Permit ' ~ CITY OF TIGARD MECHANICAL PERMIT
i� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00673
��' II 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/2004
PARCEL: 2S114BB -01500
SITE ADDRESS: 10285 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 029 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: 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: AIR HANDLING UNITS
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 3
Remarks: Installation of gas lines for kitchen stove, future tees for dryer and barbeque.
Owner: FEES
BRANDERHORST, JOHAN Description Date Amount
10285 SW SERENA WAY [MECH] Permit Fee 10/6/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 10/6/200' $5.80
Phone: Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line lnsp
Final Inspection
Reg #:
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: • -s • law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are se : in OAR
952 -001- •rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct qu- do to OUNC by cal ng
(503) 46 -6699.
Issue B y: u 1 110e .0/ 0 ' Permittee Signature: A / � .,
Call (503) 639 -4175 by 7:00 P.M. for inspections n-eded the , xt . sines /.ay
i
Mechanical Permit Application FOR OFFICE l SE ONLY
Chit of 1 Aed `4 Date/B Received y: Q / l� Permit No.: ��i� 4° /,(40 / 4
1312 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ;ra. I Date/By:
Permit:
Inspection Line: 503.639.4175 J�� -•1 1 Date Ready/By: Wil H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction $1Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
{] Demolition performed Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $,5 Dl) t oo
g ri- and 2 family dwelling ❑ Commercial/industrial 0 Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
❑ Multi ❑ Master builder ❑ Other: Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heatmg/cooing
Job site address: j ,, /� / Air conditioning or heat pump
OZ p n 6/43 6 es /� 002 4 (requires site plan showing placement) 14.00
City / State/ZIP: flcy r.ci `/ ►` f;`� -' 7 _ 6 _ lib/3(, Furnace 100,000 BTU (ductslvents) 14.00
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: Duct work 14.00
`. _ /� e Hydronic hot water system 14.00
ID L A F -\vA, t l� " �7 h -,-( l 6 0 1e ii y.-e Residential boiler (radiator or
r hydronic) 14.00
ug7 u * t7 ' ' # ii _ r A. ' II i U nit heaters (fuel-type, type, not electric),
• r . . ' , . ( in -wall, in -duct, suspended, etc. 10.00
Subdivision: �; /1 1 C� / ` /1/; 1,ot no.: � for any of above 10.00
V�� I�t lr /J
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
—� Gas fireplace 10.00
J M, 19t 0. O a, 1.
r t. e II) &CP - �() Flue vent for water healer or gas
fireplace 10.00
// —
.-) O en rive = i)-1 I'1 U.Se,a LI . --ko r e,I r J Log lighter (gas) 10.00
,5-{ -Q\r e . l R • Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
PROPERTY OWNER , ❑TENANT Other: 10.00
Name: �H ICU n 15 r'(.c „de ,+ p f11_, Environmental exhaust and ventilation
I , Range hood/other kitchen
Address:
/0 Z ' u J up �F 1 J ,1 �Q - lJtjl equipment 10.00
City/State/ZIP: `fl f - b o e- 9 1 7 4 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (od i V! , Da
5� Fax ( )5/P -61'35V toilet compartments, utility rooms) 6.80
❑ ``vV CONTACT PERSON Attie/Cawispace fans 10.00
Other
Business name: 10.00
Fmtd p iping g Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pomp _
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) • Fax: : ( ) Water heater
Fireplace
E -mail: Range /
CONTRACTOR Barbecue I
Business name: Clothes dryer (gas)
Other:
Address: 1 MECHANICAL PERMIT FEES* 1
City/ State/ZIP: Subtotal }�
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7A 50
Plan review (25% of permit fee)
CCB tic.: State surcharge (8% of permit fee) 5. fQ
/c...LI !�}�C(� TOTAL PERMIT FEE
AUthorlZed Signatufe: This permit applieation expires if a permit is not obtataed w n 18 C d ays after it has been accepted as complete.
I Print name: SO il i3 2 t4 N 0 / /46 P - 57 - I i) e: iQ / /_lO / J I * Fee methodology set by Tri- County Building Industry Service Board
CITY OF TIGARD - 24 -Hour _ - •
BUILDING Inspection Line: (503)$39 -4175 MST
INSPECTIO 4 DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requ ted '6 —/'( AM PM BUP
Location l b g5 LiJ Suite MECt=?O --00 6 73
Contact Person Ph ( ) e - 6 S• 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
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
MECHANICAL
Post & Beam
Rough -In
Gas Line
Dampers
i nl
=CAL PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA — t �
Approach /Sidewalk Date Inspector - Ex,
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL