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Permit CITY TIGARD MECHANICAL PERMIT ilk DEVELOPMENT SERVICES PERMIT #: MEC2005 -00170 �� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/15/2005 PARCEL: 2S114BA -04000 SITE ADDRESS: 09635 SW SERENA WAY ZONING: R -4.5 SUBDIVISION: PICKS LANDING NO.2 LOT: 100 JURISDICTION: TIG Project Description: gas line to FP, water heater amd clothes dryer. 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: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 3 Owner: FEES ELLISON, DEANNE Description Date Amount 9635 SW SERENA WAY [MECH] Permit Fee 4/15/200: $72.50 TIGARD, OR 97224 [TAX] 8% State Surchar€ 4/15/200: $5.80 Phone: 503 620 - 7300 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg #: 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: /4„c 73G:c%&r Permittee Signature: x'�,�Vi(JA &_ 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. Mechanical Permit A ' ation FOR OFFICE USE ONLY Received Permit No - City of iar 1 ICE IVE Date/By . l • 5 8 V D5 �G /7b 13125 SW Hall Blvd.. Tigard, OR 97223 , Plan Review Phone: 503.639.4171 Fax: 503.598.1960 61,nn. Date/B Other Permit: Inspection Line: 503.639.4175 5 � i I I Y 2005 -Ai- ^:_ -, Date Ready/By: FM y: ®See Page 2 for Internet: www.ci.tigard.or.uS 200 Notifed/Method: Supplemental information CITY OF TIrgAD irag S ON COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ID New 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 ❑ Demolition ❑ her: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating /cooling ` ' ' Air conditioning or heat pump Job site address: ° I 63s S W 2 r O woi (requires site plan showing placement) 14.00 City /State /ZIP: 'T ; n p, d i 0 � 0(-77.2 9 Furnace 100,000 BTU (ducts/vents) 14.00 �J Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street /directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 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: P ■ LM f S 1,4,n A, ^/ Lot no.: 1 pa J � � Other: 10.00 Tax map/parcel no.: z5 1 1 li B A 0 4 000 Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 � �— Gas fireplace 10.00 (' ¢q ,a_ I G , 1 • ! I,,,�1 C'i X d,s t 0 a Flue vent for water heater or gas n fireplace 10.00 Y . 1/ , d�,� 4A- ` Log lighter (gas) 10.00 Wood/pellet stove 10.00 J Wood fireplace/insert 10.00 f�( PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 10.00 Other: 10.00 Name: De.JDOY\n U I S Ol Environmental exhaust and ventilation • Address: 9635 Stn/ Sareno. WO.7 equipment d/otherkitchen 10.00 City /State /ZIP: - T 1300 / DR_ °�"�Z9 Clothes dryer exhaust 10.00 J Single -duct exhaust (bathrooms, Phone: R3 6Z0 - 7300 Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater 0 • 1 5.40 Fireplace 4 i 5. 0 E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) 1 5.80 C- 0 tNJ& Other: Address: MECHANICAL PERMIT FEES* City /State/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) -�) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) 'S ' / TOTAL PERMIT FEE 7 . '3 r Authorized signatu p This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name I Date • I ' Fee methodology set by Tri County Building Industry Service Board aV111� EiIISWA- /15�26�5 r CITY OF TIGARD BUILDING qiVIISION PERMIT #: MEC2005- 00170 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/151200f; Phone: (503) 639 -4171 iker Inspection Requests (24 Hrs.): (503) 639 -4175 V II I INSPECTION WORKSHEET FOR DATE: 8/18/2006 TIME: 7 :03AM PAGE: 89 SITE ADDRESS: 09635 SW SERENA WAY CLASS OF WORK: SUBDIVISION: PICKS LANDING NO.2 LOT #: 100 TYPE OF USE: PROJECT NAME: ELLISON DESCRIPTION: gas line to FP, water heater amd clothes dryer. OWNER: ELLISON, DEANNE, PHONE #: 503- 620 -7300 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 8/18/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 035097 -01 503 -620 -7300 Y (o /o q'AS L. Corrections /Comments /Instructions: s f..,cs PERU ,v r 5 , C.10 S • yG 2 6 '/ . '?R. -E a/r- &1,1 rae- h' ,e , *'d r hAG� f 7, ` '7- xv,c,`..l rD -41-S Tin-( ems, QA QRA err - Ms- - r" = Id P-j SQL AC 1Y1i, / ? a PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL [ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: r Date: $� /f Phone #: (503 718 CITY OF TIGARD ^ BUILDING DIVISION PERMIT #: M2 -Q'OS 0 0(70 j 13125 SW Hall Blvd., Tigard, OR 97223 ` DATE ISSUED: Phone: (503) 639 -4171 �u.��� Inspection Requests (24 Hrs.): (503) 639 -4175 �:_.. 2;5 b INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: P1 cp3s' .Se--„re. t-.) cu./ j CLASS OF WORK: SUBDIVISION: l LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: • PHONE ,9)3) b7' � 3C I CONTRACTOR: 1� .e__(^ " 01--etc PHONE #: Inspection Request Scheduled For: Date: 3/ r ° 1° Pour Time: Code # Inspection Description Confirm # Contact # Message 359 r) 16,,, p cj-J. (.0,10 c Corrections /Comments /Instr ctions: (6_1s1) a6s t �, s -_) 1-2,_ kst--(S / 2 I s f' 1-,, kid' 'L& ,. , 7 &/&> i ,��z - ,� C ')� . / (451) hie om, La__ ./ (6 1 ) Act L s/ 12e '). _‘(/.4". F tZ/c A/ - s f . c ■ ,. ! - BE. »a. i P LetiA . Af_� = a-cs I - e c i i e-A,61., — ele. . --gc,,le. <---7--1_ -E--/--.- ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS Xl ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: `�(/` / -5 /3\h ) `f' Phone #: (503) 718- W2--"( CITY OF TIGARD - , BUILDING DIVISION ' PERMIT #: h�iEG2005 0017CI 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/15/2005 Phone: (503) 639 -4171 as i Inspection Requests (24 Hrs.): (503) 639 -4175 -IL INSPECTION WORKSHEET FOR DATE: 99,23/2005 TIME: 7 :07AM PAGE: ?i SITE ADDRESS: 09635 SW SFRENA WAY OF WORK: SUBDIVISION: PICKS LANDING NO.2 LOT # 100 TYPE OF USE: PROJECT NAME: ELLISON DESCRIPTION: gas line to FP, water heater amd clothes dryer. OWNER: ELLISON, DEANNE, PHONE #: 503-620.7300 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/22006 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 016500 -01 503 -620 -7300 Y Corrections /Comments /Instructions. o f J�„'e/7 ,�� 0 -61 4 i -- / .� up r T% 6 Cl 0e 7 0 �faS� , e f.9<'5 -`G,Q-nt9,v lye : 1 /9 p7 1, N Sa u Lit /--- 1 ©^..) /t , iu.> ❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ii Date: Z3=-= Phone #: (503) 718-