Permit „ _
A - CITY OF TIGARD MECHANICAL PERMIT
I �
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00105
- - ' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/18/02
PARCEL: 2S114BB -01600
SITE ADDRESS: 10305 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 030 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: 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: Replace gas to gas furnace.
Owner: FEES
SHERON, LINDA E Type By Date Amount Receipt
10305 SW SERENA WAY PRMT CTR 3/18/02 $72.50 2720020000
TIGARD, OR 97224 5PCT CTR 3/18/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
SERVICE NOW OF OREGON INC
404 SE BEAVERCREEK RD #228
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 655 -7558 Heating Unt Insp
Reg #: LIC 0110214 Final Inspection
ELE 265LHR
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -011 -0010 through OAR 952 - 001 -0080.
You may obtain , of these rules or direct questions to OU ; calli (503)246 -9189.
` , Permittee Si nature 1 1
Issue By: — _ a , i %/� 9 ��L�”
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
r . 1
MechanicalPermit Application
� � ! ! 1
Date received: 3 �$�Q'L Permitno.: M/I�O� -� 05 rM . l .f 11. City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By:P.P -Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT •
r 1 & 2 family dwelling or accessory U Commercial/industrial U Multi - family ❑ Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /0 3 D S L.J 6 E2 t7Uk • u/ (/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: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county ..[ I ZIP: er 72 q 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location o f work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
2e-PL Al -6- 443 >u 2 ti ti_? F (64e,, VT 6*. . Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: State boiler permit no.:
5lV l L E /vo cam 1 f I L HP Tons BTU /H
Address: q Dy ' 13 .v T L -.1 Z.Z$ Fire/smoke dampers/duct smoke detectors
City: — M6 04...12_ d I7.-7,55 -04-- I State: p a 7 Z Z t-r Heat pump (site plan required)
Phone: raZ,19 -S IZ I Fax: I E -mail: InstalUreplacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes ❑ No
CCB no.: I I O 21 4 InstalUreplace/relocate heaters - suspended,
City /metro lic. no.: 24 to 7i wall, or floor mounted
Name (please print): , ILL C _ 5 (.- Vent for appliance other than furnace
CONTACT PERSON
Refrigerator':
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
T hood fire suppression system
Name: I_ 11j 0 13 D L) Exhaust fan with single duct (bath fans)
Mailing address: L ti U Exhaust system apart from heating or AC
State: ZIP: Fuel piping and distribution (up to 4 outlets)
City: I Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: ' Other listed appliance or equipment:
Address: Decorative fireplace
City: "tate: I ZIP: Insert - type
Phone:
mail: Woodstove/pellet stove
,1.
1 Other:
Applicant's signature: ' i I Date: 03-1 $ - 07— Other:
Name (print): BILL A 6 s�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ /2. -CO
0 Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan (at %
Credit card number: an re ( %) $ c C
Expires within 180 days after it has been State surcharge (8 %) .... $ 6 QD
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (6/00 /COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or induding ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp
7) <3HP; absorb unit
$
Minimum Permit Fee $72.50 SUBTOTAL: to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
9) 15 -30 HP; absorb
25% Plan Review Fee (of subtotal) $ 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, induding wood stoves
101 k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 `State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ **Residential NC requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms\mech-fees.doc 12/26/01
CITY OF TI:GARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested `T 5 )) AM PM BUP
Location 1 d 30J ,20./LP�yyer _ c-dar Suite d MEC o Q 6
Contact Person Ph ( ) _ S� �Ss�3 PLM
Contractor Ph ( ) 4 Ste- 7 S'13 SWR
BUILDING Tenant/Owner ( f+ X) ELC
Footing
Foundation ELC
Access: X 3
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing NO DIC= AYA LA
Insulation
Drywall Nailing Vi #/ LAh mac`
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
• Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
�IftEt,`HA
ost & Beam
¢tough -In)
Gas Line
Smoke Dampers
Final]
PASS PART � L_
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date spector • Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TI,GARD 24 -Hour :.
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
0 BUP
Received Date Requested AM PM BUP
Location 10 3 5 Suite (4 MEC ca__,) CPS
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owr1eY y� ` (aZ Q 6 2-- ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes -- - , SIT
Post & Beam
Shear Anchors t,� �� Y
Ext Sheath/Shear M Int Sheath/Shear ! / � /6e).-14'1'941CH
Framing /
Insulation
Drywall Nailing
Firewall # �l ` �%
Fire Sprinkler
Fire Alarm
Susp'd Ceiling z;
Roof
Other: -- -
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P ART FAIL
HANICA
Post Beam
Rough -In
Gas Line
na Dampers
6; A PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS .PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA � — e ? —
D
Approach/Sidewalk Date �— Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OP G RD 24 -Hour -
• BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST CqZ UP
Received Date Reque ed 4—( AM PM BUP
/
Location G 0 30 s ".) Suite MEC ,4dC) 6 O( e
Contact Person Ph ( ) Co SS 75 PLM
Contractor
Ph ( SWR )
. BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
slab Inspection Notes:; �. � � �I
Post & Beam
Shear Anchors q ; .3 /`� a _ )
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing `& U Ma
� �..� LonkTtac,— r v• n 1 Y �
Firewall
Fire Sprinkler �y J A r. -ea aSTAI � ✓s'g?Io � ` `�, --7-v T Liric-
Fire Alarm
Susp'd Ceiling v,✓P"S 63u46v5rlory ��/L TD/� �vw U.� /1J,
Roof
Other:
Final S7dP 12 -r-c) PASS PA FAIL
PLUMBING t2"u' - -e.T c.�•,, �/�
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Rot & Beam ��
Rough-In n
Gas Line
S i • ke Dampers
-ASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: Q Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date y � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL