Permit •
CITY TIGARD MECHANICAL PERMIT
• I� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00373
s•1,L . I DATE ISSUED: 6/15/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
- I
PARCEL: 2S114BB -00900
SITE ADDRESS: 10145 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 008 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:
ELE 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: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: AC install and gas fireplace insert. Gas line existing.
Owner: FEES
BROWN, PAUL Description Date Amount
10145 SW SERENA WAY [TAX] 8% State Surcharl 6/15/2k $5.80
TIGARD, OR 97224 [MECH] Permit Fee 6/15/200 $72.50
Phone: 971 219 - 2412 Total $78.30
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Cooling Unt Insp
Reg #: LIC 126881 Final Inspection
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: Permittee Signature: 7 Q
<1/4
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t e next business ay
. .
Mechani Permit Application FOR OFFICE USE ONLY
Received 5 Permit No.:M ..., i A9-,2)3-7
City of Tigard .
13125 SW Hall Blvd., TigardWIT
.9 4EN ED Allip Date/By / /" " ,
Plan Rev' w 0 0
Phone: 503.639.4171 Fax: 001.....l.. Other Permit:
Inspection Line: 503.639.4175 11 d i, ionit,1#
_ el II Date/By:
Date Ready/By: BEI 0 See Page 2 for
Internet: www.ci.tigard.or.us N 1 ''''
Notified/Method: Supplemental Information
. ;,.„ ,, ', : COASIgl.crAig,"-:K
0 New construction B & A lO 'CiaAStr-
.1 01141:_Aki r
Mechanical permit fees* are based on the value of the work
d
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
- .
. - :, ,, ,,,, ' •:- ..,:, _. ; CATEGORY OF CONSTRUCTION . - , " " -_,';-': Value: $
_ '::.:,' :., ,.,
• RESTDENTIAli
W 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory buildi :
ng ,,, ,, • , _ __ .. „, . - ..,„ . ,,,.. , .
For special information use checklist.
I=1 Multi-family 0 Master builder 0 Other:
Description Qty. Ea. Total
- ' ': . ,_ . • , JOB SITE INFORMATION AN 2 '' 3 - 7: '.';'; :j Heating/cooling
Air conditioning or heat pump
Job site address: ve i LIE s ‘....) S e r e,nai w u
(requires site plan showing placement) t 14.00
City/State/ZIP: "rzectrel Or< 9 7iz' Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) _ 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
c " ) OriACI VO4 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 •
CSI)
--. Gas fireplace 1 10.00 ta.----
• • .„, c' • __ dIP . ' WI • .AAL a Flue vent for water heater or gas
fireplace 10.00
0 -01 0 •01; #734 E 4-7 f ■44 piAS L4,01/ Es Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
• ., Chimney/liner/flue/vent 10.00
PROPERTY OWNER , ' ---; ,.: , . ';.' 0 TENANT . ., - ..:
Other: 10.00
Name: ilczx Environmental exhaust and ventilation
Range hood/other kitchen
Address: -I (b-1, •IS' S v,...) Sep-14Q wy equipment 10.00
City/State/ZIP: `1%-es,arel oR. q 122_ q Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: (en/ ) - c - 24-1 12_ Fax: ( ) toilet compartments, utility rooms) 6.80
-'' - .. `•" -,n APPLICANT ' - ' ': - . : - [R PERSON , ' -Y! Attic/crawlspace fans 10.00
Other: 10.00
Business name: 14 et-1- •.; vv.„.
Fuel piping
Contact name: 1 o $5.40 for first four; $1.00 for each additional
Fumace, etc.
Address: p Z y 8. -Lei l altlib Gas heat pump
City/State/ZIP: - -r u ct 4.4i" tar cl'utto -a- Wall/suspended/unit heater
Phone: ( ) CO CI s-t
--s Fax: : (sty's) c i _t zrz.1.- Water heater
Fireplace
E Range
, .
" ' '`.•''' - • ' ' Barbecue CONTRACTOR ' ' - -- ' - .- .-
. - -
Clothes
Business name: s dryer (gas)
lAin leo ,t-te-q,;hla Other: .. , .
Address: Po Asenc g?-ct :_ , .,., : MECHANICAL pERMITrEg-/ :,- • - • • - -'•
_City/State/ZIP: fro oi 1 Oezx: -- az : 2 1 I 62.3..\ci...
( 9 tocAc Subtotal
Minimum permit fee ($72.50)
Phone: (S:33 )( crz, --s-
Plan review (25% of permit fee)
CCB lie.: 1•z c g State surcharge (8% of permit fee)
TOTAL PERMIT FEE lg. 86
Authorized signature: Ck_ (7)4.-4 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Cprf q 1/ Date: 6, 1 ti -43 LI * Fee methodology set by Tti-County Building Industry Service Board
i: \BuildingTerznitAC-PermitApp.doc 12/03 440.46 17T (11/02/COM/WEB)
Mechanical Permit Application - City of`figard •
Page 2 Supplemental Information
Commercial Fee Schedule:
Total Valuation: . Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\ Building \Permits\MEC- PemvtApp.doc 12/03 2
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CITY OF TIGARD 24 -Hour
BUILDING Inspectio ne: (503) 639 -4175
INSPECTION DIVISION Busine - Line: (503) 639 -4171 MST ll
BUP
Received Date Requested - f - AM PM BUP •
Location O S Suite MECoq 'O 41' O 3 73
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
-
Int Sheath/Shear _ — .rte a• 4 ,
�O -rr -' -
� -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm M 7 4 b L Gam_ / L/
Susp'd Ceiling (� 6
Roof � O
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole 6 t F 11 7 .6
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: n Unable to inspect — no access
Fire Supply Line
ADA / Approach /Sidewalk Date ` ` V Inspector Ext
Other:
Final DO NOT REMOVE this Inspection recor from the job site.
PASS PART FAIL