Permit CITY OF TIGARD
MECHANICAL PERMIT
M ,A , DEVELOPMENT SERVICES PERMIT #: MEC2004 -00470
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/19/2004
PARCEL: 2S114BA -02800
SITE ADDRESS: 09680 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.2 ZONING: R -4.5
BLOCK: LOT:111 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: 1 DOMES. INCIN:
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: Install new A/C & furnace unit.
Owner: FEES
TERRY PORTER Description Date Amount
9680 SW SERENA WAY [MECH] Permit Fee 7/19/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 7/19/200' $5.80
[MECH] Investigation Fe 7/19/200 $72.50
• Phone: 503 481 - 0979 Total $150.80
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 - 453 - 4822 Heating Unt lnsp
Cooling Unt lnsp
Reg #: LIC 62196 Final Inspection
•
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.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical ived
PerniAEOP440 FOR OFFICE USE ONLY
Rece
_ . .94 V
"City of Tigard . Date/By: - 1 . - QV i 4
Permit No.: _ 7 J
13 125 SW Hall Blvd., Tigard, OR 9N143 .I. , - (s. 2004 , e
Date/By: Plan Review _.., /
Phone: 503.639.4171 Fax: 503.59,110$60 Other Permit:
,11 1 '1
Inspection Line: 503.639.4175 Dote Ready/By. 0 See Page 2 for
Internet: www.ci.tigard.or.us
kilTY OF TIGARD NotifierVMethod: OE Supplemental Information
°MU:ONG DIVISION ...... ...... ,... .,..,........ .........,.. , .
trZia,Eliff,,,F4, ..:. ::::...;...::. . : . i:: :;ttiNimbigAgikii.:-
,:±4,4,. . :::-! :..,:::..: •:••: •:.•!::::••:•.:-- ::•!...:• :-;; ..,, V 'T47 •zii7ii.;i.; i:':::.k.,, :77 - ..ii,,TrIV:,,,,, ..:,:. -.-.:: f :. : :!, • : .: •
El New construction ddition/alteration/replacement
, Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
11$ghl .......................................................................................... '. :: . •-.' ..* ...•: .- .:,„=,„,.. ,::::..---.....-------..:......„:„, ............
*E$
:',
X1 and 2-family dwelling El Commercial/industrial p Accessory building
For special information use checklist.
1:1 Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
f. - .4 ;:iTi! 2 i0F f.: Tqg* : ,i6legittif.tOtigerigit4:15.IiiCictic•14:: • ': . : s -:-. :. .!:: •i:. Heating/cooling
Air conditioning or heat pump
Job site address: 1 ( 5 to Semx, e1/4.. 1,I3 (requires site plan showing placement) 1 14.00 Iii .00
City/State/Z1P: "Ti 1 CSfi Ck13.:0\1 Furnace 100,000 BTU (ducts/vents) t 14.00 S q • OC:D
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg/apt. no.: Project name:
Gas heat pump
Cross street/directions to job site: 4- Vv 1 4C 1 .___IC1)
.________,
Duct work 14.00
frk 14ydronic hot water system 14.00
14.00
* .S.M \ f-A P t eC C.** 0.7 r a; SeireincK Wat •
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
% 0 E.S ''' 1 in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
iiiiiiiiaSigifladgfiritt40001011*WM: H : II :E...I l.:ii ::::'::::::!-:; water eater 10.00
r Gas fireplace 10.00
1ASie■ t 1 vve.03 it/c_. -t FLL'e lfl a C....._- LUX I t F . Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
, Chimney/liner/flue/vent 10.00
ifii ......... ....p*;:: :,:: ::,:::.::::.!.,-,
Other: 10.00
-.....-
Name: leiti 4 c . o . s .,,, a ..--ppi.... Environmental exhaust and ventilation
Range hood/other kitchen
Address: GOP equipment 10.00
City/State/ZIP: '1 0/2 17 j.i...itj6 Clothes dryer exhaust 10.00
/ Single-duct exhaust (bathrooms,
Phone: (5V3) 9 iz a cl-1 dc:k Fax: ( ) toilet compartments, utility rooms) 6.80
ikiii16,0iiia . ..i)eicotO,.rr : - 1wtit§pili.i: : i:,„:: Attic/crawlspace fans 10.00
Other: 10.00
Business name: C. t IAA R4.-- CA In+rie5 I / ..1 C.. •
Fuel piping
Contact name: I C_p t-1..; A 1, -
ct. IAA 55.40 for first four; 51.00 for each additional
Address: 16 3 , 0 -7.1w rt.... Ao.e____ Furnacc, etc.
Gas heat pump
City/State/ZIP: . T. (Ai etjA 4 op._ 1-19.9.11 Wall/suspended/unit heater
Phone: (sz)) ifs' 5 ...410...... Fax: : ($-D3) 164 .... -7?9,4 Water heater
Fireplace
E-mail:
Range
t ; !:1:Z.t;::.::.4:LnineO*WC7fOR:.•.:: - ..::; . !: • ': • --- .• - . • ' - ..... Barbecue
Business name: CI ; o k616 4-e .... , Cp 14,4-4-%-a Clothes dryer (gas) __._... , .._ -
1
Address: 04)63, 5„..% 7,,,,,,c r - k e- Other:
. .t .14AW:4::PERMii. . : ....... .......... ::::.
City/State./Z1P: Toe**k.CW1/4.43‘ 0 - cv7c)-aL-4. Subtotal pfif .0*
Phone: (4113) LI C 3 - 4 8 i
Fax: (5'0 3 ) L - --?,,9..L..-) • minimum permit fee ($72.50) 72 so
Plan review (25% of pennii fcc)
CCB lie.: G 2. ( Ct L State surcharge (8% of permit fee) 6-.10
•
TOTAL PERMIT FEE 74 .0
Authorized signature: 9r,gjt 1577(112-----61,--4"‹.----- This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete. ,
Print name: KAM 1.-1- a A/LA Date: •7 • Ike methodology sct by Tri-County Building Industry Sc e Board
it?
i: \ BulldIngTermiLs\ MEC-PennhApp.doc 12103 440-4617T (I I/ 21COMIWES) I
j
ir22/.. 896 EDS ic:f...1.4.uo3 aq.ew T To e6S:60 I'D 21 ifIC
. ' C LIMATE - '`CONTROL 16500 SW 72nd Avenue Portland, OR 97224
503- 453 -4822 FAX: 968 -7224
HEATING & AIR CONDITIONING 503-453-HvAc
P C7 - 4 (21—
J /p
1 ______________________
+s' I
I ,,,,,, vi , ____________J
1 /
q` "a
5
SYSTEM DESIGN INSTALLATION SERVICE MAINTENANCE
PORTLAND-453-4822 VANCOUVER • 360 -254 -3063
E - d bZZG 896 EOS IouquoO 94ewtia eO0 =0i bO 21 Inc
CITY OF TIGARD 24 -Hour,
BUILDING Inspection Line: (503) 639 -4175
IN . CTI U DIVISION • .. Busines Lrn` (503) 639 -4171 MST
BUP
Received Y D t o Re uested / Q /T AM PM BUP
4
Location JV o. _ Suite r � U - CC 1 7Q
Contact Person `6 - Ph ( 0 ) - 7 V6 2-Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner j,-()Oki ''C/17 4 73 L
Footing
Foundation C.,,e2/1"c ELC
A ccess: �'?r-s�n zcri
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear 7 i
Ac � M� J�u5 v � E "�
Framing /" G� d
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING '
( .7
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole 6,„,. (••••: __
Storm Drain
Shower Pan
Other:
Final
P RT FAIL
EC HAN AL
Post & Beam
Rough -In
Gas Line
Dampers
PAS PART FAIL
•LECT - AL
Se -
Rough -In
UG/Slab
Low Voltage
larm
�i
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(21 PART FAIL
SITE E Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /—
ADA
Approach/Sidewalk Date Jo v Inspector
Other: 1,
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL