 NE 33 DR. STF. A Furnace. etc. �-
Uas heat pump
City/State/71P: PORTLAND OR 97211 y WalVsuspended/tmit neater
l'hone: (360) 423 -1966 Fax: : (360) 423 -1978 Water heater
"- • Fir •lace
E-mail: rstrong@oregon- aire.cum
alilifi l'• If !tl 1 Oil ( �11 i tl f 1'1' l: III,i.lr11 Range
tJ' .u1 1 ?.5 o J �( .:i "v ?,1t.ii.. J l ( 11)ti
l t ?fr ` :.trni , i�i a a ;: BarbCcu .
Business name: CAVALRY HEATING AND COOLING Clothes dryer (gas)
Address: 77I5 \E 33 DR STE A Other.`
City/State/ZIP: PORTLAND OR 97211 T = i L ' 1 c'' ;M' 71. MFEE v 4"z
Subtotal 46.75
Phone: 3G0 423.1966 v Minimum permit fee ($90.00) 90.00
( ) Fax: (360) 423 -1978
CCB lie.: 64235 _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) 10.80
_ '1O'IAL PF.RMiT FEE 100.80
This permit application aspires ills permit is not °bilked within 180
Authorized signature: _ days after it has been accepted as complete.
Print name: RON STRONG f Date: 11/8/12 1 ' Fee methodology set by Tri County Building Industry service Board
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