Permit CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00213
"' 13 125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/5/2005
PARCEL: 2S114BA -07500
SITE ADDRESS: 09785 SW SERENA WAY ZONING: R -4.5
SUBDIVISION: COPPER CREEK STAGE 2 LOT: 015 JURISDICTION: TIG
Project Description: Install a/c unit.
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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
GARY HANSEN Description Date Amount
9785 SW SERENA WAY [MECH] Permit Fee 5/5/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 5/5/2005 $5.80
Phone: 503 620 - 4589 Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97212
Phone: 503 284 - 2173
Reg #: LIC 222
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
or 1- 800 -332- . - .
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Issued B • , -au Permittee Signature: ; ; %sf_ar%i
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business da
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar Spezza 503 -284-1552 p.1
1■;;'
( FOR OFFICE USE ONLY
- 'IVettanlical Permit A ,.
_:ty of Tigard ' Recei / ��I ��% Pemut Nu.: •/
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13125 SW Hall Blvd., Tigard, O 97223 Plan eve Review _, pthcr Permit:
Phone: 503.639.4171 Fax. 503.598.1960 /h�"a t 1 +`\ D
Inspection Line: 503.639.4175 u„4i I Date Ready/By: lur See Page 2 for
www.ci.tigard.or.us ww.ci.tigard.or.us
NotifiCdM4etlp fI ®
Supplemental I irormatian
TYPE OF WORK `.COIAMFRCIAL FEE' SCHEDULE — USE CHECKLIST •
t•
Mfchapieal permit fees' arc based on the value of the work
III New construction Addition /alteration /replacement performed: Indicate the value (rounded to the nearest dollar) of all _
El Demolition ❑ Other: , mechanical materials, equipment, labor, overhead, and profit.
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Value: $
CATEGORY OF CONSTRUCTION •-..._, R ESIDENTIAL EQUIPMENT / SYSTEMS FEES'
• - and 2- family dwelling ❑Commercial /industrial El Accessory building \` i For special information use checklist. •
• El Multi family ❑ Ma builder ❑ Other: DeSEription I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump av
• Job site address: %? r S Sw S •t r -e K • u% 4 -.1 (requires site plan showing, placement) 1 '14.00 i `
Furnace 100,000 BTU (duets /vents) 14.00
City/State/ZIP: T • 1 61Z q 2-9 Furnace 100,000+ BTU (ducts/vents) 17.90
Project name: 14.00 t
Suite/bldg, /apt. no.: J Gas heat purrip
Cross street/directions to job site:
Duct work 1 4.00
. Hydronic hot water system • 14.00
Residential boiler (radiator or
. hydronic)' 14.00
Unit heaters (fuel -type, not electric),
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 .
DESCRIPTION OF WORK Water heater 10.00 10.00
Gas fireplace
A.-,4,,t a( A/c 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 /lincr /flue/vent 10.00
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PROPERTY OWNER El TENANT Other .. 10.00
Name: C ,_ 11 5- , Environmental exhaust•and ventilation
Range hood /other kitchen
Address: �� e.- S A 4- ✓-L equipment 10.00
Clothes dryer exhaust 10.00
City/State/ZIP: Single duct exhaust (bathrooms,
Phone: (3 ) (p Z...0 — 4-/ 5-21 Fax: ( ) toiletcompamnents, utility rooms) 6.80
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❑ APPLICANT TACC PERSON ( ONON Attic/crawlspace fans • 10.00
10.00
. Other:
Business name: Fuel piping -
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Contact name ",J) S $5.40 for first f our; $1.00 for each a_ dditional
>. - t.2- 2 "-Pr Furnace, etc.
Address: c�� S L. < 3 .._� Gas heat pump '
City/State /ZIP . Wall /suspended/unit heater
Water heater •
Phone: ( ) Pax: ( ) Fireplace
E-mail: . ,
• Range
. CONTRACTOR" ' Barbecue
pia) �`�� Clothes dryer (gas) _ _
Business name: AAA. a ). f / 1, Ot her:
Address: a q /5 fl E j'77 / 1,4, : / 7e '8!L 1 d • MECHANICAL , PERMIT FEES*
City /State/ZIP: ef &ie. q'-7 ,42.1. Subtotal
Minimum permit fee.S72 50)
Ph one: (513) _ /7 I F ax:( • y — a3) 2g !3. a . Plan review (25% of permit fee)
CCB lie.: , • S tate surcharge (8% of permit fee) S . $v
TOTAL PERMIT FEE 7 g_ 3 0
• `� This permit application expires if a permit is not obtained within"180
Authorized signature: as — days after it has been accepted as complete. •
i _ . - _- -^ + i ` ^ro S/ ,�� I • Fee methodologyset by Tri- County Building Industry Service Board
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CUSTOMER INFORMATION •
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NAME G,r, kAr.,..,.c ' •
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PLEASE REPAX APPLICATION WITH SITE PLAN.
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CITY OF TIGARD -
BUILDING DIVISION PERMIT #: MEC200500213
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/5/2005
Phone: (503) 639 -4171 h, A r
Inspection Requests (24 Hrs.): (503) 639 -4175 r -i:�
INSPECTION WORKSHEET FOR DATE: 6/21 /2005 TIME: 7:11AM PAGE: 113
SITE ADDRESS: 09785 SW SERENA WAY CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 015 TYPE OF USE:
PROJECT NAME: HANSEN
DESCRIPTION: Install a/c unit.
OWNER: HANSEN, GARY PHONE #: 503 - 6204589
CONTRACTOR: AAA HEATING & COOLING PHONE #: 503-284-2173
Inspection Request Scheduled For: Date: 6/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 009655 -01 503 -284 -2173 Y
Corrections/Comments/Instructions:
. G• Al, A' . 4.E : 4 , cd C ,--0-
,, '49 7L-
PA El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL lIpt CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: a Date: Phone #: (503) 718-