Permit r
CITY OF TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2001 -00381
- 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/31/01
PARCEL: 2S1 14 B B -00400
SITE ADDRESS: 10045 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas fireplace insert and gas piping.
Owner: FEES
ROSS, TIMOTHY J + ALISON L Type By Date Amount Receipt
10045 SW SERENA WAY PRMT CTR 10/31/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 10/31/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
LUDEMAN'S FIREPLACE + PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Gas Line lnsp
Phone: 646 -6409 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling
(.r,(1'4174R -q Ri l
Issue By: '� Zat Permittee Signature: QA/ f} /
all (103 39 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
L RECEIVED Date received: /D /3� /o/ C 200 / 'D0 g'/
IVEa Permit no:: ift
: City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 9722 01 q Date issued: By12) Receipt no.:
Phone: (503) 639 -4171 OCT
Fax: (503) 598 -1960 Case file no.: Payment type:
COMMUNITY DEVELOPMENT no.:
Land use approval: Building permit
TYPE OF PERMIT
X I & 2 family dwelling or accessory 0 Commercial/industrial U Multi- family • 0 Tenant improvement
O New construction )'Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /004/5 S'J .5 e /.2,e r1 a— GcJ 4 V 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: 'Block: ISubdivision: *See checklist for important application information and
Project name: -0 5 S jurisdiction's fee schedule for residential permit fee.
city/county: j /C44r,0 I ZIP: 9 ,a5/ - -- --1 -.1 2-1- Ail•1i L'- `-•D E—LLM Pk:.RMilfit - rE C I;E `-
Description and location of work on premises: AND COMMEItICALI1NDUSTRIAL EQUIPMENTSC11EDULE
r oqS -7- Set Fee(ea.) Total
Est. date of completion/inspection: // -3 - d/
Desaiptlon Qty. Res.only Res.only
Tenant improvement or change of use: HVAC.
Is existing space heated or conditioned? U Yes 0 No M r handling unit CFM
g P Mr conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No - Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors _. _
Business name: 4.(, ft)4#J A of -PLACE ANC) P4T70 State boiler permit no.: . .
M
HP Tons BTU _ _
Address: /A4,-7 5 . 5' t J eiza varda,N Road..... Fire/smoke dampers/duct smoke detectors
City: • r 1 ie . State t e ZIP: 00 ' eat pump site plan required)
Phone:
$3644 ("fog Fax :236% ' ' . E -mail: -- ns • ►replace , • • urner : T
CCB no.• Including ductwork/vent liner O Yes O No
• - — �� -- - nstalUrep • relocate eaters- suspend -
City/metro lie. no.: — wall, or floor mounted
Name (please print): a..p�Jc. Z14 A - 0 Vent for a u. fiance other than furnace
CONTACT PERSON lore -
Absorption units BTU/H
Name: /144-24 Lu-Oa At 44) Chillers HP .
Co.. sors HP
Address: :anA E • Al Z. • E 37' , , ,,, ,., vm tlmon
City: State: ZIP: Appliance vent - _
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ 11/res. kitchen/hazmat
hood fire suppression system -
Name: C7//JS O el RC 5 S Exhaust fan with single duct (bath fans)
Mailing address: /O o Sys ,5 4) Se r e n. G JaN Exhaust system apart heating or AC _
City: "7/6 4 r' 0
State:0/Z ZIP: 9 - 7 a� L Typepipms l P G " '. NO to 4 our ) _L_5 4/40 YO Oil
Phone: (03 '-6,. .• Fax: E-mail: uel .1. ing each additional over 4 outlets
ENGINEER ' , -: p p (schematic required)
Number of outlets
ame: Other listed appliance or equipment:
d . - s: Decorative lace .. .
I State: [ZIP: - nsert- type / 10.0 O /000
" on ax• E -mail: " , • . tov pel etstove
�►PP.+ ._, �2 -Ya ' . Date: /O -G/ a en
F71277print):4 04/ _4aerpa —
all judschet lit cards. please call m ar lot Permit fee $ '
j• i f Notice: This permit application Minimum fee $ '72 . SO
O t]ud ` - expires if a permit is not obtained ��
C`Dd card i / within 180 days after it has been Plan review (at State surcharge e 4gJ
_ (8%) . %) $ .. $
N s ea accepted as complete.
. '�.
outer Munchen, and FMS: TOTAL $ . 78. 36
Cardholder signature t. Inspernens outside m normal Woolen hours (mtremum that a hw hare)
gna0oe {7250 parlour. 440-4617 (6/001(.'OM)
` ��
//el./ 9 a aechonea„ no fee saoeaa�y. (.
17250 per tour
7. Additional plan rwiew reamed by changes. additions or minions to plans (annum
/0- , c,25 _ a / V 3 o charge-one-had hour
e•oup hour) ST250 p
7Q 'State contractor caw eerefcauon required for units .200k BTU. .
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date R equested 1/ AM L-PM BLD
/
Location ! 00 / `/ L.C�� uite MECmod / 3 e/
co ntact Persop Ph 6 9 !o 2 2, PLM
ntractor J Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing
Foundation CCe FPS
Ftg Drain SGN
Crawl Drain Ins ection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear /9
Int Sheath /Shear
Framing
Insulation
Drywall Nailing Pa
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �.
Roof
Misc:. -
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
�2ou h In
{ Gas Line •
Smoke ampers
rnal
PASS 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
•17 Other Dat 1/ -�� •� Inspector E x t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.