Permit CITY OF TIGARD
MO' MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00061
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/14/2005
PARCEL: 2S114BB -00200
SITE ADDRESS: 10005 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: 0 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Gas furnace replacement.
Owner: FEES
BUSH, HAZEN Description Date Amount
10005 SW SERENA WAY [MECH] Permit Fee 2/14/200E. $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 2/14/200f. $5.80
Phone: 503 684 - 5185 Total $78.30
Contractor:
EASTSIDE HEATING + AIR CONDITIONING
7200 SW JOHNSON CREEK BLVD REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97206
Phone: 503 774 - 3281
Reg #: LIC 3258
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.
f�
Issued By: � �" ,�` ai Permittee Signature: 67Y1 e ee`e
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Feb 11 05 03:48p Eastside Heating 503 - -774 -3057 p.2
Neleciivfitbal Permit A ECE 11A E
City of Tigard Received_ 6' Permit Na: meG o6- 000
13125 SW Hall Blvd, Tigard, OR 97223 FEB 11 2005 Plea Review
Phone: 503.639.4171 Fax 503.598.1960 Date/By Other Permit
Inspection Line: 503.639.4175
Internet: www.tztigard.or.us J'�. .� I- Date Ready/By: ta'is: 0 See Page 2 for
CITY OF TIG - ^ Notified/Method: 774 Supplemental Information
,.... ... : L E I IN DIXI N _
Vt- i' r4.39R, ,:
r OF: . RK-t„ ',t • :::t`t:: ,';: :;TP4c COMM ikoili :IEISE !
❑ New construction IAddition/altet on/replacement Mechanical permit fees* are based on the value of the work
1:1 Demolition Er Other: Indicate the value (rounded to the nearest dollar) of all
.- .. _ equipment. overhead, and profit.
r
mechanical materials, i merit. labor ovethea a dpro fi
s�;;°,: ,� :.-: •, ,c � 'AT'EGORY COIYSPBUCTnO1 " " - Value: S
1 - and 2 family dwelling I=1 Commercial/industrial ❑ Accessory building RFSmEi!r..`rPl►�+rrr1sYSr s FEES '. ��^
Multi For special information use checklist.
j :: 4 y ❑ Master builder ❑ Other: Description Qty. Ea Total
1W -. JOB SfTE;INIFOR AND;•. Q� ,- Heating/cooling
Job site address: 1�)� X ).; S ( :1f �' � Air conditioning or heat pump
- / (requites site plan showing *Derma) 14.00
City /State/ZIP: f _ � go rA 0 n 7) 4 Furnace 100,000 BTU (ductsl.ents) j 14.00 j LI -�
Suite/bldg /apt. no.: t 0 Project � e: Furnace 100,000+ BTU (dart /vents) 17.90
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
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 10.00
Subdivision: i Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
v.- L >' " 4t '' ` :1 ∎10 CRIPT I O
ON F„WORK ••" f. ; s-.; ' ' ` ' Water heater 10.00
Gas fireplace 10.00
'R.!? p / -) co - I C k ✓7 0 cp Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood replarnsert 10.00
P ROPEKTX :4 r:' .... ll "r Chimney/liner/flue/vent
10.00
..., _,. - :: � .�� I a r pc . r: : TENANIT' :err :: . • Chimney/lfiner /flu 10.00 , •
Name: p� l
---� e,. K T 1 4 ,„ R �.4 s_. 1 J (.'t v,i �s . 1.1..... Environmental exhaust and ventilation
Address: Range hood other kitchen
equipment 10.00
' City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (sr_y t -L/ _ s ErS F ( ) toilet compartments. rlcnts,utilityroams) 6.80
. ' : ms`s " '"'E fl 'APPLI s : +: ... *.i . a' CONTA Attidcrawls
CT'PER3pN' �;�;.. ; � `• pace fans 10.00
Business name: . 1c4--c) ` I Other 10.00 -
I�' , / 'lam , , 1.1 1� E ,, A Fuel piping;
Contact name: I - t r ) S5.4D for (ins friar, SI.00 for each additional
Address: Furnace. etc
Gas heat pump
City/State/ZIP: WalVsuspended/unit heater
Phone: (3-12..) 7 . u- 7 Y �l Fax:: ( ) Water heater
E -mail: � Fireplace
.- .:=; - .� `.Flan '. CONTRACFOR �` ," z�f:-. ,•-. ; ,:�;,,.-: Range
. :4
- :�`'�:; .;"� i' `ti'�.yx:•� _ . �. ' Barbecue
7 7 l ( /n� f Other:
Address: Clothes dryer (gas)
Business name:
,7_"1 % KLL I -e %LT! AO r C. O .? /l
Addr n� (oh
7 �()C� r).` r1n i eer_ : > :MECanxrCA)LP IgIt EE FEES* -=
Addr II 1 /i '
City/State/ZIP:
�O ,,, ...4..1 ci„,i r\ l n i_,_ _L 7 -201 7 subtotal
Phone: ( �•2) �. 3 i 1 1 x: j12� 7 1 G1 - J _ Mi r e view paatit fee (572.5 e ) }Z � 7 !! 'L I 7� Plan review (25%ofpermit fee)
CCB lie.: _
State surcharge (8'Y. of permit fee) y .
TOTAL PERMIT FEE -7 Fc 3 (')
Authorized signature: � CK !., � This permit application expires ifa permit is not obtained mthio
days after it has been accepted as complete.
Print name: • .�` . ,- -. 1 Date: - _ _ - �� • Fee methodology set byTn- Cotmty &fading Industry Service Board
•
11aui IdinalPermirslb¢C -Pam ilApp.doc 12/03 440-4617T ( I UabCOM/W®)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
IN ECTION DIVISION Business Line: (503) 639 -4171 MST
? BUP
C
Rec wed -.33 Date Requested �, a7 5- AM PM BUP
Location VD O o S ? ( l J Suite 240C' G U ®( J
1/ �vL c.
Contact Person V--✓• Ph ( ) '7? 4 - 3 2 , PLM
Contractor Ph ( ) SWR 1
BUILDING Tenant/Owner ELC lam
Footing , ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ' - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation N/\,'■, `,/ L_ r; - S 3 6 1
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
otn r: "k,\Nf V L --kc , 1 ,S S 4- t I v\a ( Al )� ` 1, � 0) tA ►V q I`� .S
Final Ps \, •
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer C _ i
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA ART FAIL
M CH CAL
Post & Beam fidtifiti6
(2
Rough -In
Gas Line
Sm. e Dampers
• , • PART FAIL
' L - 3CAL
Sery ce
Rough -In
UG/Slab
Low Voltage
Fire Alarm
PART FAIL [II Reinspection fee of $ required before next inspection: Pay at City Hall, 13125 SW Hall Blvd.
SI El Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA r, —
Approach/Sidewalk Date Q ✓ c Inspector - - Ext
Other:
Final DO NOT REMOVE this inspection record from the Job - Ite.
PASS PART FAIL