Permit CITY MARI MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00300
DATE ISSUED: 7/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 133DD -07300
SITE ADDRESS: 12726 SW DANBUSH CT ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT: 112 JURISDICTION: TIG
Project Description: Install approximately 40' of gas line to range location.
CLASS OF WORK: OTR 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: DOMES. INCIN:
NAT 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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
MIKE STEVENS Description Date Amount
12726 SW DANBUSH CT [MECH] Permit Fee 7/3/2006 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 7/3/2006 $5.80
Total $78.30
Phone: 503 784 - 3850
Contractor:
KOEHLER CONCEPTS LLC
10772 SE HWY 212 REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Contact #: FAX 503- 650 -1220
PRI 503- 650 -9550
Reg #: LIC 120277
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
or 1 -800 -3 1. 234\
Issued By. 0-L -6-11 Permittee Signature
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit cans 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 Application �. l „, I � ' I j t)I( 1( I'I i)i I �} ` k'
0 1 25 5 off }l JI ar d Tigard, Oft 97 E C E I V E D R° y' � � Pumeh No•: i CA D ��
Plan Review Other Pervut
Phone: 503.639A171 Fax: 503.598.1960
Inspection Line- 503.639.4175 JUN 3 0 200 ! � '1 Date Ready/By: RI See Pagge 2 for
Internet: www.ci.tigard.or.us Nolif ied/Mothod; I /a, SupplementnI tnfoneetton
CITY OF TIGA -
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❑ New construction Addition /alteration/rcplacetnent f the weak
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials,9uipment, labor, overhead, and profit.
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1 Multi- farnily ❑ Master builder ❑ Other: Description k Qty. I Ea. I Total
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%lam r ti �5� t:,X' Air conditioning or heat pump
lob site address:
Z.1ZL,@ i nqu i res site plan showing placement) 14.00
City/State/ZIP: . ` ,,,.. or „,),, tk'--.1]-2- Furnace 100,000 BTU (duets/venal) 14.00
Furnace 100,000+ BTU (ducts/vents) _ 17.90
Suite/bldg./apt. no.: Project name: Gas hest pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system _ 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in - wall. to - duet. suspended, etc. 10.00
Subdivision Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map/parcel no.: Other fuel appliances _
u p , tw -Y .-< Y rr 9 ❑,T vP r I ! I ('1,'i, 111 Ii.:, n'
••� , , , Y 1�f 1+41'�1 f , , , l I r rl ( t {s , : ,, 1' Witter 10.00
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Gas fireplace 10.00
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K1...oas - - • ` em■C Q.4-.,a)... Flue vent for water heater or gas
fireplace 10.00
w •".1 =�+II...ah Lop cps) 10.00 ,
Wood/pellet stove, 10.00
Wood fireplace/insert _ 10.00
f , n+'ra'c rr^^ , 7 •� r f 7^ - T-rm -- - rr I -1-1:1- r Chimney/liner /flue/vent 10.00
1 . I l, { I f i11 .r: I It ritTk 3 7, r1 �Ifibiik1lgh} . wl Ft 7 1 7 I�SJf�th i,r\ ntr P11(IrTI li.d cab ����l.lil ll ..r,,., t�,,Y -, - - .,�, u I'LL; ,''l l. l ,I. , .>�i 1 1 �, ��E�;, k .,:. ,:�,a -.: �_ 10.00
Nerve: `C`c 5,._.e_ pip Environmental exbanst and ventllatlon
tzss: _ \ Range hood/other iltchee
Add
�Z..� ZLQ SI.,.„, --- taee� ~ CJ� equipment - 10.00
City/State/ZIP :-...,t 0.r,,'t1 '- C Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: p'1) , (b - V i b () Fax: ( ) toilet compartments, utility rooms) 6.80
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+ . - 17 - „' t '�' _ fn( * I ur { 7 }r � .G _17 . t' '77 "1j 1 J 1' :.71. , A Uc/c fans 10.00
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Y Other: 10.00
Business name: \4b2,......\pAt.- oh. •_' _ Fuel pipinyt
Contact name: t , , 55,40 for flrat four: S1.00 for each additional _
Furnace, etc.
Gas heat pump
. f •� Wall/suspended/unit heater
Phone:) C,Q -C\S Fax:: (4) ldr1J _Vtis..) Water heater
Fireplace
E-mail: , c > . tel,Ls - -r te\ - Range
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Clothes dryer (gas)
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Address: \V •G t..� \� / 1, I i1 1,l i
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City /State/ZIP: G - r a1+„ cr . �.0 . subt
Minimum permit fee ($72.50) `T2,,S
Phone: eg5e, les0 QsS Fax: SI$S ) (dQ QL1) Plan review (25°x6 of permit fee)
CCB Iic.: \ ` ^' State surcharge (8% of permit fee) ,tbr.
TOTAL PERMIT FEE 1 3i..)
Thle permk eppllea ton expire' If a permit V not obtained within 1190
Authorised signature: _ days after It hue been accepted ee complela
I Print name Date: GAD ..-4( • Fee methodology set by Tri -County Building Industry Service Board
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CITY OF TIGARD v
,
BUILDING' DIVISION
PERMIT #: MEC2006-00:$00
13125 SW Hall Blvd.,, Tigard, OR 97223 DATE ISSUED: 7
Phone: (503) 639-4171 .ireviii . Aig 6 -00 300
Inspection Requests (24 Hrs.): (503) 639-4175 a t _._ pb O r . ■ ■ . . 111
INSPECTION WORKSHEET FOR DATE: 7/1212006 TIME: 7 : 05 AM PAGE: 29
SITE ADDRESS: 12726 SW DANBUSH CT CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT #: 112 TYPE OF USE:
PROJECT NAME: STEVENS
DESCRIPTION: Install approximately 40 of gas line to range-location.
OWNER: STEVENS, MIKE PHONE #: 503
CONTRACTOR: KOEHLER CONCEPTS LLC PHONE #: 503-650-9550
Inspection Request Scheduled For: Date: 7/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 032976.01 503-794-3850 Y
Corrections /Comments/ Instructions:
#1 2 (- t9' (----- To -..._- :20 _, .
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14 PARTIAL APPROVAL D CANCEL El NO ACCESS
I I FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: ----/-7 Date: 7—/.2,...--- 4-9 Phone #: (503) 718- - L .4 ( 7 175
•