Permit CITY OF TIGARD MECHANICAL PERMIT
91 a:. COMMUNITY DEVELOPMENT Permit#: MEC2016-00413
T[G A l T3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2016
Parcel: 251146601200
Jurisdiction: Tigard
Site address: 10225 SW SERENA WAY
Project: Miller Subdivision: PICK'S LANDING NO.1 Lot: 26
Project Description: Installation of A/C. Placement of unit must meet manufacturers requirements.
Contractor: OWNER Owner: MILLER, CASEY C
10225 SW SERENA WAY
PORTLAND, OR 97224
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 06/09/2016 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 06/09/2016 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment-Mechanical 06/09/2016 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B — ✓
Y: �/ r Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicat ECEIVED FOR OF1 1( 1. FSF 0\1.1
City of Tigard Received Q
Date/By: �O 7 �0 g, Permit No�/t�J -e 0 ,—OD94 3
IS 13125 SW Hall Blvd.,Tigard,OR 97223 JUN 9 2016 Plan Review / J
Phone: 503.718.2439 Fax: 503.598.1960Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD Date/By:
I Iwo:I) Date Ready/By: luris: El See Page 2 for
Internet: www.tigard-or.gov BUILDING Dv'sION Notified/Method:
Supplemental Information
'iii'00 WORK ' C:OMie** rit, (li"y1 CN iA:t4* tdST
Mechanical permit fees*are based on the value of the work
lew construction `Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
o Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
'ats CAA'EQRY`by CONSTRUCTION ,
Value:$
RESIDENTIAL EQUIPMENT 1SYSTEMS IN 5*
rif I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder 0 Other: Description Qty. Ea. Total
"' Heating/cooling:
' jo$ S 'iIVtFORIViATIOI i AND LOCATION. Air conditioning I 46.75 yb.7"-.
Job site address: (e3ca S S =potimN Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tlbsg_13 /oz_ / et 7aay Furnace 100,000+BTU(ducts vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
1 : SE (AA 3 '; () F v f uP—tilet'A. 4o.SSC hydronic) 23.32
//��
Unit heaters(fuel-type,not electric),
iS c C09-4QeQ.. b F A Werl Ax.1c• Plc-YS CT'- in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
ADQl4-+6 /\&L Czt-A %-nttvo- uNiT '-iv x\STIt3b fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
fis PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: CA . M I t. Range hood/other kitchen
��ff equipment 33.39
Address: to a c S I.J C c.--(46-1.:49s- 1.4-•\°C`'( Clothes dryer exhaust 33.39
City/State/ZIP: -r-,6,rig_p ' (fl as Ll Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(S 0. ) 311 7 -'?ji1 I Fax:( ) Attic/crawlspace fans 23.32
'';10 APPLICANT': 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: /.�C-. INS`i Furnace,etc.
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: Barbecue
rCONTRACTOR Clothes dryer(gas)
Business name: N/EX-.._ Other:
MECHANICALPERAI'1<',I S* ,
Address: Subtotal 949,61-0
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /Q i,c-;
CCB lie.: TOTAL PERMIT FEE /00 M:)
f This permit application expires if a permit is not obtained within 180
� days after it has been accepted as complete.
Authorized signatur --- * Fee methodology set by Tri-County Building Industry Service Board
Print name: (�,pts-.t /AA tLl:@'L Date: (Cita!/co / / g , ,7�
I:Building Permits,MEC PermitApp_040113.doc 440-4617T)1102 COM WEB) l�
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: ; ,Fermat Fee '
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
L`.
Building Permits\MEC_PennitApp_040I 13.doc 2
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
10225 SW SERENA WAY, TIGARD, OR, 97224
Record Type:
Residential - Mechanical
Inspection Type:
699 Mechanical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MEC2016-00413
Inspector:
Jeff Grove
Contractor