Permit CITY TIGARD MECHANICAL PERMIT
410, i� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00798
4•4001., I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/5/2005
PARCEL: 2S1 14 BA -03 800
SITE ADDRESS: 09655 SW SERENA WAY ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 102 JURISDICTION: TIG
Project Description: Fireplace insert and gas line.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
AARON /MICHE SALDIVAR Description Date Amount
9655 SERENA WAY [MECH] Permit Fee 12/5/200f $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 12/5/200E $5.80
Phone: 503 830 - 3948 Total $78.30
Contractor:
T & K MECHANICAL
11525 SW CANYON RD REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005
Phone: 503 626 - 4652
Reg #: LIC 121165
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: /lj Permittee Signature: /7)1, � � act 1 L t
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
s f.
• )FICF USE ONLY M echanical Permit Application Received FOR OF Mechanical '`'
`°' Date/B . l2 > 0 j Permit No.: �i - • • •`. 0U A
Plannin Approval Building
City of Tigard � �+ �� R PP
Date/0 : Permit No.:
13125 SW Hall BIvd. C
(� Plan Review Other
Tigard, Oregon 97223 c 0 0 200 ;1 Date/B , ,� v Permit No.:
Phone: 503 -639 -4] 71 Fitt :�S03 -59$ - 1960 Post- Review Land Use
+F � �u, lrh Date/B ; Case No.:
Internet: www.ci.tigard pr ( - l c T w. - ' T �l� l Contact • a i See m g e z for
�- e.
24 -hour inspection. Req t. 0 -4 Tc Name/Method: I AM Su icmentai Information.
BUILDIN
_ .: ... . ....... E:'O .OItK :::J!;; '�i�i- , . .. Ol`1�Y11':R .., .
•i + :"- .;i�l�r_ •;:C 'CI �AYIi:FE • SC' �.k,. , . s ' >?GHE sT':.
❑ New construction [1 Demolition Mechanical permit fees* are based on the total value of the work
.. • i `' ddition/alteration/r - e lacement 0 Other: performed. Indicate the value (rounded to the n dollar) of all
.. , : : . . • •• . , N . I • , mechanical materials, equipment, labor, overhead and profit.
': :.: ,.. �;: � �CAfiEGUR' Y' OFe�': �UA1S' �' �?y; 1C! rIU11T'„; ;�:I�,!ta�!!t;�'�i�i'�;ns "=ii.
_ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Buildin ❑ Multi - Family .. ;':#':s1(DE,lK' "ait(ita ig8 Nor /SXSt sWEE..'Sir ul:E;i5:•-.
0 Master Builder Other: olr - _ T
Description Qt Fee eat Total
I I 'I k' 1: •':
- , , . ';::TOB'SY'1'E:�Ik''ORMA1`YON•' ail' i1'.! �UGiA iI?i�0]V'.;�,!it;!i(It,l�l�i,, �.; Furnace - add-on air conditioninp ** 14.00
Job site address: cllr `i S' S W Ssz -ns_-n a i+- )(.J -1 (s heat pump 14.00
Suite #: - I Bldg. /Apt. #: Ductwork 14 -00
Pro eet Name: CA. f Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
• _Sin wall, in-due sue ended, etc.) 14.00
Flue/vent (for any of above) - 1 10.00
Subdivision: Lot #: Repair units 12• x5
• • • "" '' ' ' 'Quite t iel lianc`eS"
iaX . . :.: map/parcel Water heater
-
oo
7alrSCllileTr • :I:1f.: w i
�';,•.:..:.:.- - ..: .: br�', t7r� 1!i�!:;,:... ;; °;�F, � �! 1 0.00
. �,: o ; ;'visa S� r�
gA S k r" S e v 4 - S 1 n _., Flue vent (water heater /gas fireplace) 1 , 10.00 , / U-co
Lo. li - hter :as 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 1 10.00 J O._ CA)
Chimney/liner /flue/vent 10.00
.. ^� � ,}� ::ta i� a;jI� _ 10.00
' .i � tJ 'S�'�. ., :..., i.:: •.i ' [II)i! � ' .�. .. 1. •.;� hi� �.,. ��:6�In �N IMIi Other:
::. '; :.: :, `Envirdnitictital Exiii.olt & iaZin!;.'•', ;,;:: '..
ame: ' ;: 'i ve,itil"
�9.� ' Ctt>�_ R ange hood /other kitchen equipment 10.00
Address: a ,,�
S te>_rt o� (�� Clothes dryer exhaust 10.00
City /State /Zip: - r (5t Cfj �• Q_ S 7 a a 4 Single duct exhaust
Phone: *S3 0 - 3 Li . Fax: (bathrooms, toilet compartments,
'6' ,APPT1iGAl1► t?;: " ;:,;'.,.r..,° '.:E0 �00lit MPO. '' utility rooms
Name: ` _ Attie/crawl space fans 10.00
Other. 10.00
.' .:, . : :
Address: ��7 � X I I-p ; ...
, .... , .:.:; .. 55.40 for firF'dcI Yrpra(,: , .1 . _
City /State /Zip: ' o GI ear eiv L. Gvt C I I * *(' st 4, $1.00 each additional)
Phone: 55yy .c-11- 3 (Fax: � (fl -+Jl F urnace, etc. _ w«
Gras heat pump **
E - mail: Wall/suspended/unit heater **
- :: ;. • '` "CONT12.'i!il : i " .■ i..; ..i 5 M ... I !Mlr Water heater _
Business Name: -C IL 1ml thc6 , C -► Fire lace I * S:/C.)
Address: - - - P,0 B .X 1 LP Range
Ra Q *«
City /State /Zi cy9 c 4 ocrp CAr2- cil i l (' Clothes dryer (gas) ««
P h o n e : } Li -CH 7 3 Fax: Lt (.1) • 6 I G1 Other «
CCB Lic. #: l a I E 0 Total:
�]vl echanical'Pcrmlt Fce *
Authorized -7 G Subtotal: $ 2i .5• .c/ 0
Signature: ��w \ Date:l L �� `
�, Minimunri Permit Fee $72.50 $ 1,� .')=
l< Plan Review Fee (25% of Permit Fee) $
`� (Please print name) St ate S urcharg e ( 8% of Permit Fee ) $ . ' C
TOTAI, PERMIT FEE $ - ri - 3 O
Notice: This permit application expires if a permit Is not obtained within *Fee methodology set by Trl- County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
is \Dsls\Pcnnit Forms \MecPcrmitApp.doe 01 /03
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CITY OF TIGARD t �`
BUILDING DIVISION PERMIT #: MEC2005 -00798
13125 SW Hall Evd., Tigard, OR 97223 DATE ISSUED: 12/512005
Phone: (503) 639 -4171 .;I
Inspection Requests (24 Hrs.): (503) 639 -4175 ��' F_
INSPECTION WORKSHEET FOR DATE: 1:16/2005 TIME: 7:02AM PAGE: 63
SITE ADDRESS: 09655 SW SERENA WAY CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 LOT #: 102 TYPE OF USE:
PROJECT NAME: SALDIVAR
DESCRIPTION: Fireplace insert and gas line.
OWNER: SALDIVAR, AARON /MICHELLE PHONE #: 503-830 -3948
CONTRACTOR: T & K MECHANICAL PHONE #: 503-628
Inspection Request Scheduled For: Date: 12/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 022996.02 503 -844 -9173 Y
Corrections /Comments/ Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: l2_,-- -o5 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005.0079f
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/6/2005
Phone: (503) 639 -4171 1I�I
Inspection Requests (24 Hrs.): (503) 639 -4175 ,...' F_
INSPECTION WORKSHEET FOR DATE: 12/6/2006 TIME: 7:02AM PAGE: 64
SITE ADDRESS: (19655 SW SERENA WAY CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 LOT #: 102 TYPE OF USE:
PROJECT NAME: SALDIVAR
DESCRIPTION: Fireplace insert and gas line.
OWNER: SALDIVAR. AARON /MICHELLE PHONE #: 503 -830 -3348
CONTRACTOR: T & K MECHANICAL PHONE #: 503-626-4662
Inspection Request Scheduled For: Date: 12/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 022996-01 503 -844 -9173 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: I� — (0—a Phone #: (503) 718-