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_ 12682 S6V DA14BUSH COURT
CITY OF T I G A R D MECHANICAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . : M E C9 9 01
DATE ISSUED: 03/24/99
PARCEL: IS133DD--0710kl
SITE ADDRESS. . . : 1i-1682' SW DANBUSH CT
SUBDIVISION. . . . : VILLAGE AT SUMMER LAKE PARK ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 1 10 JURISDICTION: TIG
CI-ASS OF WORK. . :ALT FLOOR TURN. . . . : 0 EVAP COJLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . : R2, VENTS W/O APPL.: 0 VENT SYSTEMS: 0
T 0 R I E S. . . . . . . . 0 BOILERS/COMPRESSORS HOODS. — . . . . : 0
FUEL TYPES-- 0-3 HP. . . . : 0 DOMES. INCIIia: 0
:GAS 3-1.5 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15--30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSToVES. . : 0
GAS PRESSURE. . . 7-'0+ HP. . . . - 0 CLO DRYERS. . : 0
NO. OF rA.1 HANDL I NG UNITS OTHER UNITS. : I
FURN ( 100K BTU: 0 1,0000 cfm: 0 GAS OUTLETS. : 1
FURN ) =100K BTU: 0 > 10000 c-Fm : 0
Remarks : Fireplace insert and qas piping.
Owner: FEES
JANICE EBNER type amoi-int by date t-eept
12682 SW DANDUSH C1 PRMI $ 25. 00 B 03/24/99 99-313940
. ----:313940
TIGARD OR 97223 FJ11 $ 1,215 B 03/24/9? 99
Phone #:
Contractor:
HOLMES INSTALLATION SERVICE
PAYMOND FLANDERS -------------- ----------------------- --
33535 NW VADIS ROAD 26. 25 TOTAL
CORNELIUS OR 97113
P1
hone #: 647-9320
Reg #. 00102.4
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas !.ane Insp
Tigard Municipa) Code. State of Grp. Specialty Codes and all other Final In:pection
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 gore
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the O"gon Utilif-i Notification Center. Those rules are
set forth in DAR 952-01-FAII through OAR 95?-88I-8890. You may
obtain copies of these rules or direct questions to OW by call4ng
(503)246-9187.
Tssi-te By - Per-mittee Signati-It-ej)
4-+++++4........................4 s-+-+++4.................4...........................
Call 639-4175 by 7:00 p. m. for, inspections needed the next bl.ts ;ness day
4++++-+++++++++++++•1-++++4-++..................4...1-++++++++++++++++++++•++++•+-t++
CITY OF TIGARD Mechanical Permit Application Plan Check*
Recd By
13125 5W HALL BLVD. Commercial and Residential Rete Recd�- _
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type PermittfMfrjF T( t 77
__ _ Iiiicomplete or illegible applications will not be accepted Called
Name of Developme t/Proiect ErabIle
tion - — -
1l� A Mechanical Code Qty Price Amt
.lob Street Address SuiteN I A) Permit Fee _ 1 10.00
Addrass b� C 1) Furnace to 100,000 BTU
includin ducts&vents _sed footnote 1,2 6.00
B dgM C y/5tate Zip 2) Furnace 100,000 BTU+
UI QcA CM 7 3 Including ducts&vents s_oe footnote 1,2 7.50
Name(or name of business) 3) Floor Furnace
Owner ",l�_ including vent see footnote 1,2 6.00
ailing'Address 4) Susp9nded heater,wall heater
or floor mounted heater see footnnte 1,2 6.00_
5) Vent not included if,appliance permit
CHy/State Tlp Phone 3.00
- - ( Check ali that apply 'Boller Heat Air —
Norm(or nameof business) `— For Items 6-10,see or Pump Cond qty Price .Amt
footnotes 1,2 Com
6)<3HP;absorb unit to
Occupant M dlinpAddress 100K BTU
6.00
_ 7)3-15 HP;absorb unit
ty/state. Zip Phone 100k to 500k BTU 11 00
8)15-30 HP;absorb --—
Name unit.5-1 mil BTU 15.00
Contractor 9)30-50 HP;absorb
L / C j C e unit 1.1.75 mil BTU 22.50
Prior to permit Mailing' dress 10)>50HP;absorb unit
issuance,a copy (1/i✓ >1.75 mil BTU 1 57_.50
of all licenses Hy/State Zip Phone 11)Air handling unit to 10,000 CFM
are required d e-u,(ue/, WS U1,9r 4.50
expired in COT oesg'on Const Cont Board Llc.M cep.Dale 12)Air handling unit 10,000 CFM+ _
_odtabase )
7.50
Architect` Narne — 13)Non-portable evaporate cooler
4.50
or Meiling Address 14)Vent fan connected to a single duct
3.00
15)Ventilation system not Included in
Engineer Cny/state Zip Phone - appliance permit4.50
16)Hood served by mechanical exhaust
Describe work to be dare: - 4.50
17)Domestic Incinerators
New O Repair Q Replace with like kind Yes^ No O _ 7.50
Resldentia;jQ Commercial O 18)Commercial or industrial type incinerator
30.00
Additional Information or description of work - 19)Repair un"s -
20)Wood stove 4.50
NOTE: For Commercial projects only;Units over 400 lbs.require _ 4.50
structural gas calks. 21)Clothes dryer,etc.
Type of fuel oil O natural gas(X LPG O electric O 4.50
22)Other units --
I hereby acknowledge that I have read this application,that the information (V 1'� I 4.50
given Is correct,that I am the owner or authorized agent of 23)Oas piping one to fbur outlets
the owner,the!plans submitted are in compliance with Oregon State laws. See footnote 1 2.00
24)More than 4-per outlet(each)
Signature of Owner/Agent Date— — 50
3 z4
_._
Minimum Permit Fee 125.00 SUBTOTAL 21S
Contact Person Nathe Phone
f foZ7'7_��1 C -_. __-__ 5%SURCHARGE
PLAN REVIEW 25%!'; -UBTOTAL
Foonotes for commore lal projects only: _ Re ulq red for ALL commercial permits only
1. Provide full schematic of existing and proposed gas line and pressure TOTAL
2. Provide drawings to scale showing existing and proposed mechanical
unfts_ —_ _�— •State Contractor Boiler Certification required -
-Residential A/C requires site plan showing placement of unit
I:Yrecli doc rev 02/4/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST --------
F3UP
_Date Requested._ ��2 S' �� AM —_PM _`_ BLD
Location 1 1�y�Z V��u'1 1�1,CS�- C^s�f Suite _ MFC
Contact Person my; 5�,�,{/��/L, . Ph FLM
Contractor—_ Ph SWR
BUILDING -� Tenant/Owner _ i ELC
Retaining Wall
Footing Access: ELR --
Foundation FPS
Fly Drain _
Crawl Drain Inspection Notes: SGN
Slab
Post& Beam - ------ ----- - ------- -- SIT ---- -
Ext Sheath/Shear
Int Sheath/Shear ----- -
Framing
-- -- ---
Insulation ---
Drywall Nailing
Firewall =- ------ --___ --
Fire Sprinkler -
- - --
Fire Alarm � ---
Susp'd Ceiling
Roof / - --
Misc -
Final - --�--- -
PASS PART FAIL - _--?z
PLUMBING `
Post& Beam - --- -- __
Under Slab
Top Out - ----------
Water Service
Sanitary Sewer --
Rain Drains
Final
PASS PART FAIL
ECHANIC .
Post eam - - - - - - --
Rough In
Smoke Darpers
$ASS � PART FAIL
ELECTRICAL - ----
Service - I
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE ---- -
Backfill/Grading - - - --
Sanitary Sewer
Storm Drain ( )Reinspection fee of$ required before next inspe,:Uon. Pay at City Hall, 13125 SW Had Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RE:_ ( ]Unable to inspect no access
ADA
Approach/Sidewalk
Other Date 2 Inspector Extva-
Final - - - r
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639.4175 Business Line: 639-4171 MST _ —
//
_ __Date Requested ->V �(�l/ _AMBIJP
_ Pm - BLD
Location____ l 2(� �.. ("ba S1/L, C4—Suite __ —
MEr. —
Contact Person f'tr 41 d S -Ph '2 ��1 CLPLM
Contractor Ph SWR
BUILDING Tenant/Owner _ ELC Z--]L�
Retaining Wall ELR _
Footing Access:
Foundation
FPS
Ftg Drain L% ,r-I" �"L•t ° L� _ _
Crawl Drain Inspection Notes: SGN _—
Slab
Past 8 Beam - — 1 v_ 0 ----------- SIT --
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler - -- : ._----._�_.._.— Lf
Fire Alarm / --
Susp'd Ceilir g
Roof
Misc
Final
PASS PART FAIL -- --
PLUMBING
Past& Beam - - - ------
Under Slab
Top Out - - -- -- �— r-- -- - - —
Water Service
Sanitary Sewer -----
Pain Drains
Final -
PASS PART FAIL
MECHANICAL
Post& Beam
Rough In
Gas Line --- -
Smoke Dampers
Final - -
PASS PART FAIL
;LEC�T�:I(W
e -
Rough In -- --
UG/Slab
Low Voltage -
Fire A
IIPASS,�/PART FAIL - _.------
Backfill/Grading -- --� ----
Sanitary Sewer
Storm Drain ( j Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply line [ j Pleise call for reinspection RE' _ -- _ _ [ ] Unable to inspect- no access
ADA
Approach/Sidewalk
(1
Other �te — [rl _inSpP,CtOr "C'�---EXt --
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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