Permit r . ,
4 1 6 CITY OF TIGARD MECHANICAL PERMIT
i�* DEVELOPMENT SERVICES PERMIT #: MEC1999 -00255
�' r�' II 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 6/14/99
PARCEL: 2S114BB -01400
SITE ADDRESS: 10265 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 028 k JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN:P COOLERS:
i��
TYPE OF USE: SF UNIT HEATERS: ! �,w�' VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: 0 VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
OIL 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
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit. Placement of a/c unit must comply with standard setbacks.
Owner: FEES
CHRISTOPHE JABLONSKY Type By Date Amount Receipt
10265 SW SERENA WAY PRMT DEB 6/14/99 $50.00 99- 316094
TIGARD, OR 97224 5PCT DEB 6/14/99 $2.50 99- 316094
Total $52.50
Phone:
Contractor:
SUNSET FUEL CO
PO BOX 42287
PORTLAND, OR 97242 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone: 503 - 234 -0611 Final Inspection
Reg #: LIC 00002374 EXPIRED
ELE 26 -113C
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 m obt i copies of these rules or direct questions to OUNC by calling 503)246 -9189.
IssuelBy: ILR- Permittee Signature: a ,AQQ, ee-�
�— Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex business day
A-- l' RECEIVED
•
CITY OF TIGARD JUN 14 19Schani Permit Application Plan Ch #
13125 SW HALL BLVD. Commercial and Residential Dat B /j!
TIGARD, OR 972iS MMUNITY DEVELOPMENT Date Recd Ci �y J9
(503) 639-4171, x304 Date to P.E. -
Date to DST
Print or Type 6c-c- r 9q - 06333 Permit# M £Cl 9gq -va2sr
Incomplete or illegible applications will not be accepted Called
!lame ar Development/Aioiea Description
_ Table 1A Mechanical Code
Job Strerm Addy -�4 stale'? _A) Permit Fee . rg 1 Price Amt aVabla
16.00
Address _ 1) Furnace to 100,000 BTU
Up f City/State Zip including ducts & vents see footnote 1,2 9.65
2) Furnace 100,000 BTU+ t _
including ducts & vents see footnote 1,2
� N (or name of business! 3) Floor Furnace
`O 12.00
Owner t✓/ I r .. � business), 1 Including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
/60 �a5 6w Sofa"? wg / or floor mounted heater see footnote 1,2 9.65
City/State Zi Phone 5) Vent not included in appliance permit 4.75
4 City plc( y(1 1233= Check a!! th apply: 'Bolter Heat ' Air
I 5 plc( 98 L1 7/&2 For Items 6 -10, see or Pump Cand Qty Price Amt
Na (or name of business) • footnotes 1,2 Comp
6) <3HP;absorb unit to '
Occupant Mailing Address 100K BTU X 9.65 q.g
7) 3-15 HP;absorb unit
100k to 500k BTU 17.65
- City/State Zip I Phone 8) 15 -30 HP; absorb -
unit .5-/ mil BTU
Contractor 9) 30-50 HP; absorb 24.15 _
6ia_c6i �ye / unit 1 -1.75 mil BTU
Prior to 10) >50HP; absorb unit - - I. 36.00
�� M(�S' D /7 >1 mil BTU
issuance, a copy ,L 60.15
of all licenses /Br 11 Air handling unit to 10,000 CFM
Zip Phon � /�
are required if I t h- 7 , ,,,,,,,e 97i ,�i 7.00
expired in COT er ;on Conk_ �r Con u; 12) Air handling unit 10,000 CFM+
3 / �
database G 11.75
Architect Name 13) Non - portable evaporate cooler
14) Vent fan connected to a single duct 7.00
or " Mailing Address
15) Ventilation system not included in 1 , 4.75 "
Engineer Cny /State I Phone appliance permit - Zlp 7.00
16) Hood served by mechanical exhaust •
Describe work to be done: 7.00
xp� 17) Domestic incinerators
New Repair 0 Replace with like kind: Y est!' tom, D 18) Commel 12.00
Re ditial 0 Commercial 0
) rcia or industrial type incinerator
19) Repair units _ 48.25
Additional information or description of work
20) Wood stoveigas FP /other units/clothe dryer /etc. 8.40
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets 7.00
struclurai gas calcs. See footnote 1
Type of fuel: oil natural gas 0 LPG 0 electric O 22) More than 4 -per outlet (eac . 5
I hereby acknowledge that !have read this application, that the information
Minimum Permit Fee $60.00 SUBTOTAL O. a Y'. �G I 'Cg +
given is correct, that I am the owner or authorized agent of 5% SURCHARGE 4 az C e
the owner, that plans submitted are in compliance with Oregon State laws. PLAN REVIEW 25% OF SUBTOTAL : !r ,,,,.
Required for ALL commercial permits only "' Wit«
Signature of Owner /Age TOTAL +, r �5a
Other Inspections and Fees: i
Contact PerurMJame 1. Inspections outside of normal business hours (mininum charge -two
I g �7�,� P hone hours) $60.00 per hour
/W /c G ct 9.36/-o&// 2. Inspections for which no fee is specifically Indicated (minimum
FoGa projects only: 3. Additional plan review required by changes, additions or revisions to
l proe onl
oonotes for mer charge -half hour) $50.00 per hour
F Provide full schematic l existing o n l r
9 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 A/C requires site pian showing placement of unit
t:'.nechperm.doc rev 02/4/99
7.00 VI 0961 865 205 YVd VT :Z1 OHM 66 /Z0 /90
UifV9I.L AO A110