Permit k € CITY O TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00533
I " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/9/2004
PARCEL: 2S 11488 -05700
SITE ADDRESS: 10010 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
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:
OTH • 1
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: S OUTLE S: 1
Remarks: Install gas fireplace insert to include gas line
Owner: FEES
RUMMEL, BRADLEY G + LORI A Description Date Amount
10010 SW SERENA WAY [MECH] Permit Fee 8/9/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 8/9/2004 $5.80
Phone: Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 503 - 646 - 6409 Gas Line Insp
Heating Unt Insp
Reg #: LIC 51469 Final Inspection
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.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00533
-- cJII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/9/2004
PARCEL: 2S114BB -05700
SITE ADDRESS: 10010 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install gas fireplace insert ( not running gas line).
Owner: FEES
RUMMEL, BRADLEY G + LORI A Description Date Amount
10010 SW SERENA WAY [MECH] Permit Fee 8/9/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 8/9/2004 $5.80
Phone: Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 51469
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.
Issued By: lc1t�/r Permittee Signature: _
Call (503) 639 -4175 by 7 :00 P.M. for inspections needed the next business day
AUG. 9. 2004 10:52AM 0.222 .1/2
MeehanicalPermit Application
¢
City of i ar8 D eceived c� view
: x Permit No.: ' t
Pl ro Re�
13125 SW Hall lvd, Ti ard, OR 97223 � DerRe `' V kV\ G.2aQV -as 33
g Other Permit
Phone: 503.639.4171 Fax: 503.598. } ` • i? er.r,t, to Date/By:
Inspection Line: 503.639.4175 ` I tt - f - Date Ready/BY: Jens 121 Sec Page 3 for
Internet: www.citigard.or.us - d � 1, N oti5ed/Mctltod• �'f I 6 - Supplemental Information
11 . E ii t ,t--.
2` . r - 1/4 COMMERCIAL FEE* SCHEDULE - USE CHECMLST
Li dO��ti tion/re Mechanical permit fees* are based on the value of the work
0 New construction
"CJr` performed, Indicate the value (rounded to the neatest dollar) of all
❑Demolition ❑ mechanical materials. e.ui. labor_ overhead and .ro(t
CATEGORY OF CONSTRUCTION _ Value: $ ,
and 2 family dwelling El i 0 Commercial/industral Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special Infifortnniion use checklist.
❑ Multi family ❑ Master builder 0 Other. Description I Qty. Ea. I Total -
JOB SITE INFORMATION AND LOCATION Heating/cooling
` s �q / Air conditioning or heat pump
Job site address: /Oa AO �� �CR th (re. aims site . Ian showia • laament) 14.00
City/State/ / r O'/2 9 7 a V Furnace 100,000 B TU (ductrJveents) _ 14.00
Suite/bldg./apt. no - Project name: ,p / Furnace 100.000+ BTU (ducts/vents) 17,90
• /l 4�1 /77 a /� _ Gas heat pump 14.00 _
Cross street/directions to job site: Ductwork _ 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 _
Subdivision Lot no.: Flue/vent for any of above _ 10.00
Other: _ 10.00
Tax map/parcel no.: Other fuel appliances _
DESCRIPTION OF WORK Water heater 10.00
=AS - 4// Gas fireplace 10.00
,- Cr ) Flue vent for water heater or gas
fireplace 10.00
Peen /7 4 �. Log lighter (gas) 10.00
/ Wood/pellet stove _ _ 10.00
Wood fi eplat linsert / , 10.00 /O -
' PROPERTY OWNER I ❑ ChimneyAincdtlue /vent / 10.00 /ma
Other: 10.00
Name: x/24 c,e -7?,,,,,_,,, Environmental exhaust And ventilation _
Address: /O O /Q .SW C rn CJ* � pem hood/other kitchen 10.00 ,
City /State/ZTP: # r c-e . eve 9 , aaf/ Clothes dryer exhaust 10.00
t a y. ! � 3 _ / ( toilet
Single-duct compartments, (bathrooms.
� , � �i s/
Phone: Fax: ) milct coal wtmements, utih rooms) 6.80
APPLICANN I ❑ CONTACT PER SON Attic/orawjpace fans 10.00
Business name: 2.6,,,g, C M O /1 5 Other: 1 0.00
F uel piping
Contact name: c7,,41' c 1?e R SS.40 for first four; $1.00 for each additional _
_ Furnace, etc.
Address: !a Co 7� vow �7 ewe/ee ovi reel?
Gas butt punt I
City /S ) ebyrr � �2 70C� WalVsuspended/unitheater ,
Phone: (f , ) 4D � - 7 Cv5 17 Fa : ( 5 ) G Y , - 0.3 Water heater
R Fireplace
E -mail:
Range _
CONTRACTOR , Barbecue
•
Business Clothes dryer (tale) _
- ,
ess name: A/,1 €_
Address: , MECHANICAL PERMIT FEEs+t
City /Stute/tIP: Subtotal , ad — 1
Phone: ( ) Fax ( ) Minimum permit fee ($72.50) 7�,�^Q
Plan review (25% of permit fcc)
CCB tic.: 5/6;1- a c 's,3 � State surcharge rge (8% of permit fee) ...5:yd
TOTAL PERMIT FEE 783 Q .
Atlthorized'si(;1latllt�: This permit application expittS ifs permit is nor obtained within 180
days alter It has been accepted as complete.
' I Print name: n ( j �(J I unto: 6 0 _d(/ I + Fee mctbodalogy set by Sri -county Bwldin8lndusty Service Board '
cni �y '` 9 J
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503)639 -4171 MST
BUP
Received Date Requested /� AM PM UP
Location 00/6 v Suite MEC c 06 q-06 s33
Contact Person y► L Ph ( ) 6 4 7 1 4 — 40c-to? PLM
Contractor Ph ( ) SWR
BUILDING Tenan . �5�1 ELC
Footing 6p-1- [ (p 3 T ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath /Shear M A-! i I /`� ?� i1-r c j 7
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
V IP4 , 1:1111;3
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam,. Q. „ �{
Rough -In ' , Y p"�{�
;1'
moke Dampers
S ART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line -
ADA
Approach/Sidewalk Date � Inspecto Ext
Other:
Final DO NOT REMOVE this Inspection record • o the job site.
PASS PART FAIL