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13210 SW BRITTANY DR
CITYOF T I GA R D MECHANICAL PERMIT
DEVELOPMENT SEWCES PERMIT#: MEC2003-00708
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6;)94171 DATE ISSUED: 12/11/03
PARCEL: 1 S133DC-10200
SITE ADDRESS: 13210 SW BRITTANY DR
SUBDIVISION: BRITTANY SQUARE NO. 3 ZONING: R-12
BLOCK: LOT: 068 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UN°.T HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILERS/COMPRESSORS _ HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAiR
FIRE DAMPERS?: 30 - 50 HP: OODS UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation ol'gas fireplace and gas hiking.
Owner: _ FEES
PAVLUKOVICH, ROBERT Description Date Amount
13210 SW BRITTANY DR
TIGARD, OR 97223 I�il ('lll omit I�c 12/11/03 $72.50
IANN1 811 State surcharl 12/11/03 $5.80
Phone: Total _ $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Mechanical Insp
Reg# Final Inspection
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 wiii expire if work is
rc: Oarted withir, 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
r-:;uires you-to-follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952.001-00
Issu d By: Permittee Signature: "-
Call (504,09-4175 by 7:00 P.M. for Inspections needed the next business day
Nled—nical Permit Application Received � Mechanical
DateB : Permit No.:Y/�C'std5"40 70 g
It Of TiaC(I Planning Approval Building
y Dat" Permit No.-
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard.or.us Date/By Case No.:
24-hour Inspection Request: 503.639-4175 Contact Juns.: See Page 2 for
P 4 Name/Method. Supplemental information.
TYPE OF WORK ICOMMERCIAL FEE"SCHEDULE-USE CHECKLIST
New construction Demolition Mechanical permit fees•are based on the total value of the work
.}Addition/alteration/re lacement I LJ Other: performed. indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
1 & 2-Family dwell'ing Commercial/Industrial Value: S_ _ See Page 2 for Fee Schedule
Accessea BUildin Multi-Family RESiDENTiAIL EQUIPMENT/SYSTEMS FEE-SCHEDULE
Master Builder Other: Descri donQty I Fee ea. Total
Headn Conlin
JOB SITE INFORMATION and LOCATION Furn:ce-add-on air conditionin •• 14.00
Job site address: aGas heat pump_ 14.00
Suite#: B1dg./Apt.#: Duct work 14.00
Project Name: IH dronic hot waters stem 14.00
Cross street/Directions to job site: Residential boiler
�rfor radiator or h dronic system) 14.00
Ww te_.- Q 6 fC0'd l�jeE'/TNS' Unit heaters(fuel,not electric)
in wall in-duct,sus ended,etc.) 14.00
Flue/cent for any of shove 10.00
Subdivision: Lot#: Repair units12.15
Tax map/parcel #: other Fuel A Ilaacd
p Water heater 10.00
DESCRIPTION OF WORK Gas fireplace _ 10.00 _
Flue vert(water heater/ as fir lace) 10.00
j7,JiS LeNt C SJ 4r0NL i' - Lo lighter as 10.00
Wood/Pellet stove 10.00 _
Wood fireplace/insert 10.00
_ Chimney/liner/flue/vent 10.00
PROPERTY OWNER TENANT Other. 10.00 _
Name: At�/} �,r' .L , r �V r L f Environmental Exhaust ds Ventilation
Address: (j Range hood/other kitchen equipment _ 10.00
jT�—> , az Clothes dryer exhaust 10.00
City/State/Zip: ,:�•t•�� r- r; Z
Single duct exhaust
Phone:sir-)f> e Fax: I (bathrooms,toilet compartments,
APPLICANT I 000NTACT PERSON utili rooms) 6.80
Name: 5 r+ Y Ahic/crawlspace fans 10.00
Other: 10.00
Address- -- _ Fuel Piping
City/State/Zip: "(35.40 for first 4,$1.00 each additional
Phone: Fax: Furnace.etc, ••
Gas heat pump ••
E-mail: Wall/suspended/unit heater •• _
_C 4TRA OR Water heater ••
Business Name: L Fire lase •• _
Address: _ Range .60
BBQ 0*
City/State/Zip: Clothes dryer(gas) ••
Phone: Fax: Other: — ••
CCB Lir. #; Total:
Authorized // Mechanical Permit Fees*
Signature: —��� Date Subtotal: S )`1 4�
Minimum Permit Fee$72.50 S _�
_— l '!4✓L� , Plan Review Fee(25%of Permit Fee) S
(Please pnnt name) State Surcharge 8%of Permit Fee S 5
TO CAL PERMI r FEE S '" r
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 pian required for exterior A/C units.
i Tsts\Permit ForrnsVNecPermitApp.doc 01103
Mechanical Permit Aanlication - City of Tigard
Page 2 - Supplemental Information
_Commercial Fee Schedule: _
TOTAL VALIDATION: PERMIT 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 each
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$1.60 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.S 10,000.00 and$1.35 for
each additional$100.U0 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
_ I and including$100,000.00.
$100,001.00 and up $1,396.50 for the first$100,000.000 and
$1.10 for each additional$100.00 or fraction
thereof.
All New Commercial Built bibs twgvire 2 sets of'plans.
08udding\Permit Forms\Mec0. ritAppPg2 09-01.03 doc
1
CITY OF TIGARD 24-Hour
BUILC'.NG Inspection Lina: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP -- —
Received _--.._. Date Requested—_I d- ��"'` AM_ — PM BUP �y
Location __�3 �� — �— , Suite MEC �3 —6 d 2Q 0
Contact Person f2) Ph( _) ��� 7a _ PLM _
Contractor _— -----_-__ Ph(— ) _ _ SWR —
BUILDING _ Tenant/Owner —_ --_— ELC —
Footing —
Foundation ELC — —
Access:
Ftg Drain ELR —_—_
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam _..
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - - -------------
Insulation
Drywall Nailing _. ... - ---- ----- --
Fii-ewall
Fire Sprinkler --._-------- ---------
Fire Alarm
Susp'd Ceiling —--- -- --- — --- - -- —
Roof
Other: —^-- —
Final -------- --
PASS PART FAIL -- - —
PLUMBING _
Post& Beam
Under
�'� ------- -
Under Slab -- — _
Rough-In
Water Service --— ---- — — -
Sanitary Sewer
Rain i Drains - - — --- ---
Catch Basin/Manhole
Storm Drain ---------- ——— -- -
Shower Pan
Other --- — — — - ----
Final
PASS _P_ART FAIL
—MECHANICAL_
Post& Beam ,p
Smoke Dampers -- -- ------- --
XA
PART_ FAIL - ---- — —
C_TRICAL
Service — — -- ------ -- ---------
Rough-In
UG/Slab -
Low Voltage _ — ----- -- __ — —
Fire Alarm
Final u Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE -_ [� Please call for reinspection RE: —_— E] Unable to inspect-no access
Fire Supply Line
ADA �� /6 3
Approaar/Sidewalk Dote v Inspector --Ext
Other: _
Final — — O NOT REMOVE this Inspection record from the fob site.
PASS PART FAIL