Permit 17
• CITY OF TIGARD MECHANICAL PERMIT
, DEVELOPMENT SERVICE PERMIT #: MEC2005 -00193
l • DATE ISSUED: 4/25/2005
� -°".' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134DB-00800
SITE ADDRESS: 11145 SW 114TH PL ZONING: R -4.5
SUBDIVISION: WINTERS ADDITION LOT: 002 JURISDICTION: TIG
Project Description: 25ft. gas line to range.
CLASS OF WORK: ALT' FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
GOETZ, HOWARD V Description Date Amount
11145 SW 114TH PL [MECH] Pen Fee 4/25/200E. $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 4/25/200: $5.80
Phone: 503 - 524 - 8002 Total $78.30
Contractor:
KOEHLER CONCEPTS LLC
10772 SE HWY 212 REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Phone: 503 - 650 - 9550
Reg #: LIC 120277
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: , A , 4_ ' � � !� Permittee Signature: 0y3 j,,-',, f , ;7'L
CaII 503 - 639 -4175 by 7:00 a.m. for inspections that business d ay.
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.
04/X/2005 04:20 FAX 5036501220 KOEHLER CONCEPTS a 002/003
. _
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City of Tigard Received
Date/By: 95 4)5 i ii 0 EMSEEMINIMI
13125 SW HMI Blvd., Tigard, OR 97223 Mae Revie
Phone: 503.639A171 Fax 5"."8.196 2 2 2005 1,11.da"1(‘' Date/By: Other Permit
Inspection Line: 503,639,4175 ;: '.. ,',;i••• 1 Data Randy/By; kin ta see Pegs 2 for
Internet www.chtigard.orus CITY OF TIGARD Notified/Method: Supplemental Information
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, . --- ' ...,' " ' 1VIechanicul permit fees ere based on the value of the work
0 New construction Da Addition/alteration/replacement
perfonned. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ID Other: mechanical materials, equipment, labor, overhead. and profit
'. ;, ' ; : : Value: $
i ,1 t e:i i i0crIPPA r li'OFM:040001, 10 0 1 !Y'iP:.■, ; i; 9 :PNV / A' 1 1:.`if 41 ::'i : "4"v ', . , .y , , ,- , .' ' . ' ' li . , 1 ' ;1 'i
2:1 1- and 2-family dwelling El Commercial/industrial ['Accessory building
For special iefformation use checklist.
0 Multi-lismily 0 Master builder 0 Other; Description 1 Qty. 1 Ea. d Total
.:.i H u ti ng i coo li nR
1 l ' ' ' ' ' 1; ';' '` r■': 7 ! ■.■.....r..... , r111 .. . ..■ , .. 1 0, . . ). ■ .. ,, ) . , 0; ' .' 1 IR . 1.1 , I '.:t"
Air conditioning 4r heat pun
Job site address: 11145 SW 114 PLACE m (requires site plan showing placement) , 14.00
City/State/ZIP: TIGARD OR 97223 Furnace 100,000 BTU wois/voeng _._ 14,00
Furnace 100,000+ BTU (duets/vents) 17.90
Suitablds./apt. no.: Project name: GOETZ
Gas heat pump 14.00
Cross street/directions to job site: Duct work _ 14.00_
Hydronlc hot water stern 14.00
Residential boiler (rediator or
hydronie) 14.00
Unit heaters (fuel-type, not electric),
in-wall. in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
...q" , : .'. WOlatt;.:.:i :1;?1:,x ! l.:'?i;i;i;,:, 4 ;,. .;,ii.;,;i,; Water heater 10,00 ..
Gas fireplace 10,00
RUNNING APPROX 25FT GAS FUEL PIPING TO RANGE Flue vent for water heater or gas
fireplace 10,00 _
- Log lighter (gas) 10.00
Wood/pellet stove . 10.00 ,
Wood 0T:4=e/insert 10.00
1 .....:-....(.....1;;;;;.,4. . cm I •,c I ... CilinlitCynineriflueivent 00
iiiiitiogrt.owize, w” , ., ..... .... 1 ....ba. Imo 1 1 ■ 10.
.... .. .,.. .. .. . , . ...., .,. 1" n
Name; HOWARD GOETZ Environmental exhaust and ventiladon
Range hood/other kitchen
Address: 11145 SW 114 PLACE equipment 10.00
*--- -
City/Stott/ZIP: TIGARD OR 97223 _ Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: (503)524-8002 Fax: ( ) toilet compartments, utility rooms) 6.80
. .
I i r !!;'f Atticierawis fans 10.00
Business name: KOEHLER CONCEPTS Other: 10.00
LLC
Fuel piping
Contact name: TODD 55.40 for first four; 81.00 for with additional
Addross: 10772 SE HIGHWAY 212 Furnace, etc.
—..—.---- Qs heat pump
City/State/ZIP: CLACKAMAS OR 97015 Wall/suspended/unit heater _.
Phone: (503) 650-9550 Fax: ; (503) 650-1220 Water heater __
Fireplace •
E-mail: KOEI1LERCONCEPTSgQWEST.NET Range ) 54.0 540
1. . ,,, r.: , ' 4 , i"" 1 j. %■ :I% r 4 ; i'dOctiititieftd0";,:?,7Afi!ir!!"talV;r,. f qlr, Barbecue
,r,:l , q1 1 t:"%I";' r :•!" ,' • !I . • • ,, „!,, ,„■,ll•'• II • ';., 1.11 kr• • oi • ,••,/,', i •• • i ••• •I 4 ',1
Clothes
Business name: KOEHLER CONCEPTS LLC dryer (gas)
Other:
Address: 10772 SE HIGHWAY 212
City/State/ZIP: CLACKAMAS OR 97015 subtend _ - Co
Minimum permit fec (572.50) 7t .6(;)
Phone: (503) 650-9550 Fax: (503) 650-1220
Plan review (25% of permit fee)
CCB lic.; 120277
" — --'-) / — (..2 (... State surcharge (8% of permit fee) 5. SO
TOTAL PERMIT FEE 7 8. 30
ThlipermIt application expires if a permit is nut obtained within 180
Authorized signature: .7 s i e ■ , l---- days after It has boon accepted IllIvIMPIete.
I . Print name: TODD KOEHLER J Date: 04-22-05 • Fee methodology set by Tri-County Building Industry Service Beard
1. \Sul Itli ninPermiunlvISC.PennitApe doc I Z/01 440.40 11T (1 1/07JCOMAVP_B)
•