Permit CITY OF TIGARD MECHANICAL PERMIT
11- COMMUNITY DEVELOPMENT Permit #: MEC2009 -00142
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2009
Parcel: 1 S 133DD 12800
Jurisdiction: Tigard
Site address: 11881 SW 126TH PL
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 165
Project: Jimerson
Project Description: Replace gas furnace, and a/c unit.
Owner: FEES
JIMERSON, DAVID A Description Date Amount
11881 SW 126TH PL Air Conditioning or Heat Pump 04/02/2009 $14.00
TIGARD, OR 97223 Furnaces < 100K BTU 04/02/2009 $14.00
PHONE: FlueNent For Any of Above 04/02/2009 $6.80
12% State Surcharge - Mechanical 04/02/2009 $8.70
Contractor: Minimum Fee Adjustment - Mechanical 04/02/2009 $37.70
GAROKEN ENERGY COMPANY
3565 SW 182ND AVE
BEAVERTON, OR 97006
PHONE: 503 - 848 -3838
FAX: 503 - 356 -9002
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue
Total $81.20
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 -0100. You may obtain a copy of the rules
Issued By: /Q(V- �
1 (� Q � Permittee Signature: S Sl SL a t. CCA-zt (
� Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 -31 -2009 13:11 FROM :GAROKEN ENERGY CO. IN 5033569002 TO : 5035981960 P.3
Mechanical Permit Applicatio tRECEIVE , t►1(t►i i It I , •,1 t) \I ,
City of Tigard MAR 31 2009 may: 3. 3\ •cc Permit No.: M rearQ
;� ; • 13125 SW Hall Blvd., Tigard, OR 97223 Play Review
Phone: 503.639.4171 Fax: 503.598.1960 D Other Permit:
C, n rt ll Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Suns: - 0 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: 1 (,) Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction 15-Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
- and 2- family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES
❑ Accessory building
❑ Multi - family ❑ Master builder For special information use checklist.
❑ Other: Description J Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cook
Job site address: SZS l I 2L o Air conditionin: • heat pump
L ( 'uses . an showiax placement) 1 14.00
City/State/ZIP: 71/4--x0-4. p -- - .... 1.1 i •i i.: •(•U (ducts/vents) / 14.00
Furnace 100,000+ BTU (ducta/vents) 17.90
Suite/bldg. /apt. no.: F name: ca. \tM .12,y Gas heat pump 14.00
Cross street/directions to job site: ((((��\� Duct work 10.00
i
Hydronic hot water system 14.00
Residential boiler r (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: I Lot no.: Flue/vent for any of above / 6.80
Other 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/� f, Gas fireplace 10.00
( Q ,5 � Flue vent for water heater or gas
"[ �� fireplace 10.00
j Log lighter (gas) 10.00
(7 \et,Ci.., o\ ( .) I to Wood/pellet stove 10.00
Wood fireplace/insert 10.00
'7 • PROPERTY OWNER l 0 TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: J )` p �, �� Environmental exhaust and ventilation
Address: �^r ' v ` Range hood/other kitchen
' S (' P , , equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) I Fax: ( ) toilet compartments, utilittrooms) .. 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other. 10.00
Business name: ✓ n
QNt . Fuel piping
Contact name:
0 w� $5.40 for first four; $1.00 for each additional
Address:
��-19 s1 Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
llll� Fireplace
E -mail:
�L7n`c k.0 -cov .a ./.4.---v . Z. s n . v\.i Range
CONTRACTOR Barbecue _ _
Business name: C GAO , _ „ 1sj � • M\C Clothe dryer (gas)
Address: --.5/t? Ay .61 . ,e, IAA MECHANICAL PERMIT FEES*
City/State21P: Ciwe. u(.. 0.1100 (es Subtotal
Phone: ( Fax: Minimum permit fee (572.50) p, a)
�� ) $ L � $� �? p �3 ) 35 0 a ' Plan review (25% of permit fee)
CCB lic.: 4 •3 \ a Lf State surcharge (12% of permit fee)
TOTAL PERMIT FEEL r )•-C�
Authorized signal rr �-4���0 Tb,a permit application expires u a permit Is not ob in ISO
�1p� 1 - days after it has been accepted as complete. i 3 J O V\ v■Ot_D �� cit...-1,...., cit...-1,...., 3 0 el