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12761 SW DANBUSN CT '-
CITYOF TIGARD __ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMI #: MEC2004-00348
13125 SW Hall Blvd., Tigard. OR 97223 (503) b39-4171 DATE ISSUE0: 6/P/-' Cuff
SITE ADDRESS: 12761 SW DANBUSH CT PARCEL: 1 S133DD-07700
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 70NING: R45
BLOCK: LOT: 116 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: s EVAP COOLERS:
TYPE OF U:;E: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 1.5 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: 10000 cfm: — OTHER UN;TS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Add exterior A
Owner: — �— — FEES_ `_--
DENNY GHIM Description Date Amount
12761 SW DANBUSH CT
TIGARD, OR 97223 [MECH] Permit Fee 6/8/2004 $72.50
[TAX]8%.Slate Surchart 6/8/2004 $5.80
Phone: 503-579-2350 Total $78.30
Contractor:
BRAUK ENTERPRISES INC
DBA/BULL MT MECHANICAL
13580 SW RHETT CT REQUIRED INSPECTIONS
TIGARD, OR 97224 ---�
Phone: 503-702-2945 Final Inspection
Reg#: _IC 157814
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 'lregon Utility Notification Center. Thoi a 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:
Call ( 3) 639-4175 by 7:00 P.M. for inspections needed the next busless day
Mechanical PermiED
City of Tigard Received permit Na 3
13125 SW Hall Blvd.,Tigard,OR 97223 naceBy. ro
Plan Review -
Phone: 503.639.4171 Fax: 503.598.1960 1004 Date/By: Other Permit
Inspection Line: 503.639,4175 �� Y V� f I�ARD Date Ready/By: Jul is U See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
F�l1I►.nINr n►Vl�lnn� - —
;,,;i,e j',i Y " . , —TYPE OF WOW � _ ---- COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
[_]New construction Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit
CATEGOkY OF CONSTRUCTION Value 5
(� I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building— RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
❑Multi family El Master builder El Other: For special information use checklist
_ Description Qty. Ea. Total
JOB SITE INFO ATION AY610CATION — Heating/cooling
Job site address:— in 7(7� —� Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/Zip: � h-, it 2- 2 3 Furnace 100,000 BTU ducts/vents) 1400
Furnace 100,0004 BTU ductatvents 1790
Suite/bldg./apt.no.: _' Project name: h r Gas heat pump 14.00
Cross streoUdirections to job site: Duct work 1400
H dronic hot waters stem 14.00
Residential boiler(radiator or
h dronic) 14.00
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc 10.00
Subdivision: I Lot no. Flue/vent for any of above 10.00
—---- -- — -- Other: 1000
Tax map/parcel no.: Other fuel aptIllances
DESGRII''CION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas I
fireplace 1000
-- - -- - -
—Log lighter as _ 10,00
Wood/pellet stove 10.00
Wood fireplace/insert _ 10.00
Chimne /linevflue/vent 10.00
—Z PROPERTY C iVNER T -- -❑ TENANT.- _
- Other. 10.00
Name: I��'
n �.� �t Cyt Environmental exhaust and ventilation
Address: 7 ? > f" Range hood/other kitchen
(.� equipment _ 10.00
City/State/ZIP: t11 Clothes dryer exhaust �— 10.00
---- Single-duct exhaust(bathrooms,
Phone:(S 3l Fax:( ) toilet compartments,utilityrooms 6.80
—�� 0 A PLTCA.NT ' d CONTACT PERSON — Attic/crawls acc fans _ 10.00
Business name Other: 10.00
--- -- --- - --- - - Fuel piping _
Contact name: $3.40 for first four;$1.00 for each additional
Address: Furnace,etc.
--- - Gas heat pu2T.
City'State/I P Wall/suspended'unit heater
Phone:( I Fax: .! Water heater
- ---- - - ----- ---— - - --- Fireplace
E-mail:
- —_----- - — _- -- - Ran e
CONTRACTOR
,y� Barbecue _
-Business name: L �u �� pGcwG�T/hJ //�GG`j/F�u'G'/j Cloth.d er as) — _ --_
(l:hrt
Address: 3 S C) �C i, J � 6'KIry �lLt II:1�U �I Ptlt�11! t F!
City/State/ZIP:
( 6A 7 eco 2C( Al S"U3) S2�/ �j S 3-� Mmlmum Permit tee 15 50)
Phone: `7 FP.x:( "y _Plan review(25%of permit fee)
CCB lie. Q - ? State surcharge(B%of permit fee)
(_.---- TOTAL PERMIT
Authorized signature: _ Lam' �� - --- This permit application expires if a permit is not obtain d uhtlstao
days after It has been accepted as complete.
Print nameTie /���e��j'r✓ Date , -� (b1 Fee methodology set by Tri-County Building Industry Service Board
i'JSuiWinpPemvUtMEGPrmutAppdoc 12.07 / 4404617T(II102R,3AVWEa)
Mechanical Permit Application - City of Tigard '
Page 2 - Supplemental Information
Commercial Fee Schedule:_
Total.Valuatioq:� _� Permi(,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 ea.-h 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
$1.35 for each additional$l OO.OU 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
$100,009.00.
$100,000.01 and up $1,396.50 for the first$100,000.00 and
$1.10 for,.ach additional$100,00 or
&action thereof.
Note: All new commercial buildings require 2 sets of plans.
i:dBuilding\Pcrmits\MEC-PetmitApp.djc 11/03 2
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CITY OF TIG"ARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
& BUP _
Hecei\,ed D Hequested �/ 0--- pM__ BUp
Location _� �� ?L-��1; -�' Suite _ E
Contact Person _ Ph( ) _ =� � PLM
Contractor Ph( _) SWR j���
BUILDING Tenant/Owner ELC A 0-u
Footing
Foundation ELC
Ftg Drain ACC@SS:
Crawl Drain ELR
Slab Inspection Notes: SIT
Post& Beam -
Shear Anchors —
Ext Sheath/Shear —
Int Sheath/Shear —Framing
Insulation (rlL+
Insulation —
Drywall Nailing -
Firewall -
Fire Sprinkler
Fire Alarm ----
Susp'd Ceiling — —_
Roof
Othei:
Final ----- --------- __� -
PASS PART F''AIL
Post& Beam
Under Slab _ -
Rough-In --
Water Service _
Sanitary Sewer
Rain Drains
Catch Basin/Manhole —
Storm Drain
Showbr Pan
Other: -- - —
Final ��------� -
PART__, FAIL
AECHANICAL,
�'gSYS Beam — — -
Rough-In
Gas Line Ars Smoke Damp
PART FAIL
z
i4ICA
L
Service --
Rough-In _
UG/Slab
Low Voltage
Fire Alarm - -
Final Reinspection PASS PART FAIL t--I pection fec of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE —' E] Please call for reinspection RE:—_ Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dab InspeoW ut
Other:
Final DO NOT REMOVE this Inspection record from the job She.
PASS PART FAIL