Permit /1
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00469
`V DATE ISSUED: 7/16/2004
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
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PARCEL: 2 S 114 BA -00400
SITE ADDRESS: 09885 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.2 ZONING: R -4.5
BLOCK: LOT: 135 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: 0 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: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Gas furnace replacement.
Owner: FEES
GREENE, LINDA SUZAN NE Description Date Amount
9885 SW SERENA WAY [MECH] Permit Fee 7/16/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 7/16/200 $5.80
Phone:
Total $78.30
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 656 - 1184
Reg #: LIC 447
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: 3 - „kg/ Permittee Signature: j
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
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. .:1 ical Permit Appliettioti - FOR .
OFFICE USE ONLY
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City of Tigard Received
13125 SW Hall Blvd., Tigard, OR
Phone: 503.639.4171 Fax: 503.598.1960 ' ..:', ')`1 4,4 ,, .,,,, Plan Review
'' Other Permit:
Inspection Line: 503.639.4175 , r , r Date/By:
. ,, - g
- A ,.-... III- Date Ready/By: 0 See Pa e 2 for
Internet: www.ci.tigard.or.us ' ,,•-• -.■ - !! . - ....--, ., -, .1 -' -
. 4 , .1 Notified/Method: EN Supplemental Information
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' ..-: -• ..-":: ' : '.: 4- ..'' ., ' ..'' ': ' '.;; - - .. ":: - TYPE PF':W9 ' 7: ':: '':'..-':::‘':: :.:- : ,=7' : ::'(0k*E ' ii,(4..t. ktl!'s. -: USE CHECKLIST
0 New construction 0.2 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
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
crAtiOday OF :." CONsuigcziON. '',..:: ,_.., . . . ..
-,- -0SibETOUX,,EVII/P1ONTISySTEMS FEES*
Er'. and 2-family dwelling 0 Commercial/industrial 0 Accessory building - - - - ' ' ... ' .
For special l information use checkli - - st.
0 Multi 0 Master builder 0 Other: Description I Qty. I Ea. I Total
'''f LOCATION.,;.,':11'.. - 7 Heating/cooling
Air conditioning or heat pump
Job site address: Okee.5 -%.......) C DEeENU 2 S L.t...)AA (requires site plan showing placement) 14.00
City/State/ZIP: ^r / Furnace 100,000 BTU (ducts/vents) 14.00 I 1
i t 0,4 I ct-lagm
L. R. 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: Doe Ca ki k te Duct work 14.00
Hydronic hot water system 14.00
1. C14._ easr \ t ,,,ki..__ \ e4 Residential boiler (radiator or
4. - C_-‘%: cA , - Q . hydronic) 14.00
.-ern...J.1- ok- (10,)
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 1.0.00
Subdivision: Lot no.: Flue/vent for any of above - i--- 10.00 24
• Other: 10.00
Tax map/parcel no.: Other fuel appliances
rat - 74j*"§tRIpTioScjiy*Wk 2.. Water heater . 10.00
c .._ Gas fireplace 10.00
V - ..117■ C-ct?tai.c ,e _ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) - 10.00
. Wood/pellet stove 10.00
Wood fireplace/insert 10.00
.. ..,.:.,,a l - m _..,,,,.... z ..,,,,,„...,.. ,, , :;‘,, , ,,.. i , :, , i ,,... ,:,. ,. 4 .,,,.. i ., ,, 1 ,.... ....,,.. . 4 Chimney/liner/flue/vent
A i /flue/ vent 10.00
',..tii,M1.1r ,,,( 7 1 . -1 ,1! 4 vt,I,V.1A:.' , - - ... , r.. - . T. ' '.1' 2;= .'--1■: •: 2 - I "1""il`, '^ ;.''' - L - . 1 . : ",, ' 4 ' ,' oth 10.00
Name: \.--t t4ACN, iyecik.k.e__ Environmental exhaust and ventilation
Range hood/other kitchen
Address: \$4,0 5■.)..) S'CltrUP - . -- -1 - equipment 10.00
City/State/ZIP: As.).2.-CAehrs) 6-- CLIektipet Clothes dryer exhaust
Single-duct exhaust (bathrooms, 10.00
Phone: (503 ) sai Fax: ( 5CS) 4 (%,. .7,4.7 8 toilet compartments, utility rooms) 6.80
. xiiveAri ii; --',..- 7 7 . -''''': " ' :: '' 7 .51 1?'"(1 6 10' 4i - : '' ' r ' ''''' Attic/crawlspace fans 10.00
• ... - Other:
Business name:. , .,
. . , T t ' s 0- p. ( ,
Fuel piping 10.00
Contact name: $5.40 for first four; $1.00 for each additional
Address: BELL HEATING, INC. Furnace, etc.
Gas heat pump
City/State/ZIP: 15550 SE PIAZZA AVE. Wall/suspended/unit heater
CLACKAMAS, OREGON 97015
Phone: ( ) 656 a. 3 st 1 • • 64 c, -1 5, \ Water heater
Fireplace
E-mail: ,
. Range
,' -'t" ---- , ' • '-‘, ---" ' • - •..,-', CONTRACTOR ' ' '.- ' ....- - • ,---,-. .. - ,'", • , Barbecue
Clothes dryer (gas) •
Business name:
Address: BELL HEATING, INC. Other:
-,•-i e -..--- ,-
15550 riAzzA AVE
- , ,, 'MECHANICALIPIERMIT FEES - - - ' •
SE .
City/State/ZIP: CLACKAMAS, OREGON Q7016 Subtotal 4.3
Phone: ( )655-1184 ime-ffs493 ) co.C(9 -is q Minimum permit fee ($72.50) --7/S
Plan review (25% of permit fee)
CCB lic.: !..i ti-1 . State surcharge (8% of permit fee)
..,.• -. TOTAL PERMIT FEE 75 . Y 3
Authorized signature:
Oh . , This permit application expires if a permit is not obtained within 180 '
0 1
days after it has been accepted as complete.
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Print name: ..a ))401 Date: •-7/(0,../ • Fee methodology set by Tri-County Building Industry Service Board
iABuildingTermitsWEc-PertralApp.doc 12/03 4:4 - 617T 11(02/COM/WED) •
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
4 TotaI _.. ,
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 forthe first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and •
$1:80 for each additional $100.00 or -
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.4.for each additional $100.00 or •
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including • •
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and . .
$1.10 for each additional $100.00 or
fraction thereof.
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Note: All new commercial buildings require 2 sets of plans.
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imuilding\Permits1MEC-PeemicApp.doc 12/03 2 •
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CITY OF TIGARD 24 -Hour . "
• BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 • MST
BUP
p�
Received p p Date Requested 0 - 3/ ' - AM PM BU � '
Location / W !� Suite o� 00 c/-6O V if-6g
Contact Person _______76.6.P.—_,,_______. Ph ( �) F7/ -AI'i /907 PLM
Contractor. Ph ( _ )_ SWR
BUILDING Tenant/Owner - EL C
Footing _
Foundation .. ELC
Access:
Ftg Drain ELR
Crawl Drain'
Slab Inspection Notes: . , SIT _
Post & Beam V -
Shear Anchors • '
Ext Sheath/Shear -
Int Sheath/Shear 1/� ""\A— 702- (7
Framing
Insulation ,
Drywall Nailing
Firewall
V Fire Sprinkler .
Fire Alarm Ail
Susp'd"Ceiling "Jr
Othe — , 111. � - ®�i _ _ J
Final ` 1
PASS PART FAIL 11, ® ' A
PLUMBING i V A
Post & Beam Wil � _
Under Slab - ,
Rough -In
Water Service • V b., i V
Sanitary Sewer \ , AMIlik %AIR Rain Drains • �a- S or Dra in /Manhole �i
Storm Drain -
Shower Pan .
Other:
Final
PASS PART FAIL
MECHANICAL V
Post & Beam
Rough -In
Gas Line
Dampers
•AS • PART . FAIL - . - - .
•
. EC RICAL
Se •e • _
Rough -In •
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspectionRE: Q Unable to inspect no access -
Fire Supply Line
ADA
Approach/Sidewalk Da Inspector. - - Ext .
Other: -
Final - DO NOT REMOVE this inspection record from the Job site:. V.. .
PASS PART FAIL