Permit ., CITY OF TIGARD
11, MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00663
DATE ISSUED: 11/9/2007
TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S111CC 07500
SITE ADDRESS: 15845 SW GREENS WAY ZONING: R -12
SUBDIVISION: SUMMERFIELD NO.2 LOT: 102 JURISDICTION: TIG
PROJECT: STABENOW
Project Description: Gas furnace install.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVRS:
FURN < 100K BTU: 1 AIR HANDLING UNITS CU) DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
HERB STABENOW Description Date Amount
15845 SW GREENS WAY
TIGARD, OR 97223 [MECH] Permit Fee 11/9/2007 $72.50
[TAX] 8% State Surcha 11/9/2007 $5.80
Total $78.30
Phone: 503- 624 -9020
Contractor:
•
GAROKEN ENERGY COMPANY
3565 SW 182ND AVE
BEAVERTON, OR 97006 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 848 -3838
FAX 503- 356 -9002
Reg #: LIC 43124
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 : / ' Permittee Signature: 4 c' //'�� C:,a
t 1 -tNt
Call 503.639.4175 by 7:00 a.m. for inspections 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.
NOV -9 -2007 11:25 FROM:GAROKEN ENERGY CO ,..IN 5033569002 TO:5035981960 P.1
,.- C .,
r .,
Mechanical P: r $ I i t s � FOR OFFICE USE ONLY
City of Tigard Received, ,., PemtltN
13125 SW Hall Blvd., Tigard, OR '7 Datear I / y i - 49 0 I
Phone: 503.639.4171 Fax: 503.5ill,it.0 0 9 2007 Plan Review
Other Pe
4,„,.,:,....,,i .Date Ready
/By: t: Dasch3y:
Inspection Line: 503.639.41 Ready/By: &1 See Page 2 for
Internet: www.ei.tigard. uII Y O0, I. e ' t ~ pP
v Y /1 1 3 lJ� ; �^^ Notitied/Method: Su Iemeotal Intormatlon
-w.. 'r d. at,.. M L � .
f • Y k t C i 4, . YS�- •-.11..,...-7,..",e r zf` Zritd , sj+ j '.7e ir 41� 2fN1itv4« . :( = . Po 'fl$'d? <'F'
: � i. i ; ..... ii.g atti '� • :1% ,,
' - . . :... _ h � '_d -. - . 5 , 'DY I L` F1?'- 'OSE%'QHECeKLIST
! " construction Addition /alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
J Demolition ❑ Other:
rn y 9 mechanical materials, equipment, labor, overhead, and profit.
s `" x � c r ti� •rt_ m t kt NOt , � ,.. � . ;� a : r : ,r � w $ "x ,:,t .4 Value: S
a .�s. y.1. ' t• t1Y 1 jt . q'•n •,; w.
.�� and 2-family dwelling 0 building � 1 Eptulyi mx IsysTEM$ FEES*
Y g ❑ Commercial/industrial _
❑ Multi-family ❑Master builder For special information use checklist.
❑ Other:
i
r r yvr rG"S'� "x• i' Fl , •• , s DesCrlprion 1 Qty. r Ea. I Total
3 t .t .Y ;,� "� em u, E V = ' :O i xu . }a'.� $ .a , .fit f m , a I _ g � , .:r Fiw Heat ing/cooling
' t - S, !l J 1 6 p ms`s �� Air conditio ' eat um.
J5
Job site address: / J re, .Ian showin:.lacement 14.00
City/ State/ZIP: I r 3c ,, r ,,,i_ oe___ t 3 '1 ., ' ` Furnace 100,000 BTU ductsiven 14.00
no.: Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt.
1 Projectname: , ev Oce *) Gas heat pump 14.00
Cross street/directions to job site: L Duct work 14.00
Hydronic hot water system __ 14.00
I A ,p,irg,....31 Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in•well,.in -du , suspen e , c 10.00
Subdivision: Lot no.: Ftue/vent for any of above / 10.00
Other: -_- 1 10.00
Tax map /parcel no
r u ; e '4 Other fuel appliances ' ', q , r `. k 1. S v a q -o4 a Yt t� r i ' , / > Water heater t 10.00
* 1
.._ ", k._ ddt.�+L.L .L'. r_:. . r�' ..�...,.a?.,nL _ , ets.l ..rw '.s_ Yn::�j
G as f ireplace 10.00
a e •Q\ \fig Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
•
Wood fireplace/insert 10.00
r y , fi is' 1 4 � �s x er,1- .TP;t ,�w�. 1,76. ;- 1 ,�� a 11hin ,; L i .• , Chimnc�/lina /tlue/vent 10.00
v2/ it�.r.° .- }'.r�' �i. e'tti t +fist. 3!,y .. 'E .� ` % s7' -' Other: _ 10.00
Name r 4..'e- b 'k ,,J ('\c f,....0 Environmental exhaust and ventilation
Address: 5 a._ Range hood/other kitchen
equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
Phone: ( ) Fax: Single -duct exhaust (bathrooms,
U � _ 41 6D:0 ( ) toilet compartments, utility rooms) 6.80
:vs) fi ak. . g a av (r " .
: ' r . ; _ @ r ' e l 4 j ∎ , Attic/crawlspace fans 10.00
.. 1._.....v "i. 1'f �J.b�.. - .-._.S 4 <S L. LfLJ� 1: -e 2, � $_�.' .S L ..
Business name: Other: 10.00
° '""" 6 'K4 Fuel piping
Contact name: N b 1r1 Y , ` � Q �� {1 55.40 for first four; 51.00 for each additional
Address: ` Furnace, etc.
� -Jota0 Gas heat pump
City/State/ZIP: -9() Wall/suspended/unit heater
Phone: ( ) I Fax: : ( i . Water heater
Fireplace
E-mail: "' `p r Aii, 1J-Qif' Ce--(3N'1 V\.Q Range
. y► '4'-/1- >S"tc'77 -i ,, ao. r,ta � x Vii i r 7 ?]t • o= "lf • '-- , .�':rt 3 .;.i':r�': f : -...m lL._ivitlt , s. z .. 'n:s .tt_
P.d ..,IY - .44 ki s . Barbecue
Business name: ("3,9,,,,r 0 „ ,et m -:-/\_c.- Clothes dryer (gas)
Other:
Address: ii3O G 1 � ^�
` 7 g.,';. E:v .T( - su -'.M *' ,
GI, City/State/ZIP: ( (J 004. )('\ c\ I on 4 Subtotal
Phone: tb?j) $ 4t - �� nR_
x: ( � � Minimum permit fee (572.5
1 (-C - � CO ! r � I h , � (25% Plan review (25 of permit fee) )
&
GCB lic.: ) 1 *. t- State surcharge (8% of permit fee) j
C TOTAL PERMIT FEE SC I ,
Authorized signature ___ .r, /e\s , ,._ This permit application expires if a permit la not obtained within 180
I days after It has been accepted as complete.
Print n R ame: \ v 0 Y A te- Date: 11 ���}}} /// ��0 //7 t c Fee methodology set byTri- Co,mty Building Industry Service Board
i.\ BuildinglPemiu ' \ME PcrmitApp.dos 12/03 440-45 ! 1 TT (11mvCOM/WF3B) III
CITY ��������������� `— ..
��n m m OF n n�m�mmm��
BUILDING DIVISION PERMIT #: ���2DO�Q�G
| --'-- - � - - /+ ``
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2007
Phone: (503) 639-4171
he* tt ovk
Inspection Requests (24 Hrs.): (503) 639'4175 AI^- °���
INSPECTION WORKSHEET FOR DATE: 11/16/2007 TIME: 7:01/*M PAGE: 65
SITE ADDRESS: i6045 GREENS WAY CLASS OF WORK:
SUBDIVISION: SUMMERFIELD N0.2 LOT #: 1OJ TYPE OF USE:
1 PROJECT NAME: STABENOVV
DESCRIPTION: Gas furnace install.
.
OWNER: STABENOW, HERB PHONE #: 503-624902O
CONTRACTOR: GAROKFN ENERGY COMPANY PHONE #: 503-846-3838
Inspection Request Scheduled For: Date: 11/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 k4muhmnixa!finp8 059771'02 503-624'9020 N
Corrections/Comments/Instructions:
-�-~ � 4_ --- •
~� / ri o i:a.a. - •
'
fti PAS IP ~' ROALAPPROVAL E] CANCEL n NO ACCESS
`
n FA|L IR CALL FOR INSPECTION D ADDITIONAL FEES ASSESSED
� �
Inspector: Oate: Y � Phone #: (503) 718-
'