Permit .A : CITY OF TIGARD MECHANICAL PERMIT
r;" DEVELOPMENT SERVICES PERMIT #: MEC2001 -00235
4 � ' I " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/26/01
PARCEL: 2S114BB -01100
SITE ADDRESS: 10185 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 010 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: 1 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of gas furnace and installation of exterior A/C unit. NC unit cannot be placed within the required
setbacks.
Owner: FEES
CHINN, FRANK L TR + Type By Date Amount Receipt
REBECCA A TR PRMT CTR 6/26/01 $72.50 2720010000
10185 SW SERENA WAY 5PCT CTR 6/26/01 $5.80 2720010000
TIGARD, OR 97224
Total $78.30
Phone:
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 557 -2220 Final Inspection
Reg #: LIC 72623
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 co s of these rules or direct questions to OUNC by - ling (503)246 -9189.
Issue By: Permittee Signature: r
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: i Ze 2(!d/ Permit no.:// � 90 t ?5
;q I / /
,� �I City of Tigard' /� Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR Date issued: B Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case fileno.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
-Er 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1 0 lQ S 5L,./ .S ca a L G y
j i 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: IBlock: ISubdivision: *See checklist for important application information and
Project name: 1 /— jurisdiction's fee schedule for residential permit fee.
City /county: ^TtS /4
rJ / t ,, ZIP: �? 7 2 L'{ 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and `focatiddn of work on premises: f-.r� cs-- 4- / AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: 6/23 ]Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned?, Yes ❑ No Air conditioning (site plan required)
Is existing space insulated ?_Q'Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: Tr 1 (•--A-- T e10 C +r, State boiler permit no.:
` HP Tons BTU /H
Address: l3 I So S . LI44S,.,,, a r /t t,a Jr r 1 w- Fire /smoke dampers/duct smoke detectors
City: Or ,_ (...1,4 I State:0/z. I ZIP: °f 7 4,e,s Heat pump (site plan required) y_T
Phone: 5- 7 - tfli ZoI Fax: I E -mail: Install/replace furnace/burner p BTU /H
Including ductwork/vent liner XJ Yes ❑ No ,
CCB no.: 1- Z 6 Z 3 Install/replace/relocate heaters—suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration: _
I Absorption units BTU /H
Name: 0 a_s a. I 1 �. Chillers HP _
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: SS - . L - ° Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system .
Name: F 72JJ e /A/ Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
-
City: State: ZIP: Fuel pi and distribution (up to 4 outlets)
Type: pip i7 / NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: I Fax: I E -mail: Woodstove /pellet stove
Other:
Applicant's signature: I Date: Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
rm
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (6/00 /COM)
•
Commercial Schedule
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100,000 BTU Table 1A Mechanical Code Qty Price Total
1) Furnace to 100,000 BTU
induding ducts & vents 955 including duds & vents 14.00
Furnace > 100,000 BTU 2) Furnace 100,000 BTU>
including duds & vents 17.40
induding ducts & vents 1,170 3) Floor Furnace
including vent 14.00
floor furnace 4) Suspended heater, wall heater
including vent 955 or floor mounted heater 14.00
suspended heater, wall heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
Check all that apply: 'Boiler Heat Air
Vent not included in appliance permit 445 For Items 7 -10, see or Pump Cond Qty Price Total
Repair units 805 footnotes 1,2 Comp -
7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K BTU 14.00
8) 3 -15 HP; absorb unit
to 100k BTU 955 100k to 500k BTU 25.60
3 -15 hp; absorb.unit
9) 15-30 mill BTU 35.00
101k to 500k BTU 1700 10) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 52.20
15-30 hp; absorb.unit 11) >50HP; absorb unit >1.75 mil BTU
87.20
501k to 1 mil. BTU 2310 12) Air handling unit to 10,000 CFM
30 -50 hp; absorb.unit 10.00
13) Air handling unit 10,000 GEM.
1 -1.75 mil. BTU 3400 17.20
> 50 hp; absorb.unit 10.00
Non - portable evaporate cooler 10.00
> 1.75 mil. BTU 5725 15) Vent fan connected to a single dud
6.80
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
10.00
Non - portable evaporate coller 656 18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood served by mechanical exhaust 656 20) Other units, including wood stoves 10.00
Domestic incinerator 1170 21) Gas piping one to four outlets
5.40
•
Commercial or industral incinerator 4590 22) More than 4-per outlet (each)
1.00
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL MSS EVEE
Gas piping 1-4 outlets 360 8% SURCHARGE NM UM
PLAN REVIEW 25% OF SUBTOTAL yn y w c
Each additional outlet 63 Required for ALL commercial permits only .fit 0, ^'e - .
TOTAL
Other Inspections and Fees:
1. Inspections outside of normal business tours (minimum charge -two hours)
$72.50 per hour
2. Inspections for which no lee is specifically indicated (minimum charge -hall hour)
572.50 per four
Total Valuation - Fee 3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one-half tour) $72 -50 per hour
'Stale Contractor Boiler Certification required
$1.00 to $5,000.00 Minimum $72.50 "Residential ANC requires site plan showing placement of urn
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
each additional $100.00 or fraction thereof,
to and including $10,000.00
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54
for each additional $100.00 or fraction
thereof, to and including $25,000.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45
for each additional $100.00 or fraction
thereof, to and including $50,000.00
$50,000.00 and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
thereof
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CITN OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175. Business Line: 639 -4171
Q� BUP
Date Requested � � Z AM PM • BLD
Location /U/ S55 S y /, Ld c4.7 Suite MEC " / — DO -3)
Contact Person Ph 537 ZZ � PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam •
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains _
Final
PASS PART FAIL
•
C L
Post & Beam
Rough In
Gas Line - •
Smoke Dampers .
PAS FAIL
EL� CTk AL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
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
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. -