Permit •
C ITY O TIGARD MECHANICAL PERMIT
�~^ -� ' J I R
�1Ac DEVELOPMENT SERVICES GMAL. PERMIT #: MEC1999 -00270
- 13125 SW Hall Blvd. Ti 503 4 ' -4"111 DATE ISSUED: 6/22/99
Blvd., Tigard, OR 97223 ( ) PARCEL: 2S114BB -00500
SITE ADDRESS: 10065 SW SERENA WAY -
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 004 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:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of gas furnace and a/c unit. Placement of a/c unit must comply with standard setbacks.
Owner: FEES
LUKENS, JOHN P /HELEN DIAN Type By Date Amount Receipt
10065 SW SERENA WAY PRMT DEB 6/22/99 $50.00 99- 316316
TIGARD, OR 97224 5PCT DEB 6/22/99 $2.50 99- 316316
Total $52.50
Phone:
Contractor:
SPECIALTY HEATING + FABRICATIO
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 620 -5643 Cooling Unt Insp
Reg #: SUP 2570RET Final Inspection
LIC 006657
ELE 34 -341CR
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/dr�/I,; ;�"/�4, Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
CITY OF TIGARD Mechanical Permit Application �a 9f
13125' W HALL BLVD. Commercial and Residential ti 997
TIGARD, OR 97223
(503) 639 -4171, x304
Print or Type
Incomplete or illegible applications will not be accepted
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
• Job Street Address Surte# A) Permit Fee ..... . ' 16.00
1) Furnace to 100,000 BTU
Address CGS 5k) S ?rQJY� including ducts 8 vents see footnote 1,2 1 9.65 6
Bldg# City/State Zip / 2) Furnace 100,000 BTU+
7 -e_o Y>rQ 97 .2,24 including ducts & vents see footnote 1,2 12.00
Name (o name of business) 3) Floor Furnace
Owner jOh N 1 iegs including vent see footnote 1,2 9.65
Mailing Address / ' 4) Suspended heater, wall heater
f GO'S c5 S e�/1rA W or floor mounted heater see footnote 1,2 9.65
5 ) Vent not included in appliance permit _ 4.75
City /sta Zip Phone Check all that apply: *Boiler Heat Air
l44.-d ok 97y4 4 Zc!). a7 For items 6 -10, see or Pump Cond Qty Price Amt
Name (or name of Business) footnotes 1,2 Comp
a e- 100K BTUbsorb unit to 9.65 c / '
Occ upant Mailing Address 7) 3-15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip " Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor Name ' / 9) 30 -50 HP; absorb
S �2G/ 4 L'R/ ii--7 1 0)t 1-1.75 mil BTU 36.00
(( 10) >50HP; absorb unit
Prior to permit Mailing Address � >1.75 mil BTU 60.15
issuance, a copy `75-2-a Sc.() / 19 4 S T 11 Air handling unit to 10,000 CFM
of all licenses City/State Zip Phone 7.00
are required if . 7 - 7 9 1.-a- d - 11-2-3 po-s -, ja 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. ate 11.75
database li 6 S7 // / / 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
or Mailing Address 4.75
15) Ventilation system not included in
appliance permit 7.00
Engineer City /State Zip Phone 16) Hood served by mechanical exhaust
7.00
Describe work to be done: 17) Domestic incinerators
12.00
New 0 Repair 0 Replace with like kind: Yes O No O 18) Commercial or industrial type incinerator
Residentiap Commercial 0 48.25
19) Repair units
Additional information or description of work: 8.40
2 0) Wood stove /gas FP /other units /clothe dryer /etc.
��S �. �SF- �t�N,`4cp �4 G 7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas caics. See footnote 1 3.75
Type of fuel: oil 0 natural gas,$l LPG 0 electric 0 22) More than 4 -per outlet (eac .75
Minimum Permit Fee $50.00 SUBTOTAL ; ' C) 0
I hereby acknowledge that I have read this application, that the information 5% SURCHARGE ><i: >• i M€€ ': : 1,5
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL ::
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL 62, i 2)
Signature of Owner /Agent Date
Other Inspections and Fees:
1. Inspections outside of normal business hours ( mininum charge -two
Contact Person Name cc Phone hours) $50.00 per hour
.__�r h,e,r 6 ao -5-01(.1 2. Inspections for which no fee is specifically indicated (minimum
charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge - one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. *State Contractor Boiler Certification required •
"Residential NC requires site plan showing placement of unit
IArnechperm.doc rev 02/4/99
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
a -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q q BUP
Date Requested — 7 -R' l 1 AM V PM BLD
Location II CCCD S S Oal, Suite MEC 1 I q' W
Contact Person 711' I IQ,01 Ph (0 2b'S W PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC l 9 9q-40370
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
Drywall �►'�/JC /?9 9 0 0 Z' g7
Drywall Nailing /p� ! /
Firewall
Fire Sprinkler :11/4-Z<-2, Fire Alarm
Susp'd Ceiling e - L l 99 9 a to 0
Roof
Misc:
Final
4Milj
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ICHANZ�
Post & Beam
Rough In
Gas Line
Smoke Dampers
C15D
PASS _PART FAIL
<ELEOP
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
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 � Q Q
Other ach /Sidewalk Date / d 7 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.