Permit CITY TIGARD MECHANICAL PERMIT
IAr DEVELOPMENT SERVICES PERMIT #: MEC2002 -00513
�� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/02
PARCEL: 2S 114BA -02400
SITE ADDRESS: 09790 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.2 ZONING: R -4.5
BLOCK: LOT: 115 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
>
GAS OUTLETS:
10000 cfm:
Remarks: Replace gas furnace.
Owner: FEES
PHELPS, KEVIN M + KAREN M Description Date Amount
9790 SW SERENA WAY
TIGARD, OR 97224 [MECH] Permit Fee 11/18/02 $72.50
[MECH] Permit Fee 11/18/02 $0.00
[TAX] 8% StateTax 11/18/02 $5.80
Phone: [TAX] 8% StateTax 11/18/02 $0.00
Contractor: Total $78.30
FOUR SEASONS HEATING & A/C
PO BOX 66409
PORTLAND, OR 97290 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: 48283
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: ,t,i 4 a . x Z z ij Permittee Signature: CM C(A 064 r J�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
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.
Mechanical Permit Application _
Date received: ,/ Qy
Permit no.: r;G I r
i 1' I I
.f-� 1+L •'� AL City . of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW I REZ I EV ' 3 Date issued: By: Receipt no.:
Phone: (503) 639 -41 1
.. Fax: (503) 598 -1960 12 2002 Case file no.: Payment type:
"Land use approva
Nov Building permit no.:
• - '
1 ;� l,lr. PE
•r1 I & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family 0 Tenant improvement
0 New construction V Addition/alteration /replacement 0 Other:
..: : SITE INFORMATION_ - - ;.7 COMMERCIAL VALUATION; SCHEDULE • . .
Job address: q 790 S CL) See e KGe tllar 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: I Block: � checklist for important application p
lic,t. 1er. lnfinformation ztia„n and
Project name: AP X t *See .. e �r •S jurisdiction's fee schedule for residential permit fee.
City /county: r _�Q / ZIP: - q 7 Z.l L/ YI R 2 FAMI DWELLING PERMIT'FE •
Descriptjgn apd cation of work omises: AND COMMERIC:AL/INDUSTRIAL EQUIPMENTSCHEDULE
ICti'J [u-a. -0 45 4 GL v �0.4.— -e- Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? ❑ Yes CrNo Air conditioning handling unit CFM
tioning (site plan required)
Is existing space insulated? 0 Yes Ft No Alteration of existing HVAC system .
:" MECHAN CONTRACTOR Boiler /compressors. , - • - - • - _
State boiler permit no.:
Business name: Ee- ��• -,. • {C��j - HP Tons BTU /H
Address: Re /g- 6 gel . . Fire/smoke dampers/duct smoke detectors •
City: ! 6 ,`f ' / 0 4 State:OK I ZIP: 9 7,Z to Heat pump (site plan required) _
PhoneO3-775- �/yI Fax?? c_ u ef/ I E -mail: Install/replacefurnace/burner W BTU /H �
Including ductwork /vent liner 0 Yes 0 No 1
CCB no.: 4'82-$. Install/replace/relocate heaters-suspended,
City /metro lic. no.: c 'e' IDZ wall, or floor mounted
Name (please print): ,Op / ; ....r Vent for appliance other than furnace
7 . • -CONTACT PERSON
Refrigeration'
• Absorpt un BTU /H
Name: A e -_ S Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: 03 - IM 9 '7 Fax: E Dryer exhaust
- - � ' Hoods, Type U IUres. kitchen/hazmat I
• ` hood fire suppression system
Name: K vas 9- ka e vi P4 t ` $ Exhaust fan with single duct (bath fans)
Mailing. address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: '3 • -5791 Fax: E -mail: Fuel piping each additional over 4 outlets
= ENGINEER rocess piping (schematic required) M
.
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: ` I Sta I ZIP: Insert - type
Phone: 41 ax• f ' - mail: Woodstove/pellet stove Mir Other:
Applicant's signature gi � Date: m 01— Other = "
, Name (print): 0. 4 _. IIM-
Not ali'jurisdictions accept credit cards,,piease call jurisdiction for more information. Permit fee $ �y'
CI Visa ❑ MasterCard Notice: This permit application Minimum fee $ 72 . 5
Credit card number: / expires if a permit is not obtained Plan review (at _ %) $ ' •
Expires within 180 days after it has been State surcharge (8%) $ 4 $0
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ 7$-3 O
Cardholder signature Amount 440 -4617 (6/00 /COM)
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• MECHANICAL PERMIT FEES .
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: 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
including ducts & vents 14.00 �'
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including 17.40
$10,000.00. including ducts & vents
$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
j fraction thereof. footnotes below. Comp* 1 --
7) <3HP;absorb unit I
ASSUMED VALUATIONS PER APPLIANCE: to 1001< BTU 14.00
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 4 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15 -30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Veni sysienl fluff iilciuded in 056 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL:
Commercial or industrial incinerator 4,590 $ 7Z SO
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only j 3�
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION: 7g 3
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
i : \dsts \forms\rnech- fees.doc 10/11/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested / ° 3 AM PM BUP
Location 7' 7 cm J4 ?— Suite MEC S3
(
Contact Person Ph � ) 77,5 .S l/ / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 842-1-1 ELC
ELC
Footing C. 3 — SQ /
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 Ky'
Susp'd Ceiling
Roof ��
Other:
i
Final /
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab / ,
Rough In
drr
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
Smoke Dampers
f
PART FAIL
• CTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final U 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: ❑ Unable to inspect — no access
Fire Supply Line
ADA L �.
Approach/Sidewalk Date o _ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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