Permit •
a CITY OF TIGARD ' MECHANICAL PERMIT
11,
COMMUNITY DEVELOPMENT AM Permit #: MEC2012 -00179
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 2S114BB01600
Jurisdiction: Tigard
Site address: 10350 SW SERENA WAY
Project: Ognjenovic Subdivision: PICKS LANDING NO.1 Lot: 30
Project Description: Replace gas furnace. 4/19/12, reprinted to correct address from 10305 to 10350 SW Serena Way.
Contractor: SANDU INC Owner: OGNJENOVIC, GORAN
2101 NE 387TH AVE 10305 SW SERENA WAY
WASHOUGAL, WA 98671 TIGARD, OR 97224
PHONE: 503 - 740 -1333 PHONE: 503 - 750 -8305
FAX: 888 - 340 -6548
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/10/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /10/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /10/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 Noti : • • 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 • uestions to OUNC \ by ca ' g 503.232.1987 or 1.80
Issued y: _ / P_j� � � ; l � � 1 Q/ U Permittee Signa�_
Call 503.639.4175 by 7:00 a.m. for the next available insp= ion 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.
III CITY OF TIGARD MECHANICAL PERMIT
il
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00179
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04110!2012
Parcel: 2S114BB01600
Jurisdiction: Tigard
Site address: 10305 SW SERENA WAY
Project: Ognjenovic Subdivision: PICK'S LANDING NO.1 Lot: 30
Project Description: Replace gas furnace.
Contractor: SANDU INC Owner: OGNJENOVIC, GORAN
2101 NE 387TH AVE 10305 SW SERENA WAY
WASHOUGAL, WA 98671 TIGARD, OR 97224
PHONE: 503 - 740 -1333 PHONE: 503 - 750 -8305
FAX: 888 - 340 -6548
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/10/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/10 /2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /10/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 Notific t�o 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 dire uestions to-9 . calling 503.232.1987 or 1.800.332.2344.
Issu By: K t. (I I Permittee Sign ure: �, ,q 11 / ,
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.
Apr 0712 05:44p SANDU, INC. 888 - 340 -6548 p.1
1
Mechanical Permit Application__ FOR OFFICE (sr o\ L1
II City of Tigard RECEIVED ° � Q �� Permit No.: wee, O / / .ed /7
13125 SW I lal l Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax 9 pagy; Other ?emit:
Inspection Line: 503.639.4175 APR 9 2012 Dare R /Q Jeri!: B Seep 2 for
TIGARD Internet: www.tigard- or.gov Notified:Method: Supplemental Information
CITY OF TIGARD
• TYPE OF ' NG DIVISION COMMERCIAL 1W SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit
Value: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT 'SYSTEMS FEES'
i - and 2- family dwelling ❑ Cotnmerciai /industrial ❑ Accessory building For special information use cheektbt
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION
Heatine%a�ng:
Air conditioning
Job site address: 2 � - C �A VI placement) (requires site plan showing pla - 46.75
10 7v� Std S �f Furnace 100,000 BTU (ductsrve ts) 1 46.75 4I�Tr
City;State/ZlP: f r i o Q Cl *2-14 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt no.: Project name: Heat pump
_ - -_ (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
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
Otter. - 23.32
Tax map /parcel no.: Other fuel appliances:
. DESCRIPTION OF WORK Water beater 23.32
get,' G�45 ti vike- Flue vent Gas fireplace 33.39
for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert , 23.32 I
PROPERTY OWNER I❑ TENANT ChirnneYfliner /fltredvent 23.32 I
Other. _ 23.32
Name: 60044 QG iuTQ p C.- Environmental exhaust and ventilation: -
Address: 1Q l, O'S SW Seleey4 (i.l'S Range hood/other kitchen
equipment 33.39
City /StateiZIP: 11 eq2 9 72241 Clothes dryer exhaust 33.39
J / Single-duct exhaust (bathrooms,
Phone: �y 1 -$ 2 5 Fax: ( ) toilet compartments. utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: q,a)t f IOC, Other 23.32
Fad piping:
Contact name: �1) 1W c $14.15 for that four, $4.03 for each additional
Address: 21 p ( UF- M 7 Age Furnace, etc.
"�_ Gas heat pump _
City /State/ZIP: J (IQ() t.14 ctlf6 / Wall/suspended/unit heater
Phone: 008 ) 7 4 O . (SS Fax: : (8fe ) G948 Water heater
Fireplace
E -mail:
Range
CON ACTOR Barbecue
i• Clothes dryer (gas)
Business name: Cy ], u (IOC .
rr'" �� Other:
Address: _ MECHANICAL PE RMIT FEES'
City/State/ZIP: Subtotal
Phone: ( ) I Fax: ( ) Minimum permit fee ($90.00) 90. 00.
Plan review (25% of permit fee)
CCB lic.: 1 (eco+D t 1 State surcharge (12% of permit fee)
• TOTAL PERMIT FEE LOD . $p
Authorized signature: This permit application expires rf a permit is not obtained within 180
p /
8n r - • days after it has been accepted as complete. (/ (jI�(/
Print nam�� — C " — •----t.).---- Date: 1� f 06642.. I ' Fee methodology set by Tri County Building Industry Service Board
t:lBuildir PermiisUMEGPemitAspdoe 0009/10 1 4446 < 1 617T (11 /O21COM/WEB)