Permit •
CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2012 -00601
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 2S102CC00402
Jurisdiction: Tigard
Site address: 13705 SW ASH AVE
• Project: Till Subdivision: FREWING'S ORCHARD TRACTS Lot: 15
Project Description: (1) gas furnace
Contractor: GAROKEN ENERGY COMPANY Owner: TILL, DANELLE
3565 SW 182ND AVE 13705 SW ASH AVE
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503 - 848 -3838 PHONE: 503 - 550 -7705
FAX: 503 - 356 -9002
.FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/20/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/20/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/20/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
•
•
Total - $100.80
Required,ltems 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: cIF' Permittee Signature: D&J, JPPu -fl0(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.
NOV -19 -2012 16:26 FROM :GAROKEN ENERGY CO. IN 5033569002 TO:5035981960 P.1
Mechanical Permit AnnlicatioRECE - Received
I I 1'0 R 01:I:I('t: (LSE ()NIA
City of Tigard DDate/By: Permit N¢,(yic 7( }. 0 - r) C°0( 13125 SW Hall Blvd., Tigard, OR 97223 NOV 19 2012 plan Review
' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
1 1.1 Inspection Line: 503.639.4175
CITY OF TIG d t]n D aze Ready/By: lu b: ® See Page 2 for
Internet: www.tigardor.gov BUILDING LJIYIS Notified/Method: 11 fe y Supplemental Information ON
- - . - - TYPE •OF W ?CQIIOIMER ( ; . E* 7 . SC,E LLE :: `` rCg
❑ New construction Addition /alteration/replacement - Mechanical permit fees' are baud on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
[j Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
1-.. - - - Value: S
- :°�,. • t . �' '' , ; �. OAT�GOI� ](;�'O�''CO1V;31rRYJ�IO{!1`: - l'._ _' - - -.. - s... � . �... ".... _ "
' and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ;I . :r. t
-
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total
.
_ .. 308 : INFORMATIONEANVLOCATION. . Heating/cooling -
Job site address: L� , . \ Q �+ I 1 Air conditioning
/3 L � /y OJ 5 ! 1 Y ,, 1 At
.1 (sires site p p gem '� 46.75
City /State/ZIP: f l y . r . D � q'7 ,PP-"; Furnace 10 000 BTU (duw/vemnZ) 46.75 -
Japt. no.: Project name: ^'�; / Furnace 100,000+ BTU (ducts/vamp 54.91
Suite/bldg
/ ' // Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
� Hydronic hot water system 23.32
/ '[ ^ C. b4 )7 _ Residential boiler (radiator or
hydronic) , 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. _ 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
. DESCIUFIIOIV`OF WORK' Water heater 23.32 -
G S/ Fi ' C.-Q_ fireplace 33.39
Fl ue 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 • ' ` ,��,.` � .- Other: 23.32
Name: bet. n . ( o. -1 �-±-,.- (,( Environmental exhaust and ventilation
Address: LL Range hood/other kitchen
�jyvLQ.- equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
12,06-e Single -duct exhaust (bathrooms,
( ��
Phone: SD - Fax: ( ) toilet compartments, utility rooms) 23.32
. � AFB,: f _ QOM ACI fu�FRSOIy • Attic/crawlspace fans 23.32
+ c p ti Other: 2332
Business name: ''
�iGt.r CAA e.•r'C/l- Fuel pining
Contact name: n �..... c9 N. l N 314.IS for first four; $4.03 for each additional
Address: Furnace, etc.
Oas heatyump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater ,
Fireplace
E -mail: tells°kQ,✓1 l e„,vt,,e,v- * Ni g & U e_v. x1..(24- Range
- _ CONT RAC' OR Barbecue
Business name: ez,Y -p <e E £ -' C 1, �� )
Other:
Addre 3 54 ' aw i�5a. �� tic ' MECHANICAI..FFRMrr' ' : - -_ . •
City/State/ZIP: R dU a ,f..,k,f C9-. 910040 Subtotal
Minimum permit fee (590.00) 90.00
Phone: (5 i-kg. 3c c I Fax: (sp-3) '3542 clay Plan review (25% of permit fee)
CCB lie.: 1-4,- `z t4 State surcharge (12% of permit fee) /O. ra
�,� TOTAL PERMIT FEE /, _'
Authorized signatures A ` t�4M- ICU permit eppliuMoo expires If a permit b not obtained within 180
days after It bas been accepted as complete.
Print name: p y ‘ ,,‘,,A.' ' CY -a.►" f Date: . ( (Ct t, ' Fee methodology set by Tri•County Building Industry Service Board
I.\ Building\PamiuV.ffC- PamitApp.doc 10/01/09 Me-461 (11/02./C C I
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