Permit CITY TIGARD ` MECHANICAL PERMIT
, ; � DEVELOPMENT SERVICES PERMIT #: MEC2000 -00482
m ss
`� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/00
PARCEL: 2S114BB -01400
SITE ADDRESS: 10265 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 028 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:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Remove Existing Gas Furnace - Install New
Owner: FEES
JABLONSKY, CHRISTOPHER G + Type By Date Amount Receipt
NEMETH, ELIZABETH A PRMT CTR 12/8/00 $72.50 2720000000
10265 SW SERENA WAY 5PCT CTR 12/8/00 $6.00 2720000000
TIGARD, OR 97224
Total $78.50
Phone:
Contractor:
SUNSET FUEL CO
PO BOX 42287
2944 SE POWELL BLVD REQUIRED INSPECTIONS
PORTLAND, OR 97242 Mechanical Insp
Phone: 503 - 234 -0611 Final Inspection
Reg #: LIC 00002374
ELE 26 -113C
•
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 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9189.
Issue By: I �j//ypip Permittee Signature:
Call (503)1639 -4175 by 7:00 P.M. for inspections needed the next business day
12/07/00 THU 11:06 FAX 503 598 1960 CITY OF TIGARD Ij002
A Mechanical Permit . Application
RECEIVES Datereceived: P ermit no.: lml-0Z T je G Z
a il" ' City of Tigard Project/appl.no.: Expire date:
CityofTigard Address: 13125 SW Hall Blvd, Tiger i, OR 97223
Phone: (503) 639 -4171 DEC - 8 20 Date issued I Receipt no.:
By:
Fax: (503) 598 -1960 Case file no.: P ayment type:
Land use approval: COMMUNITY DEVELOPMENT Building permit no.:
',APE OF PERMIT
CI 1 & 2 family dwelling or accessory O Comm; rcial/iindustrial U Multi- family ❑ Tenant improvement
❑ New construction 'AdditkIn/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL N'ALUATION SCHEDULE
. Job address: JO ■ r SL. t - enciLvJay Indicate equipment quantities in boxes below. Indicate the dollar •
Bldg. no.: I Suite no.: ' value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: _ ZIP: • op", am 1 & 2 FAMILY DWELLING PERMIT FIX SCHEDULE
Description and to : on of • orkon premises: AND COAMMERICAIIINDi STRIAL EQIJIPM ENT SCI IEDULE
C " .ii • " - _ l 1 _' :, - nas-l1 rle Fee(ea.) Total
Est. date of completion/inspection:'' W Description Qty. Res.only Res.only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned?S .Ye; O No Andl t CFM
Air Air c coondittioning (site plan required)
Is existing space insulated? ( Yes Cl No Alteration of existing IIVAC system
MECHANICAL CONTRACCOI Boiler /compressors
Business name: • ;� wME■ • • 1 1 State boiler permit no.:
HP Tans BTU/E3
Address: 41 , XLialISI:!i�j! Fire/smoke dam rs/duct smoke detectors
City: i • _ n Stat i i4 21P:' & Heat pump (site p an requir .) „`.�
' .♦- r ri!;i; z j E -mail: Ins : rep ;cefurnace/bunter O�VTU /H b 1y
j • • Including ductwork/vent liner .i Yes O No
bp
CCB no.: „ 3 Installlreplace /relocateheaters- suspended,
City/metro lic. no.: at `... L a wall, or floor mounted
Name (please print): - _ N . - i S - l el Vent for appliance other than furnace
CONTACT PERSON 1111111111.11 Refdgeraaon:
Absorption units BTU/H
Name., Chillers _ HP
Compressors HP
Environmental exhaust and ventilation:
City: I State: I i:IP: Appliance vent .
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ tares. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
R • • �+ - - Exhaust system : • art from heating or AC
Mailing address: • ID
City: • State � i 1 i JP: � ♦ � r P PrnS an � ,� .- on up to 4 outlets
m Type: LPG NG Oil
Phone: "f. dip. MM.. E -mail: - Fuel piping each additional over 4 outlets
ENGINEER Processpiping(schematicrequired)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: State: :2P: Insert- type
Phone: E -mail: Woodstove/pelletstove
other:
Applicant's signature: ,wip r / j ►;; ste:/-9 /-co Other: ,
Name (print) ,, -.• M s A I Nat dl jurisdictions accept credit cards. please call jurisdictinn' male info =dun” N Th e rmit li cetion Permit fee $
U visa CI MasterCard P app Minimum fee $ •
expires if a permit is not obtained Plan review (at = %) $
Credit card number: tea within 180 days after it has been
complete. State surcharge (8%) .... $ -- y
Name of cardholder as shown on credit as dit card $ accepted TOTAL $ ()
` Cardholder elm= Ana =I , 440 -4617 (6n00(COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION . MST •
24 -Hour Inspection Line: 639 -4175 Business Lir!e4 639 -4171 -
BUP
Date Requested / 2'2 PM BLD _ _
Location /0 - (--)"&-) (--)"&-) �� ��� Suite _h1
fi► 2-
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing _._.
Insulation
Drywall Nailing •
Firewall
Fire Sprinkler
Fire Alarm C lti LL
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
T FAIL
CHANICAL
Post & Beam
Rough In
Gas Line
Sal eke Dampers
PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ,] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date /,2 Z 7` t✓J. Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.