Permit . ......
4 CITY OF TIGARD MECHANICAL PERMIT
j � DEVELOPMENT SERVICES PERMIT #: MEC2005 -00157
I 131 25 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/7/2005
PARCEL: 2S1 14 B A -02100
SITE ADDRESS: 09860 SW SERENA WAY ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 118 JURISDICTION: TIG
Project Description: AC install
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: 1 DOMES. INCIN:
ELE 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:
Owner: FEES
KRISTINE NELSON Description Date Amount
9860 SW SERENA WAY [MECH] Permit Fee 4/7/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 4/7/2005 $5.80
Phone: 503 449 - 4764 Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97212
Phone: 503 284 - 2173
Reg #: LIC 222
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: 410 `` _L „ ,/` Permittee Signature:
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.
.Mary Spezza 503- 284 -1552 p.2
r �1Ct iianital FOR OFFICE,
_ � @rlIIll>t A �® E USE ONLY
Received • pern im No.:
City ' of Tigard' Receive i /Os �A �n�?....4)005 6Wl ✓`
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 ^ n 0 20( /� zgr i! Date/By:
Inspection Line: 503.639.4175 APR ( v - +- +ice e: 1 � • Date Ready /By: 1 � � s lit S ee page t for
Ill Notificd/Mctltod: Supplemental Iuformalion
Internet: wew:ci.tigard.or.us F -r`W�
� - �e ®�� • COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Tit Mechanical permit fees* arc based on the value of the work
New construction KAddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, txluipment, labor, overhead. and profit.
• ❑ Demolition . . Value: $
CATEGORY OF CONSTRUCTION ' RESIDENTIAL EQUIPMENT / SYSTEMS. FEES*
I -and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use check list.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 ' I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling ' •
- Air conditioning or heat pump
Job site address: ' k0 (7 S .) e .... - C� -� (requires site plan showing placement) 14.00 l
City/State/ZIP: r,, � Furnace) 00,000 BTU (duels vents) 14.00 City/State/ZIP: : �(��� 0---?___ ° C '�
1 Furnace 100,000+• BTU (duegslvettls) 17.90
Suite/bldg. /apt. no.: I Project name: \ \�k 5 C5-\ll Gas heat pump 14.00
Duet work 14.OU
Cross street/directions to job site: 14.00
Hydronic hot water system
Residential boiler (radiator or
hydronie) - ' • 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: ' I Lot no.: Other. 10.00
' Tax map /parcel no.: Other fuel appliances '
Water heater • 10.00
• DESCRIPTION OF WORK G fireplace ' 10.00
_Y f J . f A - _,�, {� �• \C t' C _01,'C - Flue vent for water heater or gas
�V T(� \ fireplace 10.00 •
• Log lighter (gas) 10.00
• Wood/pellet stove 10.00 '
Wood fireplace/insert - 10.00
Chimney liner /flmie/vent 10.00
PROPERTY OWNER \ I ❑TENANT Other: _ 10.00
• Name: � �1,�- S 6� . Environmental exhat:st and't'entllation
r � Range hood /other kitchen' •
Address: b ID U ‘..L� �-QX � Ct__:. V r✓ equipment 10.00 •
p Clothes dryer exhaust 10.00
City/State/ZIP (JL �\ ( �� Z Single -duct exhaust (bathrooms,
Phone:
�L�) r ( Fax: ( ) toilet compartments, utility rooms) 6.80
' ��' �`rt• • ❑ CONTACT PERSON Attic/crawlspace fans • 10 0
❑ APPLICANT - — - --- - - - - - - Other: - 10.00 ,
Bu name: - Fuel piping
$5.40 for first four; $1.00 for each additional
Contact name:
Furnace, etc. • • Address: Gas heat-pump •
City/State/ZIP: Wall/stispended/unit healer •
Water heater
Phone: ( ) ,Fax:: ( ) Fireplace
E -mail: Range
CONTRACTOR , . Barbecue '
• Clothes dryer (gas)'
Business name: Ag- je..ita h rrq f na) it)? Other. - • t •
Addres d 4 /."/ fl E "flit 1 K .lie ezyd J - . - MECHANICAL PERMIT FEES`
J �/ q 7 A /� Subtotal 1
City/State/ZIP: Q�ILL e Minimum permit fee ($72.50) - TZ •( , • Phone: (5 3) . C la I Fax ( 5 ZP & Plan review. (25% of permit fee)
.. CCB lic.: g_ ' 1 State surcharge (8% of permit fee) cj
TOTAL PERMIT FEE _ '. • D
, it applltioa expires if a perm[t is not obtained within 780
Authorized signature: ���� �L 2 This perm n days after It has been accepted as complete.
I — CL v VAL (....e rl..„ — L c 1 ' Fee methodology set by Tri- County Building Industry Service Board
U i L`i l .
•
T 4
1L • CONTRACTOR A/C-HEAT PUMP --; UNIT SITE PLAN .:
fi�A /'�0,9r /NG ��lri�l , ' . Direa.4;0r, ,
:. 4's A/4 /u•L•k. Sr az ,. . idek TO SACK PDOPERTY LINE
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2 ) r4144, ke 912/v .
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N . 4 - 03: 28Y. i.rsl:Ate . . .
• 1 TO S IDE PROPERTY LINE
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t , I _ .fee4ro t Fro ?erity L;he
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U' TO STREET •
1 CUSTOMER INFORMATION • ,
NAME ¥ \' *\ QQ S c'y .
ADaarrss C ,D w : S -6xe.k . \,Q - ' • , . . .
I.
I 1 CL-k(ck C?g_ ° V - 12Lq-
FL.EASB REFAX APPLICATION WITH SITE PLAN.
•
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CITY OF TIGARD -
BUILDING DIVISION - PERMIT #: ill EGoRoo5 a Of S
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �%- �, � � ��
Inspection Requests (24 Hrs.): (503) 639 -4175
___;14 Ail
.. 1 .�
INSPECTION WORKSHEET FOR DATE: C -- --b— O TIME: /
PAGE:
SITE ADDRESS: g86 0 )G-/ L&t1 a CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: ols S y — a 1 13
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # 6 W Inspection Description Confirm # Contact # Message
-Y.--z AIC OO S I / S g5 - 01
Correct'ons /Comments /l struction W;-kA41-
All _ _ , a C - r
v • X3173
111A1A-- t.i ->
C •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: VC Date: (49/3/6 Phone #: (503) 718-