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Permit CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2003 - 00304 a 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/6/03 PARCEL: 1S133DD-07400 SITE ADDRESS: 12739 SW DANBUSH CT SUBDIVISION: VILLAGE AT SUMMERLAKE ZONING: BLOCK: LOT: 113 JURISDICTION: TIG 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: 1 DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: • FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replace existing a /c. Owner: FEES ALBAUGH, JAMES B + Description Date Amount MUNRO, JUDITH E [MECH] Permit Fee 6/6/03 $72.50 12739 SW DANBUSH CT TIGARD, OR 97223 [TAX] 8% StateTax 6/6/03 $5.80 Phone: Total $78.30 Contractor: BELL HEATING 15550 SE PIAZZA AVE CLACKAMAS, OR 97015 REQUIRED INSPECTIONS Phone: 503 Cooling Unt Insp Final Inspection Reg #: LIC 447 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 - 9-100 ou may obtain copies of these rules or direct questions to OUNC by calling (503) 6 -6699. / Issued y:� : y� / l Permittee Signature: , ..62.1/61 d Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day l0%gechanical Permit Application ' FOR OFFICE USE ONLY • . Recei ved /I Mechanical p� Date/By: 00 2 , WtO 0 Permit No.: Mge ./" City of Tigard RECEIVED Planning Approval Building g E C E 6 V E D Date/By: Building No.: 13125 SW Hall Blvd. ��!/ II� Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 5 - 98 -1960 Post - Review Land Use J U IV ') LUIJ3 i l l l � Date/By: Case No.: Internet: www.ci.tigard.or.us n . Contact ® See Page 2 for 24 -hour Inspection RequesCI 3 9 yU ,Rp '4 Name/Method: '/ 1(. , Supplemental Information. BUILDING DIVISION ....-�, ril,Rt } .; t,. x'E#111SE'CHEcicus . �;;.�� -M. _,�..;T�YPE�OF.•W,QRK _ �<�° �..<�:� <µ �: ,�.. �..- ._.. -. ..., .- i�CO1VIMERCIAL'�FEE�,�S,CHEDUL � . .. �:;.: ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work lOn/,�eplaceme ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all •. I `. = a F.CATEGORY. CONSTRUCTION ` d _ '_' '_' `4i-f: mechanical materials, equipment, labor, overhead and profit. 1 & 2- Family dwelling ❑ Commercial /Industrial Value: 5 See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family •:•: RESIDENTIAL - EQUIPMENT /SYSTEMS4EE* €SCHEDULE W'.= Description Qty Fee(ea.) Total ❑ Master Builder ❑ Other: Heating/Cooling x t- 1,4OB'SITE:INFORIVIATION -aiid L''O f' - Furnace - add -on air conditioning ** ' 14.00 Job site address: 1113q ' ,,,, ( C T Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: (. - A.0 C--. vi, . 1 R._ Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: Lot #: Repair units 12.15 Other Fuel - Appliances ' - ` ' ` Tax map /parcel #: Water heater 10.00 'IP: rt- V; .. >DESCRIPTION OF. WORK ";:' is 4 ' : :: Gas fireplace 10.00 A /L Ze 2 <-P„ Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 • Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner /flue /vent 10.00 tt ® =PROPERTY OWNER„ ... f' I'' ®tTENAN F'- `;`1 5 Other: 10.00 _ Name: - • • • Envii itahEzliaust:& Ventilation i.... �v v��. ` � � 1 - " t� \ R ange hood/other kitchen equipment 10.00 Address: t? 13G c. v' .1S1\ G Clothes dryer exhaust 10.00 City /State /Zip: Z ‘ (.,A2 ©e_ - q-7 aa Single duct exhaust Phone: s 41 Fax: (bathrooms, toilet compartments, APPLICA i :. T; °;r° : El CONTACT:PERSON ' `? utility rooms) 6.80 Name: \ Attic /crawl space fans 10.00 1 , 1 �T j T /� �� , ' Other: 10.00 Address: \ SS'© �C : 5 ZZ�t ! .. _ ,. - ... 'ri.uei,Piping .. .. . .:• .. - City /State /Zip: -,A ,,, 5 0 -- Q 701.5 * *($5.40 for first 4, $1.00 each additional) Phone: 65G- 1 �\ Fax: a 510 -1Sk\ Furnace, etc. ** V Gas heat pump ** E-mail: Wall /suspended/unit heater ** F ,:; v • :r _ a., ,€ ti.sz,;., #� :�:' r;�-sK �,^-; - <E .t':' ;t_r�,, °- �.s _'�� �=��;.�4y �' `.,�t���: .;COlV'TRACTOK - �k°`l ='s�� : _.::. _ �,`.;• Water heater ** Business Name: ° J ; av c ∎S ` 11 Fireplace ** Address: Range ** City /State /Zip:_ Clothes dryer (gas) ** Phone: __ Fax: Other: ** CCB Lic. • . "„ 4 1 €' ' l 1 iA Total: Authorized Mechanical Permit Fees* • Signature: ` � _ u//03 Date: / Z� c0 • 2 G Minimum Permit Fee $72.50 $ "1 :'-- - tY�V O/aA Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ .5, TOTAL PERMIT FEE $ ,--1 8 . Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard • Page 2 - Supplemental Information • Commercial Fee Schedule: Total Valuation: $1.00:to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Asuined V aluatio n $ ;Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents - Floor furnace including vent 955 • Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL - $ VALUATION: i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 • • . • • .) 0 6 CA y ' ti 1 F; o cP c • , PHONE: 52y1/44, 1 CUSTOMER: ADDRESS: JOB NO 1AT1 ' `5';m f L.13 k Z1 SLJ a�sN.GT, ' "�li ! 'DRA u 'DRAWN BY: � @`� 1 ev 1. BELL HEATING ING I MAP CODE: (0. 5S j I CITY OF TIGARDD" 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP 1 Received Date Requested AM PM ✓ BUP Location a- 11 1.L.r. • •_' uite MEC 3 - 00 3 Contact Person . Ph ( ) G - t (0 `T PLM Contractor Ph ( • ) K °1 SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam l • 30 -33o Shear Anchors Ext Sheath/Shear Int Sheath/Shear II Framing = _tl t CA-L .. • . G b 6 C.. i -86 6 /LLv JT Insulation �� Drywall Nailing I ` Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab. Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In (4- � - Gas Line Sm a Dampers in PART FAIL ELECTRICAL 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: ❑ Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL