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COMA2013-0832
MAP C-O MAR 2 5 20 � OF ISSUANCE: A0 RMIT #: BUILDING PERMIT APPLICATION PLEASE PRINT JOB ADDRESS: ��i IGJ 5. SUITE # CX> LOT: I BLOCK: A SUBDIVISION: Cr.�:�.�� n&� , --\ BUILDING CONTRACTOR (company name): 14 0, JJe.,�. �WKx � �( •1•�� CURRENT MAILING ADDRESS: CITY /STATE /ZIP: ��r �X �ro�7�� PH:9yn a3v yG9S� Fax # PROPERTYOWNER: Cia CURRENT MAILING ADDRESS: 3MLHA_.J.��.��SS,�f1r �f'• l CITY /STATE /ZIP: :nX S aV S PHONE NUMBER: PROJECT VALUE: $ 9 _ FIRE SPRIN�KLERED? YES NO 7� f DESCRIPTION OF WORK TO BE DONE: USE OF BUILDING OR STRUCTURE: NAME OF BUSINESS: "Total Square Footage under roof: f (K) Square Footage of alteration /addition: �, S 5F I hereby certify that plans have been reviewed and the building will be inspected by a certified energy code inspector in accordance with State Law. Plan review and inspection documentation shall be made available to the Building Department (required for new buildings, r alterations and additions) 6/ I hereby certify that plans have been submitted to the Texas Department of Licensing and Regulation for Accessibility Review. Control Number: EMM11R_T e� -- 4w %,rlz (Not required for I & 2 family dwellings) I hereby certify that an asbestos survey has been conducted for this structure in accordance with the regulatory requirements of the Texas Department of Health. (REQUIRED FOR DEMOLITIONS, ADDITIONS AND OR ALTERATION TO COMMERCIAL AND PUBLIC BUILDINGS) I hereby certify that the foregoing is correct to the best of my knowledge and all work will be performed according to the documents approved by the Building Department and in compliance with the City Of Grapevine Ordinance regulating construction. It is understood that the issuance of this permit does not grant or authorize any violation of any code or ordinance of the City Of Grapevine. I FURTHERMORE UNDERSTAND THAT PLANS AND SPECIFICATIONS ARE NOT REVIEWED FOR HANDICAPPED ACCESSIBILM Y THE CITY, AND THAT THE DESIGN PROFESSIONAL /OWNER IS RESPONSIBLE FOR OBTAINING SUCH A RO R TH THE STATE AND OR FEDERAL AGENCY S).`` _ PRINT NAME: A \. �a��cl� SIGNATURE PH #: � ��U i"�� 16 FAX #: EMAIL: . CHECK BOX IF PREFERRED TO BE CONTACTED BY E -MAIL I THE FOLLOWING IS TO BE COMPLETED BY THE BUILDING INSPECTION DEPARTMENT Construction T e. Permit Valuation: $ C-0 Setbacks Approval to Issue Occupancy Group: Fire Sprinkler: YES NO Front: foal Division: Building Depth: Left: Plumbing Zoning: Building Width: Rear: Mechanica Occupancy Load: I'f- Righ Plan Review Approval: Date:,' j Building Permit Fee: Gj. 75` Site Plan Approval: Date: Plan Review Fee: 3 ire Department: Date: Lot Drainage Fee: Public Works Department: Date: Sewer Availability Rate: Health Department: Date: Water Availability Rate: Approved for Permit: Date: f,< Total Fees: Lot Drainage Submitted: Approved: Total Amount Due: P.O. BOX 95104, GRAPEVINE, TX 76099 (617) 410 -3165 O:FORMS \DSPERMITAPPLICATIONS 1/ 02- Rev.11/04,5/06,2107,11/09,4/ /'� AB Project Reprint Confirmation Page EABPRJB3809678 Texas Department of Licensing and Regulation Architectural Barriers Project Registration Confirmation Page Thursday, March 07, 2013 EABPRJB3809678 PERSON FILING FORM Name: Sharon Krueger Phone:817- 781 -3044 Person Address: 6405 Tranquility Court, Arlington, TX 76016 Ras Number: 00000428 Project Name:The Dentist Off Main Project Address: Capitol Center 1245 S. Main Grapevine, TX 76051 County: Tarrant TENANT Contact Name:Richard Luczak Phone: 817-874-3912 Contact Address: BUILDING /FACILITY Name:Capitol Center FACILITY Owner:GCC Project Owner LLC Phone:214- 954 -1676 Owner Address:3544 University Drive, Dallas, TX 75205 Contact Name:Ben Sumner Phone: Contact Address: Contact Email: DESIGN FIRM Name:M.J. Wright & Associates Phone:817- 268 -5555 Firm Address:8233 Mid Cities Blvd Suite A, North Richland Hills, TX 76182 Designer Name:Michael J. Wright Type of License:Architect License Number: 11130 Page 1 of I PROJECT DESCRIPTION Start Date:03 /2013 Completion date:05 /2013 Estimated Cost:$110,000.00 Type of Work: Renovation /Alteration Type of Funds:This project is privately funded, on private land for private use. Are the private funds provided by a tenant? Yes State Lease No. : Scope of Work:Renovate office space to dental office. Does this building(s) have more than one level ?Yes Are there any elevators, escalators, or platform lifts in this building ?Yes Are there any boiler in this building ?No This AB Project registration Confirmation Page, construction documents, and applicable fees must be submitted in accordance with the Texas Administrative Code Chapter 68, Rule 68.51. If TDLR will be performing the review or inspection services, see Rule 68.80. If a RAS will be performing the review or inspection services, please contact the RAS as they set and collect their own fees, see Rule 68.75. In accordance with Rule 68.52, the owner of a building or facility must also obtain an inspection from the department or a registered accessibility specialist not later than the first anniversary of the completion of construction. Request for inspection shall be made by completing the Request for Inspection form and submitting it no later than 30 calendar days after the completion of construction. Apr.02.2013 10:11 AM Feris Electrical, LLC 8172444344 PAGE. 2/ 3 CITY OF GRAPEVINE V MECHANICAL TO , ELECTRICAL,), PLUMBING- FUEL GAS PERMIT APPLICATION PLEASE PRINT PERMIT # f _ BLDG. PERMIT # j . � / C1 DATE: JOB ADDRESS: i 0 SUITE i # DI ?S RIPTIO OF WORK: PROPERTY OWNER: CONTRACTING OMNPANY: ADDRESS: ADDRESS: # V3 L GE S% J,3,J CITYISTATEIZIP: CITYISTATEIYIP:k J w PHONE NUMBER: PHONE NUMBER: VSO 0 TYPE OF OCCUPANCY BUILDING AREA (SO FT PERMIT FEES AMOUNT DUE EARAC2 , eH 1- 749 $ 33.25 SINGLE FAMILY, DUPLEX 750- 1,199 $ 48.88 TOWNHOUSE, 1,200- 1,500 $ 63.18 NEW CONSTRUCTION 8 1,501- 1,750 $ 76.48 ADDITIONS (PER UNIT) 1,751- 2,000 $ 83.13 2,001- 2,250 $ 89.76 TOTAL SQ.FOOT UNDER 2,251- 3,000 $ 98.43 ROOF 3,001- 3,500 $ 103.08 3,501 - 4,000 $ 109.73 4,001+ $ 120,37 EACH LM!?F 11. A, E, I, R -1 1 - $00 $ 37,00 HOTELS, APARTMENTS, 501 - 100,000 $ 17.50 +.035 PER 1 DRINKING /DINING, 100,001 - 500,000 $ 3,500.00 + -03 SQUARE EDUCATIONAL, ASSEMBLY, $00,001 + $15,000.00 +.02 FOOT INSTITUTIONAL III. B, F, H, M,S,U EAQH TRADE 1- 500 $ 37.00 OFRCET RETAIL, WHOLESALE, 501- 50,000 $ 32.00+.01 PER 1 GARAGES, FACTORIES, 50,001- 100,000 $ 162.00+ .007 SQUARE WORKSHOPS, SERVICE 100,001+ $ 582,00+,003 FOOT STATIONS WAREHOUSE CONlsaA EACH TRADE IV. ANY OCCUPANCY GROUP VALUATION OF Wig FINISH -OUTS, SHELL COMPLETION$, 0- 500 $ 37.00 ALTERATIONS OR 501- 1,500 $ 45,00 STAND ALONE PERMITS 1,501- 3,000 $ 57.00 CONTRACT VALUATION OF WORK; 3,001- 5,000 5,001- 50,000 $ 72,00 $ 27_00+.009 $ �. 50,001- 100,000 100,001- 500,000 $ 127.00+.007 PER $ 327.00+ .005 DOLLAR /(r� l ¢s X 500,001+ $ 1,327,00+,003 VALUATION V. MISCELLANEOUS EAQH,TRADE IRRIGATION SYSTEMS $ 37.00 MOBILE HOME SERVICE $ 37.00 TEMPORARY POLE SERVICE $ 37.00 SWIMMING POOLS $ $7.00 SIGN ELECTRIC $ 37.00 O!TORMSIDS APPLICATIONS . FEGSWFP APPLICATION 4 -11 mm `_ Apr.02.2013 10:11 AM Feris Electrical, LLC 8172444344 PAGE. 3/ 3 PLAN SUBMITTAL: WHEN PLANS ARE REQUIRED BY CODES, ORDINANCES, OR AS DETERMINED BY THE BUILDING OFFICIAL, THREE (3) SETS OF PLANS SHALL BE SUBMITTED IN HARD COPY FORMAT, ENGINEER SEALED PLANS AND CALCULATIONS SHALL BE SUBMITTED AS REQUIRED BY CODES, ORDINANCES OR WHERE OTHERWISE REQUIRED BY STATE L.AW, OTHER INSPECTIONS AND FEES: • INSPECTIONS OUTSIDE NORMAL BUSINESS HOURS (2HR MINIMUM) ..................... .........................$42.00 /HOUR" • REINSPECTION FEES .................. ............................... I"......... ................ ....... .................. ......... $42.00 • PERMITS FORWHICH NO FEE IS SPECIFICALLY INDICATED ............................ ............................... $37.00 • INSPECTIONS FOR WHICH NO FEE IS SPECIFICALLY INDICATED (112 HOUR MINIMUM) ........... ..........$42.00 /HOUR • ADDITIONAL PLAN REVIEW REQUIRED BY CHANGES, ADDITIONS, OR REVISIONS TO APPROVEDPLANS ......................... ............................... ......................... ............ ....................$42.00 /HOUR • BUILDING PERMIT FEES FOR THE GRAPEVINE- COLLEYVILLE INDEPENDENT SCHOOL DISTRII T SHALL BE 25% OF THE FEES ESTABLISHED IN THIS TABLE • FOR USE OF OUTSIDE CONSULTANTS FOR PLAN CHECKING AND INSPECTIONS, OR BOTH ......... ACTUAL COSTS" I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND ALL WORK WILL BE PERFORMED ACCORDING TO THE DOCUMENTS APPROVED BY THE BUILDING DEPARTMENT AND IN COMPLIANCE WITH THE CITY OF GRAPEVINE CODES REGULATING CONSTRUCTION, IT IS UNDERSTOOD T AT THE ISSUANCE OF THIS PERMIT DOES NOT GRANT OR AUTHORIZE ANY VIOLATION OF ANY CODE OR ORDINA NCE OF THE CITY OF GRAPEVINE. I FURTHER CERTIFY THAT ALL WORK THAT 1S REQUIRED TO COMPLY WITH ANY FEDER kL, STATE, AND 1 OR LOCAL LAW REGARDING ENERGY CONSERVATION WILL BE PERFORMED IN ACCORDANC WITH THOSE LAWS, AND THAT VERIFICATION OF ENERGY CODE COMPLIANCE SHALL BE SUBMITTED TO THE CITV UPON REQUEST. 0 a J,�bt ai�L . . '(� & k 8 L V9 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT PRINTED NAME (OR HOMEOWNER FOR HOMEOWNERS PERMITS) PHONE #:_ r 9 � LW � 3 LI EMAIL: "OR THE TOTAL HOURLY COST TO THE JURISDICTION WHICHEVER I$ GREATER. 'ACTUAL COSTS INCLUDE ADMINISTRATIVE AND OVERHEAD COSTS. CITY OF GRAPEVINE, BUILDING INSPECTIONS, P. O. BOX 95104, GRAPEVINE, TX 76099 (817) 41 8121!01 MISE0: 10!09, 8/08, 2107, 7107, NO, 11109, 4111 WPORMS08 APPLICATIONS • FEEWU APPLICATION 4-11,doc i , e MECHANICAL CITY OF GRAPEVINE ELECTRICAL PLUMBING '/ FUEL GAS PERMIT APPLICATION (PLEASE PRINT) PERMIT # ! v ; j _ t BLDG. PERMIT # DATE: APR JOB ADDRESS: SUITE # \' 'AS DESCRIPTION OF WORK: PROPERTY OWNER: CONTRACTING COMPANY: \ v \ \,va ADDRESS: ,, o ADDREMSS: K.( .� CITY /STATE /ZIP: CITY /STATE /ZIP: PHONE NUMBER: PHONE NUMBER: TYPE OF OCCUPANCY BUILDING AREA (SQ FT PERMIT FEES AMOUNT DUE EACH TRADE I. R -3 1- 749 $ 33.25 SINGLE FAMILY, DUPLEX 750- 1,199 $ 49.88 TOWNHOUSE, 1,200- 1,500 $ 63.18 NEW CONSTRUCTION & 1,501- 1,750 $ 76.48 ADDITIONS (PER UNIT) 1,751- 2,000 $ 83.13 2,001- 2,250 $ 89.78 TOTAL SQ.FOOT UNDER 2,251- 3,000 $ 96.43 ROOF 3,001- 3,500 $ 103.08 3,501- 4,000 $ 109.73 $ 4,001+ $ 120.37 EACH TRADE II. A, E, I, R -1 1- 500 $ 37.00 HOTELS, APARTMENTS, 501 - 100,000 $ 17.50 +.035 PER DRINKING /DINING, 100,001 - 500,000 $ 3,500.00 +.03 SQUARE EDUCATIONAL, ASSEMBLY, 500,001 + $15,000.00 +.02 FOOT $ INSTITUTIONAL EACH TRADE III. B, F, H, M, S, U 1- 500 $ 37.00 OFFICE, RETAIL, WHOLESALE, 501- 50,000 $ 32.00+.01 PER 1 GARAGES, FACTORIES, 50,001- 100,000 $ 182.00+ .007 SQUARE WORKSHOPS, SERVICE 100,001+ $ 582.00+.003 FOOT $ STATIONS, WAREHOUSE CONTRACT EACH TRADE IV. ANY OCCUPANCY GROUP VALUATION OF WORK FINISH -OUTS, SHELL COMPLETIONS, 0- 500 $ 37.00 ALTERATIONS OR 501- 1,500 $ 45.00 STAND ALONE PERMITS 1,501- 3,000 $ 57.00 3,001- 5,000 $ 72.00 CONTRACT VALUATION OF WORK: 5,001- 50,000 50,001- 100,000 $ 27.00+.009 $ 127.00+ .007 PER 100,001- 500,000 500,001+ $ 327.00+ .005 DOLLAR $ 1,327.00+.003 TVALUATI ON $ V. MISCELLANEOUS EACH TRADE n� IRRIGATION SYSTEMS $ 37.00 MOBILE HOME SERVICE $ 37.00 TEMPORARY POLE SERVICE $ 37.00 SWIMMING POOLS $ 37.00 SIGN ELECTRIC $ 37.00 $ O: \FORMS \DS APPLICATIONS - FEES \MEP APPLICATION 4- 11.doc [013 PLAN SUBMITTAL: WHEN PLANS ARE REQUIRED BY CODES, ORDINANCES, OR AS DETERMINED BY THE BUILDING OFFICIAL, THREE (3) SETS OF PLANS SHALL BE SUBMITTED IN HARD COPY FORMAT. ENGINEER SEALED PLANS AND CALCULATIONS SHALL BE SUBMITTED AS REQUIRED BY CODES, ORDINANCES OR WHERE OTHERWISE REQUIRED BY STATE LAW. OTHER INSPECTIONS AND FEES: • INSPECTIONS OUTSIDE NORMAL BUSINESS HOURS (2HR MINIMUM ) ............................ ...................$42.00 /HOUR" REINSPECTIONFEES ................................................................................... ............................... $42.00 • PERMITS FOR WHICH NO FEE IS SPECIFICALLY INDICATED ............................ ............................... $37.00 INSPECTIONS FOR WHICH NO FEE IS SPECIFICALLY INDICATED (112 HOUR MINIMUM ) ......................$42.00 /HOUR • ADDITIONAL PLAN REVIEW REQUIRED BY CHANGES, ADDITIONS, OR REVISIONS TO APPROVEDPLANS .................................................................... ............................... ....................$42.00 /HOUR • BUILDING PERMIT FEES FOR THE GRAPEVINE- COLLEYVILLE INDEPENDENT SCHOOL DISTRICT SHALL BE 25% OF THE FEES ESTABLISHED IN THIS TABLE • FOR USE OF OUTSIDE CONSULTANTS FOR PLAN CHECKING AND INSPECTIONS, OR BOTH......... ACTUAL COSTS"' I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND ALL WORK WILL BE PERFORMED ACCORDING TO THE DOCUMENTS APPROVED BY THE BUILDING DEPARTMENT AND IN COMPLIANCE WITH THE CITY OF GRAPEVINE CODES REGULATING CONSTRUCTION. IT IS UNDERSTOOD THAT THE ISSUANCE OF THIS PERMIT DOES NOT GRANT OR AUTHORIZE ANY VIOLATION OF ANY CODE OR ORDINANCE OF THE CITY OF GRAPEVINE. I FURTHER CERTIFY THAT ALL WORK THAT IS REQUIRED TO COMPLY WITH ANY FEDERAL, STATE, AND / OR LOCAL LAW REGARDING ENERGY CONSERVATION WILL BE PERFORMED IN ACCORDANCE WITH THOSE LAWS, AND THAT VERIFICATION OF ENERGY CODE COMPLIANCE SHALL BE SUBMITTED TO THE CITY UPON REQUEST. SIGNATURE OF CONTRACTO R AUTHORIZED AGENT (OR HOMEOWNER FOR HOM ERS PERMITS) PHONE #: PRINTED NAME EMAIL: `OR THE TOTAL HOURLY COST TO THE JURISDICTION WHICHEVER IS GREATER. - ACTUAL COSTS INCLUDE ADMINISTRATIVE AND OVERHEAD COSTS. CITY OF GRAPEVINE. BUILDING INSPECTIONS, P. O. BOX 95104, GRAPEVINE, TX 76099 6/21/01 REVISED: 10/01, 5/06, 2/07, 7/07, 8/09, 11/09, 4/11 O:IFORMSM APPLICATIONS - FEES \MEP APPLICATION 4- 11.doc (817) 410 -3165 1 CITY OF GRAPEVINE PWS ID# 2200013 WATER CUSTOMER SERVICE INSPECTION CERTIFICATION DATE: &Q Las /l.;s BUILDING SWIMMING POOL ADDRESS: /,'q5- 5, .1 ,4141 SrE- 104 '/ 46 �^1 z IRRIGATION PERMIT #: 13 -' 11 `7 0 �S(� S- cb6a PLUMBING - F/Ij I hereby certify that I have inspected the water supply system at the above referenced address. To the best of my knowledge, the materials and methods used in the installation of this system comply with the plumbing code adopted by the City of Grapevine. Plumbing code is located in Chapter 7, Article VIII, (Ordinance number 92 -17), and Chapter 7, Article V, (Ordinance number 01 -93). In addition, to the best of my kn led , no cross connection exists at this address at the time of inspection. IT -�3�O0 SI N R S EC LICENSE NUMBER TITLE L,2 DATE INSPECTOR ti MAY 10 2015 —� - CITY OF GRAPEVINE s MECHANICAL t"" ELECTRICAL PLUMBING FUEL GAS l PERMIT APPLICATION (PLEASE PRINT) PERMIT# 13 - l 41- � BLDG. PERMIT# /3 - 08 3 DATE: MAY 10 201: JOB ADDRESS: ;� ' ; SUITE # DESCRIPTION OF WORK: PROPERTY OWNER: CONTRACTING COMPANY: ADDRESS: ADDRESS: CITY /STATE /ZIP: CITY /STATE /ZIP: PHONE NUMBER: PHONE NUMBER: TYPE OF OCCUPANCY BUILDING AREA PERMIT FEES AMOUNT DUE (SQ FT) EACH TRADE I. R -3 1- 749 $ 33.25 SINGLE FAMILY, DUPLEX 750- 1,199 $ 49.88 TOWNHOUSE, 1,200- 1,500 $ 63.18 NEW CONSTRUCTION & 1,501- 1,750 $ 76.48 ADDITIONS (PER UNIT) 1,751- 2,000 $ 83.13 2,001 - 2,250 $ 89.78 TOTAL SQ.FOOT UNDER 2,251- 3,000 $ 96.43 ROOF 3,001- 3,500 $ 103.08 3,501 - 4,000 $ 109.73 $ 4,001 + $ 120.37 EACH TRADE II. A, E, I, R -1 1 - 500 $ 37.00 HOTELS, APARTMENTS, 501 - 100,000 $ 17.50 +.035 PER DRINKING /DINING, 100,001 - 500,000 $ 3,500.00 +.03 SQUARE EDUCATIONAL, ASSEMBLY, 500,001+ $15,000.00 +.02 FOOT $ INSTITUTIONAL EACH TRADE 111. B, F, H, M, S, U 1- 500 $ 37.00 OFFICE, RETAIL, WHOLESALE, 501- 50,000 $ 32.00+.01 PER 1 GARAGES, FACTORIES, 50,001- 100,000 $ 182.00+.007 SQUARE WORKSHOPS, SERVICE 100,001+ $ 582.00+.003 FOOT $ STATIONS, WAREHOUSE CONTRACT EACH TRADE IV. ANY OCCUPANCY GROUP VALUATION OF WORK FINISH -OUTS, SHELL COMPLETIONS, 0- 500 $ 37.00 ALTERATIONS OR 501- 1,500 $ 45.00 STAND ALONE PERMITS 1,501- 3,000 $ 57.00 3,001- 5,000 $ 72.00 CONTRACT VALUATION OF WORK: 5,001- 50,000 $ 27.00+.009 50,001- 100,000 $ 127.00+ .007 PER $ 100,001- 500,000 500,001+ $ 327.00+ .005 DOLLAR $ 1,327.00+.003 IVALUATION $ J 7 v EACH TRADE V. MISCELLANEOUS IRRIGATION SYSTEMS $ 37.00 MOBILE HOME SERVICE $ 37.00 TEMPORARY POLE SERVICE $ 37.00 SWIMMING POOLS $ 37.00 SIGN ELECTRIC $ 37.00 $ O:\FORMS \DS APPLICATIONS - FEES \MEP APPLICATION 4- 11.doc al) PLAN SUBMITTAL: WHEN PLANS ARE REQUIRED BY CODES, ORDINANCES, OR AS DETERMINED BY THE BUILDING OFFICIAL, THREE (3) SETS OF PLANS SHALL BE SUBMITTED IN HARD COPY FORMAT. ENGINEER SEALED PLANS AND CALCULATIONS SHALL BE SUBMITTED AS REQUIRED BY CODES, ORDINANCES OR WHERE OTHERWISE REQUIRED BY STATE LAW. OTHER INSPECTIONS AND FEES: • INSPECTIONS OUTSIDE NORMAL BUSINESS HOURS (2HR MINIMUM ) ............................ ...................$42.00 /HOUR" REINSPECTIONFEES ................................................................................... ............................... $42.00 • PERMITS FOR WHICH NO FEE IS SPECIFICALLY INDICATED ............................ ............................... $37.00 • INSPECTIONS FOR WHICH NO FEE IS SPECIFICALLY INDICATED (1/2 HOUR MINIMUM) .. ....................$42.00 /HOUR ADDITIONAL PLAN REVIEW REQUIRED BY CHANGES, ADDITIONS, OR REVISIONS TO APPROVEDPLANS .................................................................... ............................... ....................$42.00 /HOUR • BUILDING PERMIT FEES FOR THE GRAPEVINE - COLLEYVILLE INDEPENDENT SCHOOL DISTRICT SHALL BE 25% OF THE FEES ESTABLISHED IN THIS TABLE • FOR USE OF OUTSIDE CONSULTANTS FOR PLAN CHECKING AND INSPECTIONS, OR BOTH.........ACTUAL COSTS* I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND ALL WORK WILL BE PERFORMED ACCORDING TO THE DOCUMENTS APPROVED BY THE BUILDING DEPARTMENT AND IN COMPLIANCE WITH THE CITY OF GRAPEVINE CODES REGULATING CONSTRUCTION. IT IS UNDERSTOOD THAT THE ISSUANCE OF THIS PERMIT DOES NOT GRANT OR AUTHORIZE ANY VIOLATION OF ANY CODE OR ORDINANCE OF THE CITY OF GRAPEVINE. I FURTHER CERTIFY THAT ALL WORK THAT IS REQUIRED TO COMPLY WITH ANY FEDERAL, STATE, AND / OR LOCAL LAW REGARDING ENERGY CONSERVATION WILL BE PERFORMED IN ACCORDANCE WITH THOSE LAWS, AND THAT VERIFICATION OF ENERGY CODE COMPLIANCE SHALL BE SUBMITTED TO THE CITY UPON REQUEST. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (OR HOMEOWNER FOR HOMEOWNERS PERMITS) PHONE PRINTED NAME EMAIL: FOR THE TOTAL HOURLY COST TO THE JURISDICTION WHICHEVER IS GREATER. - ACTUAL COSTS INCLUDE ADMINISTRATIVE AND OVERHEAD COSTS. CITY OF GRAPEVINE. BUILDING INSPECTIONS, P. O. BOX 95104, GRAPEVINE, TX 76099 6121/01 REVISED: 10/01, 5/06,2/07,7107,8/09.11/09. 4111 OAFORMS \DS APPLICATIONS - FEES\MEP APPLICATION 4- 11.doc (817) 410 -3 J LD 501 r051 VaR JUN � � 2013 PIPED MEDICAL (SAS 7a 489 - 500076071 TACY SYSTEMS ( ) (800) 982 -1944 SYSTEMS CERTIFICATION INC. Clinical Environmental Consulting Pass _ Fail _ - -- Provisional - - -- % City /State: r4'lie �/ i t� � Facility /C AfF / / Technician: -- Date: (t% - � ' E/ - -, This test is being performed for: El Preventive Maintenance ['New Construction El Piping Modification �omyressed Air itrous Oxide ❑Nitrogen ❑Carbon Dioxide G/acuum Oxygen t f ❑All Piped Gases ,eve f Project Location: Entire Facility Zoned Area: . � Installation by: computerized performed using an electronic, comp en orient content, and The following tests for evidence of l oxygen contaminant e centlanalyzer, LPM and ISCFM flow meters. Tests include oxygen percent cross connection infrared spectrophotometer, digital ydr p through a 0.41E verification against Hal function. Hydrocarbons as Methane, and Dew P flowinc�p as Temperature G-400 fellow (100 -400 LPM) verification and alarm function. Solid Particulate testing s I ,questiondw by II be forwarded for weight and analysis. micron polycarbonate filter and verified by sight; samp ' Yes El No El N/A Oxygen System is certified as USP Grade A* ❑ No ❑ N/A f � []'""Yes Compressed Medical Air is certified USP Grade N *- ��r [''""Yes ❑ No ❑ N/A Nitrous Oxide System is Certified USP Grade* ❑ Yes ❑ No �N /A Nitrogen System is certified USP Grade E* irve �� L9---Yes ❑ No El N/A Vacuum System is certified as meeting NFPA 99 Standard s *� ❑ /Yes ❑ No ❑ N/A Alarms function properly for intended parameters El Yes [I No �N/A Carbon Dioxide System is certified to USP Standards* * went license and medical gas endorsement for the Board of Plumbing and Examiners; other credentials may be required om specification standards published by the Compressed Gas Association, Inc.; NFPA 99 Latest Published Edition Standa�ds enforceable by Texas Department of Health, and U. . ( Fr p Pharmacopoeia. Installers in the State of Texas must possess a c� ' `� by laws governing individual states. Stacy Systems' medical gas hol s current NITC certification credentials for AS E 6 � f % f dl/ Fnllnw. / ff with no interest financial or otherwise, from the Designer; Installer, n. The under, and Sapp NFPA 99 requires contaminant verification when the system integrity has been compromised by new construction or piping modification. The undersigned agr that the medical gas verification agency is completely independent, Results hav been revie ed and accepted by: Results are certified by: ms Rep Authorized Party Advised ster seCttative (60E� I3-o�,)3 -- "267-013 CITY OF GRAPEVINE .SUN P BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE ANNUAL TEST OTHER PWS I.D.# 2200013 ; NAME OF BUSINESS WHERE DEVICE IS LOCATED: ADbRESS OF SITE SERVICED: PLUMBING PERMIT IF APPLIC/A�8SE: # TESTER LICENSE NUMBER: ! i 6 EXPIRES: b ` �- DATE OF LAST TEST GAUGE CALIBRATION: 7 - 12-- THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS. TYPE OF ASSEMBLY '/REDUCED PRESSURE PRINCIPLE PRESSURE VACUUM BREAKER DOUBLE CHECK ATMOSPHERE VACUUM BREAKER MANUFACTURER: SIZE: MODEL: ✓I SERIAL NUMBER: 4 1 If PHYSICAL LOCATION OF METER: k)04 � H Reduced Pressure Principle Assembly Pressure Vacuum Breaker The above is certified to be true. TESTERS FIRM NAME:dLC3 CITYISTATE /ZIP: C 'D W e 6 ADDRESS:` 3 �LQitg 6�6 6 — -- 13 PHONE NUMBER: ?" 5; 2- ( .36-75 Z DATE: 2 PRINT NAME: 4'. X y I 1`��� e CS SIG NATURE:�� DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010 0 :1FORMIBACKFLOW 1/9/98 Revised: 01111106 Double Check Valve Assembly i Air Inlet I Check Valve Ili heck 2nd Check Relief Valve Open at psid psid n losa�t losed Tigh Opened at P Did not open Leaked To psid S Q a (� psid � ed Leaked I II M-=I . '^` I v 0 Test DC- Closed Tight Closed Tight Opened at Opened at Psid After Rp psid psid psid . Repair The above is certified to be true. TESTERS FIRM NAME:dLC3 CITYISTATE /ZIP: C 'D W e 6 ADDRESS:` 3 �LQitg 6�6 6 — -- 13 PHONE NUMBER: ?" 5; 2- ( .36-75 Z DATE: 2 PRINT NAME: 4'. X y I 1`��� e CS SIG NATURE:�� DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010 0 :1FORMIBACKFLOW 1/9/98 Revised: 01111106 CITY OF GRAPEVINE ,SUN 2 6 2013 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE PWS I.D.# 2200013 NAME OF BUSINESS WHERE DEVICE IS LOCAT ADDRESS OF SITE.SERVICED: -�Sa PLUMBING PERMIT IF APPLICABLE: # ANNUAL TEST IRRIGATION OTHER A iK�1 5 ,> z TESTER LICENSE NUMBER: U 1 0 V V n 7( -I EXPIRES: DATE OF LAST TEST GAUGE CALIBRATION. 9'- 7_ 12- 0-2-9— THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS. TYPE OF ASSEMBLY REDUCED PRESSURE PRINCIPLE PRESSURE VACUUM BREAKER DOUBLE CHECK ATMOSPHERE VACUUM BREAKER MANUFACTURER: %' SIZE: MODEL: �l SERIAL NUMBER: q0 y l 7 5 PHYSICAL LOCATION OF METER: L) C"(- O eok 00' The above is certitlea to oe 'Erue. n I� f TESTERS FIRM NAME: /��de� ADDRESS:4 13� 0w 5pe CITY /STATE /ZIP: Gr©� ( e/ , �' �� DATE: 6- ZC -t75, PHONE NUMBER: 9 1 '7` 12 (a D 7_5� PRINT NAME: Dcw i d Ad w SIGN ATU �- DOUBLE CHECK VAL VE INSPECTION MUST BE CALLED FOR INSPECTION A T (S 17) 410 -3010 O:IFORMIBACKFLOW 119/98 Revised: 01 /1110 6 Reduced Pressure Principle Assembly Pressure Vacuum Breaker Double Check Valve Assembly Air Inlet Check Valve 1st Check losed T 2nd Check (C osed Tigh Relief Valve Opened at Open at psid Did not open psid Leaked Initial Test RP- psid D psid ® Leaked leaked II MyNr. II I UrJIN. Teat DC- Closed Tight Closed Tight Opened at Opened at Psid After RP psid psid psid . Repair — The above is certitlea to oe 'Erue. n I� f TESTERS FIRM NAME: /��de� ADDRESS:4 13� 0w 5pe CITY /STATE /ZIP: Gr©� ( e/ , �' �� DATE: 6- ZC -t75, PHONE NUMBER: 9 1 '7` 12 (a D 7_5� PRINT NAME: Dcw i d Ad w SIGN ATU �- DOUBLE CHECK VAL VE INSPECTION MUST BE CALLED FOR INSPECTION A T (S 17) 410 -3010 O:IFORMIBACKFLOW 119/98 Revised: 01 /1110 6 '?)- � ( q �iTY OF GRAPEVINE '��N262013 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT ANNUAL TEST NAME OF PWS: GRAPEVINE IRRIGATION OTHER PWS I.D.# 2200013 NAME OF BUSINESS WHERE DEVICE IS LOCATED: ADDRESS OF SITE SERVICED: ( ,q E; J , � A I rl 1 `� PLUMBING PERMIT IF APPLICABLE: # ���' �Li'�- EXPIRES: Ili ` 201 TESTER LICENSE NUMBER: P a Db LA 5 I L4 DATE OF LAST TEST GAUGE CALIBRATION: 9 -7 _ THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS. TYPE OF ASSEMBLY EDUCED PRESSURE PRINCIPLE DOUBLE CHECK PRESSURE VACUUM BREAKER ATMOSPHERE VACUUM BREAKER MANUFACTURER: MODEL: I� () (-A SERIAL NUMBER: PHYSICAL LOCATION OF METER: SIZE: / 77 ec0,� C(0>C 4) 0 r L 15g VkA eS +t C ADDRESS:14 1 3 O W e A S O t, CITY /STATE /ZIP: C t` d W (Qy I 7 G 63 DATE: 6- 2- 0 -- 1 7j PHONE NUMBER: 1 -7 2 1° l PRINT NAME: A \dov ; SIGNATURE'S DOUBLE CHECK VAL VE 11VSPECTI0N MUST BE CALLED FOR INSPECTION A T (817) 410 -3014 O:IFORMIBACKFLOW 119198 Revised: 01 /11/06 Pressure Principle Assembly Pressure Vacuum Breaker FFReduced Double Check Valve Assembly 1st Check 2nd Check �8 ip,9�d T_i_ osed Ti �I Relief Valve Opened at I Air Inlet Check Valve Open at pTep' id Did not open C1 °Za Initial Test R P-__ psidl�,4 psid Leaked Leaked II .aJN. u�tl Tact DC- Closed Tight Closed Tight Opened at =psiid at , Psid After RP psid psid Repair — The above iS certified t0 be true. TESTERS FIRM NAME��Q�� �aCT �6w— hS(1C'Cl�QV1S' ADDRESS:14 1 3 O W e A S O t, CITY /STATE /ZIP: C t` d W (Qy I 7 G 63 DATE: 6- 2- 0 -- 1 7j PHONE NUMBER: 1 -7 2 1° l PRINT NAME: A \dov ; SIGNATURE'S DOUBLE CHECK VAL VE 11VSPECTI0N MUST BE CALLED FOR INSPECTION A T (817) 410 -3014 O:IFORMIBACKFLOW 119198 Revised: 01 /11/06 MAR 1 2 2013 I a-�-S S . moo,. rx e De r\:H,, f - c) Mou 1, nCCMcheck Software Version 3.9.1 8�e Interior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type: New Construction Project Title: DR LUCZAK DENTAL OFFICE Construction Site: Owner /Agent: Designer /Contractor. D Fixture Watt 1245 S. MAW STREET MIKE WRIGHT LARRY BLACKMON LOT 16, BLOCK 1 M.J. WRIGHT & ASSOCIATES INC. LARRY BLACKMON INC 2 GRAPVINE, TX 76051 8233 MID - CITIES, STE A 6716 AZLE AVE. Linear Fluorescent 2: 24" T8 17W / Electronic 2 NORTH RICHLAND HILLS, TX 76182 FORT WORTH, TX 76135 33 33 817- 268 -5555 817- 238 -9801 2 29 Total Proposed Waits = Section 2: Interior Lighting and Power Calculation Section 4: Requirements Checklist A B C D Area Category Floor Area Allowed Affowed Waft (ft2) Watts / ft2 (B x C) Healthcare - Clinic 1250 1 1250 Total Allowed Watts = 1250 Section 3: Interior Lighting Fixture Schedule A Fixture ID . Description I Lamp / Wattage Per Lamp I Ballast B Lamps/ Fixture C # of Fixtures D Fixture Watt E (C X D) Healthcare- Clinic (1250 sq.ft.) Linear Fluorescent 1: 48" T8 32W / Electronic 2 16 65 1040 Linear Fluorescent 2: 24" T8 17W / Electronic 2 1 33 33 Compact Fluorescent 1: Triple 4 -pin 26W / Electronic 1 2 29 58 Total Proposed Waits = 1131 Section 4: Requirements Checklist Lighting Wattage: LJ 1. Total proposed watts must be less than or equal to total allowed watts. Allowed Watts Proposed Watts Complies 1250 1131 YES Controls, Switching, and Wiring: Q 2. Daylight zones under skylights more than 15 feet from the perimeter have lighting controls separate from daylight zones adjacent to vertical fenestration. © 3. Daylight zones have individual fighting controls independent from that of the general area lighting. Exceptions: 0 Contiguous daylight zones spanning no more than two orientations are allowed to be controlled by a single oontrolling device. © Daylight spaces enclosed by waits or ceiling height partitions and containing two or fewer light fixtures are not required to have a separate switch for general area lighting. Project Title: DR LUCZAK DENTAL OFFICE Report date: 02/20/13 Data filename: 11BLACKMONSERVER1Blacimron12013 JOB80R. LUCZAKICOMCHECK.cck Page 1 of 2 L] 4. Independent controls for each space (switchloccupancy sensor). Exceptions: Areas designated as security or emergency areas that must be continuously illuminated. LJ Lighting in stairways or corridors that are elements of the means of egress. Lj 5. Master switch at entry to hotellmotel guest room. C] 6. Individual dwelling units separately metered. Ej 7. Medical task lighting or art/history display lighting claimed to be exempt from compliance has a control device independent of the control of the nonexempt lighting. Ej 8. Each space required to have a manual control also allows for reducing the connected lighting load by at least 50 percent by either controlling all luminaires, dual switching of alternate rows of luminaires, alternate luminaires, or altemate lamps, switching the middle lamp luminaires independently of other lamps, or switching each luminaire or each tamp. Exceptions: L] Only one luminaire in space. L] An occupam- sensing device controls the area. [] The area is a condor, storeroom, ieatroom, public lobby or sleeping unit. Ll Areas that use less than 0.6 Watts / sq.ff. I7 9. Automatic lighting shutoff control in buildings larger than 5,000 sq.ft. Exceptions: LJ Sleeping units, patient care areas; and spaces where automatic shutoff would endanger safety or security. 10. Photocell /astronomical time switch on exterior lights. Exceptions: D Lighting intended for 24 hour use. 11- Tandem wired one4amp and three lamp ballasted luminaires (No single -lamp ballasts). Exceptions: 0 Electronic high - frequency ballasts; Luminaires on emergency circuits or with no available pair. Section 5: Compliance Statement Compliance Statement: The proposed lighting design represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application. The proposed lighting system has been designed to meet the 2009 iECC requirements in C `OMMchhock Version 3.91 and to comply with the rqZndatory requirements in the Requirements Checklist. f >Fti11J1_4 2 i Name - Title Signature Datd Project Title: OR LUCZAK DENTAL OFFICE Report date: 02120/13 Data filename: 11BLACKMONSERVER\Blackmon\2013 JOBS\DR. LUCZAK\COMCHECK.cck Page 2 of 2 61�(l 2009 IECC C®Mcheck Software Version 3.9.1 Mechanical Compliance Certificate Section 1: Project Information Project Type: New Construction Project Title: DR LUCZAK DENTAL OFFICE Construction Site: Owner /Agent: 1245 S. MAIN STREET MIKE WRIGHT LOT 1B, BLOCK 1 M.J. WRIGHT t£ ASSOCIATES INC. GRAPVINE, TX 76051 8233 MID - CITIES, STE A NORTH RICHLAND HILLS, TX 76182 817- 268 -5555 Section 2: General information Building Location (for weather data): Grapevine, Texas Climate Zone: 3a Section 3: Mechanical Systems List Designer /Contractor. LARRY BLACKMON LARRY BLACKMON INC 6716 AZLE AVE. FORT WORTH, TX 76135 817 - 238 -9801 Quantft System Type & Description 1 HVAC System 1 (Single Zone) : Heating: 1 each - Central Fumace, Electric, Capacity = 15 kBtu/h Cooing: 1 each - Split System, Capacity = 48000 kBtu/h, Efficiency = 13.00 EER, Air - Cooled Condenser, Air Economizer 1 Water Heater 1: Electric Storage Water Heater, Capacity: 20 gallons w/ Heat Trace Tape installed Section 4: Requirements Checklist Requirements Specific To: HVAC System 1 : L1 1. Equipment minimum efficiency: Split System: 8.70 EER (9.41PLV) 2. Newly purchased equipment meets the efficiency requirements 0 3. Discharge dampers prohibited with fan motors > 25 hp Ll 4. Integrated economizer is required for this location and system- L] 5. Cooling system provides a means to relieve excess outdoor air during economizer operation. p 6. Hot gas bypass prohibited unless system has multiple steps of unloading or continuous capacity modulation L) 7. Hot gas bypass limited to 25% of total cooling capacity Requirements Speck To: Water Heater i : 0 1. Water heating equipment meets minimum efficiency requirements: No efficiency requirements for water heater with storage capacity less than 20 gallons. 0 2. First 8 It of outlet piping is insulated ❑ 3. All heat traced or externally heated piping insulated ❑ 4. Hot water storage temperature controls that allow setpoint of 90 °F for non - dwelling units and 110 °F for dwelling units. Q 5. Automatic time control of heat tapes and recirculating systems present © 6. Heat traps provided to inlet and outlet of storage tanks Generic Requirements: Must be met by all systems to which the requirement is applicable: LJ 1. Plant equipment and system capacity no greater than needed to meet loads Exception(s): Project Title: DR LUCZAK DENTAL OFFICE Report date: 03/07/13 Data filename: 1tBLACKMONSERVER1Blackmon12013 JOBS0R. LUCZAKiCOMCHECK.cck Page 1 of 6 ❑ Standby equipment automatically off when primary system is operating ❑ Multiple units controlled to sequence operation as a function of load ❑ 2. Minimum one temperature control device per system ❑ 3. Minimum one humidity control device per installed humidification/dehumidification system ❑ 4. Load calculations per ASHRAE/ACCA Standard 183. ❑ 5. Automatic Controls: Setback to 55 °F (heat) and 85 °F (cool); 7-day clock, 2 -hour occupant override, 10 -hour backup Exception(s): ❑ Continuously operating zones ❑ 2 kW demand or less, submit calculations ❑ 6. Outside -air source for ventilation; system capable of reducing OSA to required minimum ❑ 7. R -5 supply and return air duct insulation in unconditioned spaces R -8 supply and return air duct insulation outside the building R -8 insulation between ducts and the building exterior when ducts are part of a building assembly Exception(s). ❑ Ducts located within equipment ❑ Ducts with interior and exterior temperature difference not exceeding 15 °F. ❑ 8. Mechanical fasteners and sealants used to conned duds and air distribution equipment ❑ 9. Ducts sealed - longitudinal seams on rigid ducts; transverse seams on all duds; UL 181A or 181E tapes and mastics Exception(s): ❑ Continuously welded and locking -type longitudinal joints and seams on ducts operating at static pressures less than 2 inches w.g. pressure classification ❑ 10. Hot water pipe insulation: 1.5 in. for pipes < =1.5 in. and 2 in. for pipes >1.5 in. Chilled water /refrigeranUbrine pipe insulation: 1.5 in. for pipes —1.5 in. and 1.5 in. for pipes >1.5 in. Steam pipe insulation: 1.5 in. for pipes < =1.5 in. and 3 in. for pipes >1 S in. Exception(s): ❑ Piping within HVAC equipment. ❑ Fluid temperatures between 55 and 105 °F. ❑ Fluid not heated or cooled with renewable energy. ❑ Piping within room fan -coil (with AHRI440 rating) and unit ventilators (with AHRI840 rating). ❑ Runouts <4 ft in length. ❑ 11. Operation and maintenance manual provided to building owner ❑ 12.Thermostatic controls have 5 °F deadband Except +on(s): ❑ Thermostats requiring manual changeover between heating and cooling ❑ Special occupancy or special applications where wide temperature ranges are not acceptable and are approved by the authority having jurisdiction. ❑ 13. Balancing devices provided in accordance with IMC (2006) 603.17 ❑ 14. Demand control ventilation (DCV) present for high design occupancy areas (>40 person /1000 ft2 in spaces >500 ft2) and served by systems with any one of 1) an air -side economizer, 2) automatic modulating control of the outdoor air damper, or 3) a design outdoor airflow greater than 3000 cfm. Exception(s): ❑ Systems with heat recovery. ❑ Multiple -zone systems without DDC of individual zones communicating with a central control panel. ❑ Systems with a design outdoor airflow less than 1200 cfm. ❑ Spaces where the supply airflow rate minus any makeup or outgoing transfer air requirement is less than 1200 cfm. ❑ 15. Motorized, automatic shutoff dampers required on exhaust and outdoor air supply openings Exception(s): ❑ Gravity dampers acceptable in buildings <3 stories ❑ Gravity dampers acceptable in systems with outside or exhaust air flow rates less than 300 cfm where dampers are interlocked with fan ❑ 16.Automatic controls for freeze protection systems present ❑ 17. Exhaust air heat recovery included for systems 5,000 cfm or greater with more than 70% outside air fraction or specifically exempted Exception(s): ❑ Hazardous exhaust systems, commercial kitchen and clothes dryer exhaust systems that the International Mechanical Code prohibits the use of energy recovery systems. ❑ Systems serving spaces that are heated and not cooled to less than 60 °F. ❑ Where more than 60 percent of the outdoor healing energy is provided from site - recovered or site solar energy. ❑ Heating systems in climates with less than 3600 HDD. Project Title: DR LUCZAK DENTAL OFFICE Report date: 03/07/13 Data filename: \ \BLACKMONSERVER\Blackmon\2013 JOBS\DR. LUCZAK \COMCHECK.cck Page 2 of 6 L] Cooling systems in climates with a 1 percent cooling design wet -bulb temperature less than 64 °F. ❑ Systems requiring dehumidification that employ energy recovery in series with the cooling coil. F1 Laboratory fume hood exhaust systems that have either a variable air volume system capable of reducing exhaust and makeup air volume to 50 percent or less of design values or, a separate make up air supply meeting the following makeup air requirements: a) at least 75 percent of exhaust flow rate, b) heated to no more than 2 °F below room setpoint temperature, c) cooled to no lower than 3 °F above room setpoint temperature, d) no humidification added, e) no simultaneous heating and cooling. Section 5: Compliance Statement Compliance Statement The proposed mechanical design represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application. The proposed mechanical systems have been designed to meet the 2009 IECC requirements in COMcheck Version 3.9.1 and to comply with the m atory requirements n the Requirements Checklist. r i i S "r-) Z�: L— -7 J Name - Title Signature Date Section 6: Post Construction Compliance Statement 0 HVAC record drawings of the actual installation, system capacities, calibration information, and performance data for each equipment provided to the owner. Cl HVAC O&M documents for all mechanical equipment and system provided to the owner by the mechanical contractor. Cj Written HVAC balancing and operations report provided to the owner. The above post construction requirements have been completed. Principal Mechanical Designer -Name Signature Date . ..... ---- _ .... Project Title: DR LUCZAK DENTAL OFFICE Report date: 03/07/13 Data filename: \ \BLACKMONSERVERi31ackmon\2013 JOBS \DR. LUCZAK\COMCHECK.cck Page 3 of 6 COMcheck Software Version 3.91 Mechanical Requirements Description 2009 (ECC The following list provides more detailed descriptions of the requirements in Section 4 of the Mechanical Compliance Certificate. Requirements Specific To: HVAC System 1 1. The specified heating and/or cooling equipment is covered by the ASHRAE 90.1 Code and must meet the following minimum efficiency: Split System: 9.70 EER (9.4 IPLV) 2. The specified equipment is covered by Federal minimum efficiency requirements. New equipment of this type can be assumed to meet or exceed ASHRAE 90.1 Code requirements for equipment efficiency. 3. Fans with motors > 25 hp may not be equipped with discharge dampers. 4. An integrated economizer is required for individual cooling systems over 54 kBtu/h in the selected project location. An Integrated economizer allows simultaneous operation of outdoor -air and mechanical cooling. 5. Cooling system provides a means to relieve excess outdoor air during economizer operation to prevent overpressurizing the building. 6. Cooling systems must not use hot gas bypass or other evaporator pressure control unless the equipment is designed with multiple steps (or continuous) capacity modulation. 7. For coding systems > 240 kBtu/h, maximum hot gas bypass capacity must be no more than 25% of total cooling capacity. Requirements Specific To: Water Heater 1 : 1. Water heating equipment used solely for heating potable water, pool heaters, and hot water storage tanks must meet the following miniumum efficiency: No efficiency requirements for water heater with storage capacity less than 20 gallons. 2. Insulation must be provided for the first 8 ft of outlet piping for a constant temperature nonrearculating storage system and for the inlet pipe between the storage tank and a heat trap in a storage system. 3. Insulation must be provided for pipes that are externally heated (such as heat trace or impedance heating). 4. Service water - heating equipment shall be provided with controls to allow a setpoint of 110 °F for equipment serving dwelling units and 90 °F for equipment serving non - dwelling units. Lavatory outlet temperatures shall be limited to 110 °F. 5. Systems designed to maintain usage temperatures in hot water pipes, such as recirculating hot water systems or heat trace, must be equipped with automatic time switches or other controls that can be set to switch off the temperature maintenance system during extended periods when hot water is not required. 6. Heat traps must be provided on inlet and outlet vertical pipe risers serving storage water heaters and storage tanks not having integral heat traps and serving a nonrecirculating system. Beat traps must be installed as close as practical to the storage tank. Acceptable heat traps are either a) a device specifically designed for the purpose or b) an arrangement of tubing that forms a loop of 360 °F, or c) piping that from the point of connection to the water heater (inlet or outlet) includes a length of piping directed downwards before connection to the vertical piping of the supply water or hot water distribution system. Generic Requirements: Must be met by all systems to which the requirement is applicable: 1. Ali equipment and systems must be sized to be no greater than needed to meet calculated loads. A single piece of equipment providing both heating and cooling must satisfy this provision for one function with the capacity for the other function as small as possible, within available equipment options- Exception(s): The equipment and/or system capacity maybe greater than calculated bads for standby purposes. Standby equipment must be automatically controlled to be off when the primary equipment and/or system is operating. Multiple units of the same equipment type whose combined capacities exceed the calculated load are allowed if they are provided with controls to sequence operation of the units as the Iced Increases or decreases. 2. Each heating or cooling system serving a single zone must have its own temperature control device. 3. Each humidification system must have its own humidity control device. 4. Design heating and cooling loads for the building must be determined using procedures in the ASHRAE Handbook of Fundamentals or an approved equivalent calculation procedure. 5. The system or zone control must be a programmable thermostat or other automatic control meeting the following criteria: a) capable of setting back temperature to 55 °F during heating and setting up to 85 °F during cooling, b) capable of automatically setting back or shutting down systems during unoccupied hours using 7 different day schedules, c) have an accessible 2-hour occupant override, d) have a battery back -up capable of maintaining programmed settings for at least 10 hours without power. Exoeption(s): A setback or shutoff control is not required on thermostats that control systems serving areas that operate continuously. Project Title: DR LUCZAK DENTAL OFFICE Report date: 03/07/13 Date filename: 11BLACKMONSERVERSIackmon12013 JOBSIDR. LUCZAKICOMCHECK.cck Page 4 of 6 - A setback or shutoff control is not required on systems with total energy demand of 2 kW (6,826 Btu/h) or less. The system must supply outside ventilation air as required by Chapter 4 of the Intemational Mechanical Code. If the ventilation system is designed to supply outdoor -air quantities exceeding minimum required levels, the system must be capable of reducing outdoor -air flow to the minimum required levels. Air ducts must be insulated to the following levels: a) Supply and return air ducts for conditioned air located in unconditioned spaces (spaces neither heated nor cooled) must be insulated with a minimum of R -5. Unconditioned spaces include attics, crawl spaces, unheated basements, and unheated garages. b) Supply and return air ducts and plenums must be insulated to a minimum of R-8 when located outside the building. c) When ducts are located within exterior components (e -g., floors or roofs), minimum R-8 insulation is required only between the duct and the building exterior. Exception(s): Duct insulation is not required on ducts located within equipment. Duct insulation is not required when the design temperature difference between the interior and exterior of the duct or plenum does not exceed 15 °F. B. Mechanical fasteners and seals, mastics, or gaskets must be used when connecting ducts to fans and other air distribution equipment, including muitiple -zone terminal units. 9. All joints, longitudinal and transverse seams, and connections in ductwork must be securely sealed using weldments; mechanical fasteners with seals, gaskets, or mastics; mesh and mastic sealing systems or tapes. Tapes and mashes must be listed and labeled in accordance with UL 181A and shall be marked '181A -P' for pressure sensitive tape, '181A -M' for mastic or'181 A -H' for heat - sensitive tape. Tapes and mastics used to sea[ flexible air ducts and flexible air connectors shalt comply with UL 181 B and shall be marked '181 B -FX' for pressure - sensitive tape or'181 B -M' for mastic. Unlisted duct tape is not permitted as a sealant an any metal ducts. Exception(s): - Continuously welded and locking -type longitudinal joints and seams on ducts operating at static pressures less than 2 inches w.g. pressure classification. 10. All pipes serving space - conditioning systems must be insulated as follows: Hot water piping for heating systems: 1 1/2 in, for pipes <=1 1/2 -In. nominal diameter, 2 in. for pipes >1 112 -in. nominal diameter. Chilled water, refrigerant, and brine piping systems: 1 1/2 in. insulation for pipes < =1 1 /2 -in. nominal diameter, 1 1/2 in- insulation for pipes >1 1 /2 -in. nominal diameter. Steam piping: 1 112 in, insulation for pipes < =1 1 /2 -in. nominal diameter, 3 in. Insulation for pipes >1 1/2 -in, nominal diameter. Exception(s): Pipe insulation is not required for factory- installed piping within HVAC equipment- Pipe insulation is not required for piping that conveys fluids having a design operating temperature range between 55 °F and 105 °F. Pipe insulation is not required for piping that conveys fluids that have not been heated or cooled through the use of fossil fuels or electric power. Piping within room fan -coil (with AHRI440 rating) and unit ventilators (with AHRI840 rating). Pipe Insulation is not required for runout piping not exceeding 4 ft in length and 1 in, in diameter between the control valve and HVAC coil. 11- Operation and maintenance documentation must be provided to the owner that Includes at least the following information: a) equipment capacity (input and output) and required maintenance actions b) equipment operation and maintenance manuals c) HVAC system control maintenance and calibration Information, including wiring diagrams, schematics, and control sequence descriptions; desired or field- determined set points must be permanently recorded on control drawings, at control devices, or, for digital control systems, in programming comments d) complete narrative of how each system is intended to operate. 12. Thermostats controlling both heating and cooling must be capable of maintaining a 5 °F deadband (a range of temperature where no heating or cooling is provided). Exception(s): Deadband capability is not required if the thermostat does not have automatic changeover capability between heating and cooling. Special occupancy or special applications where wide temperature ranges are not acceptable and are approved by the authority having jurisdiction. 13. Balancing devices provided in accordance with IMC (2006) 603.17. 14. Demand control ventilation (DCV) required for high design occupancy areas ( >40 person /1000 ft2 in spaces >500 ft2) and served by systems with any one of 1) an air -side economizer, 2) automatic modulating control of the outdoor air damper, or 3) a design outdoor airflow greater than 3000 cfm. Exception(s): - Systems with heat recovery. Project Title: DR LUCZAK DENTAL OFFICE Report date: 03/07/13 Data filename: 11 BLACKMONSERVER\Blacknwn12013 JOBSIDR. LUCZAK \COMCHECK.cck Page 5 of 6 Multiple -zone systems without DDC of individual zones communicating with a central control panel. Systems with a design outdoor airflow less than 1200 cfm. Spaces where the supply airflow rate minus any makeup or outgoing transfer air requirement is less than 1200 cfm. 15. Outdoor air supply and exhaust systems must have motorized dampers that automatically shut when the systems or spaces served are not in use. Dampers must be capable of automatically shutting off during preoccupancy building warm -up, cool -down, and setback, except when ventilation reduces energy costs (e.g., night purge) or when ventilation must be supplied to meet code requirements. Both outdoor air supply and exhaust air dampers must have a maximum leakage rate of 3 cfratU at 1.0 in w.g. when tested in accordance with AMCA Standard 500. Exception(s): Gravity (non - motorized) dampers are acceptable in buildings less than three stories in height. Systems with a design outside arc intake or exhaust capacity of 300 cfm (140 Us) or less that are equipped with motor operated dampers that open and close when the unit is energized and de- energized, respectively. 16. All freeze protection systems, including self - regulating heat tracing, must include automatic controls capable of shutting off the systems when outside air temperatures are above 40 °F or when the conditions of the protected fluid will prevent freezing. Snow-and ice- melting systems must include automatic controls capable of shutting off the systems when the pavement temperature is above 50 °F and no precipitation is failing, and an automatic or manual control that will allow shutoff when the outdoor temperature is above 40 °F. 17. Individual fan systems with a design supply air capacity of 5000 cfm or greater and minimum outside air supply of 70 percent or greater of the supply air capacity must have an energy recovery system with at least a 50 percent effectiveness. Where cooling with outdoor air is required there is a means to bypass or control the energy recovery system to permit cooling with outdoor air. Exception(s): Hazardous exhaust systems, commercial kitchen and clothes dryer exhaust systems that the International Mechanical Code prohibits the use of energy recovery systems. Systems serving spaces that are heated and not cooled to less than 60 °F. Where more than 60 percent of the outdoor heating energy is provided from site - recovered or site solar energy. Heating systems in climates with less than 3600 HDD. Cooling systems in climates with a 1 percent cooling design wet -bulb temperature less than 64 °F. Systems requiring dehumidification that employ energy recovery in series with the cooling coil.. Laboratory fume hood exhaust systems that have either a variable air volume system capable of reducing exhaust and makeup air volume to 50 percent or less of design values or, a separate make up air supply meeting the following makeup air requirements: a) at least 75 percent of exhaust flow rate, b) heated to no more than 2 °F below room setpoint temperature, c) cooled to no lower than 3 °F above room setpoint temperature, d) no humidification added, e) no simultaneous heating and cooling. Project Title: DR LUCZAK DENTAL OFFICE Report date: 03/07/13 Data filename: \ \BLACKMONSERVER\Blackmon\2013 JOBS \DR. LUCZAK\COMCHECK.cck Page 6 of 6 City of Grapevine Building Inspection Department Plan Review Comments P.O. Box 95104 Phone: (817) 410 -3129 Grapevine, Texas 76051 Fax: (817) 410 -3536 NAME OF PROJECT: The Dentist off Main ADDRESS: 1245 S Main St. #100 PLANS EXAMINER: ALLEN HUNT NUMBER OF STORIES: 1 TOTAL SQ. FT: 1,100 ZONING: HCO OCUPANCY: B OCCUPANT LOAD: 14 EXITS REQUIRED: 1 FIRE SPRINKLED: NO CU: N/A COMMENTS: 1. ALL EGRESS DOORS ARE TO BE OPENABLE FROM DIRECTION OF EGRESS WITHOUT THE USE OF KEY, SPECIAL EFFORT OR KNOWLEDGE. 2. MAUNUALLY OPERATED FLUSH BOLTS OR SURFACE BOLTS ARE NOT PERMITTED. 3. PROJECT SHALL BE DESIGNED TO COMPLY WITH THE 2009 IECC. VERIFICATION OF COMPLIANCE SHALL BE SUBMITTED TO THE CITY BY A CERTIFIED ENERGY CODE INSPECTOR PRIOR TO THE ISSUANCE OF BUILDING FINAL APPROVAL OR CERTIFICATE OF OCCUPANCY. 4. ALL CHANGES FROM THE CITY APPROVED PLANS WILL REQUIRE REVISED PLANS SUBMITTED AND ADDITIONAL FEES DUE. 5. COORDINATE ALL FIRE ALARM, SMOKE EVACUATION, AND / OR SPRINKLER SYSTEM PLANS, APPROVALS AND INSPECTIONS WITH THE FIRE MARSHALL AND REED ENGINEERING AS BUILDING EXCEEDS 6,000 SQ'. 6. PLANS THAT EXCEED 10 SHEETS WILL REQUIRE THAT ONE SET BE BOLTED. 7. PROVIDE FULL FLOOR PLAN OF FIRST FLOOR AND LOCATE SUITE, AREA TO BE WITHIN CONSTRUCTION BY HATCHING OR OTHER MEANS. 8. PLANS PROVIDES 2 EXITS OTHER THAN MAIN ENTERANCE, NEED PLANS TO REFLECT WHERE THESE MEANS OF EGRESS TRAVEL ALL THE WAY TO PUBLIC WAY. 9. PROVIDE FOR EMERGENCY EGRESS ILLUMINATION OF MINIMUM 1fc FOR ALL COMMON AREA'S AND PROVIDE THAT BOTH THE EMERGENCY EGRESS ILLUMINATION AND THE ILLUMINATED EXIT SIGNS ARE ON NON SWITCHED CIRCUIT AND BOTH HAVE MINMUM 90 MINUTE BATTERY BACK UP. 10. THE MEDICAL GAS REQUIRES 3RD PARTY MEDICAL GAS INSPECTIONS BY CERTIFIED MED. GAS INSPECTOR. 11. MEDICAL GAS ENCLOSURE, VENTED DIRECTLY TO EXTERIOR OF BUILDING, ENCLOSURE TO MAINTANE A NEGATIVE PRESSURE AT ALL TIMES TO INTERIOR OF SUITE. PROVIDE NECESSARY MECHANICAL INFORMATION ON PLANS PROVIDING FOR THE CONDITION. 12. MEDICAL GAS ENCLOSURE / SYSTEM THAT EXCEEDS MAXIMUM ALLOWABLE QUANTITY'S PER FIRE CODE REQUIRE TO MEET ALL REQUIREMENTS OF SECTION 502.8 THRU 502.9.11 OF THE 2006 I.M.C. 13. THE VENTING FOR MECHANICAL ROOM SHOWN TO BE A COMMON VENT SYSTEM WITH BATH ROOM, SYSTEM MUST MEET SECTION 403.2 -403.4 OF THE 2006 I.M.C. 14. STERILIZATION EQUIPMENT TO DRAIN BY INDIRECT WASTE TO AN APPROVED SANITARY WASTE RECEPTICLE AND VENT SYSTEM FOR STERILIZATION SYSTEM TO BE SEPARATE FROM GENERAL SANITARY VENTING SYSTEMS. 15. CICUIT VENTING WILL BE REQUIRED FOR THE 2" WASTE LINES SHOWN FOR THE DENTAL SINKS. 16. ALL APPARATUS, DEVICES, APPURTENANCES AND / OR APPLIANCES CONNECTED TO WATER SUPPLY SYSTEM TO HAVE INDIVIDUAL BACKFLOW PROTECTION DEVICES. 17. PROVIDE FOR HOT WATER SUPPLY TO SINKS AND LAUNDRY WASHER MACHINE. 18. PROVIDE FOR STANDPIPE PER 2006 I.P.C. FOR WASHER DRAIN SYSTEM. Please review comments and have designers add information and make changes as Needed. Provide 3 new copies of plans; Plan size may not exceed 36 "x 36" in dimension, to city with one set bolted if over 10 pages. APPLICATION RECEIVED: 03/11/13 1ST COMMENTS: 03/14/13 REVISIONS RECEIVED: 31�( t,t�. REVISIONS REVIEWED: eet (4's PERMIT ISSUED: Allen Hunt - Dentist off Main review Page 1 From: Allen Hunt To: Date: 3/15/2013 10:34 AM Subject: Dentist off Main review Wiiliam, I have attached the review comments for your project. It may seem a little much but we need to follow these requirements. The Fire Marshal can determione if the Med. Gas exceeds allowable quantity's for location. If you have questions, give me a call. Thank you, Allen Hunt Plans Examiner / Field Coordinator City of Grapevine 817- 410 -3129 City of Grapevine Building Inspection Department Plan Review Comments NAME OF PROJECT: The Dentist c ADDRESS: 1245 S Main St. #100 PLANS EXAMINER: ALLEN HUNT NUMBER OF STORIES: 1 ZONING: HCO OCCUPANT LOAD: 14 FIRE SPRINKLED: NO COMMENTS: )ff Main TOTAL SQ. FT: 1,100 OCUPANCY: B EXITS REQUIRED: 1 CU: N/A 1. CONTRACTOR WILL ENSURE ALL EGRESS DOORS ARE TO BE OPENABLE FROM DIRECTION OF EGRESS WITHOUT THE USE OF KEY, SPECIAL EFFORT OR KNOWLEDGE. ARCHITECTURAL PLANS NOTED 2. MAUNUALLY OPERATED FLUSH BOLTS OR SURFACE BOLTS ARE NOT PERMITTED. CONTRACTOR TO COMPLY IF APPLICABLE (3 -6) 3. PROJECT SHALL BE DESIGNED TO COMPLY WITH THE 2009 IECC. VERIFICATION OF COMPLIANCE SHALL BE SUBMITTED TO THE CITY BY A CERTIFIED ENERGY CODE INSPECTOR PRIOR TO THE ISSUANCE OF BUILDING FINAL APPROVAL OR CERTIFICATE OF OCCUPANCY. 4. ALL CHANGES FROM THE CITY APPROVED PLANS WILL REQUIRE REVISED PLANS SUBMITTED AND ADDITIONAL FEES DUE. 5. COORDINATE ALL FIRE ALARM, SMOKE EVACUATION, AND / OR SPRINKLER SYSTEM PLANS, APPROVALS AND INSPECTIONS WITH THE FIRE MARSHALL AND REED ENGINEERING AS BUILDING EXCEEDS 6,000 SQ'. 6. PLANS THAT EXCEED 10 SHEETS WILL REQUIRE THAT ONE SET BE BOLTED. KEY PLAN PROVIDED (7 -8) 7. PROVIDE FULL FLOOR PLAN OF FIRST FLOOR AND LOCATE SUITE, AREA TO BE WITHIN CONSTRUCTION BY HATCHING OR OTHER MEANS. 8. PLANS PROVIDES 2 EXITS OTHER THAN MAIN ENTERANCE, NEED PLANS TO REFLECT WHERE THESE MEANS OF EGRESS TRAVEL ALL THE WAY TO PUBLIC WAY. MEP COMPLIANCE (9 -18) 9. PROVIDED EMERGENCY EGRESS ILLUMINATION. AND THE ILLUMINATED EXIT SIGNS ARE ON NON SWITCHED CIRCUIT AND BOTH HAVE MINIMUM 90 MINUTE BATTERY BACKUP. ON SHEET E 1 11. PROVIDED EXHAUST FAN ON SHEET M 1. 12. DOES NOT EXCEED MAXIMUM ALLOWABLE QUANTITY. 13. ELECTRICAL EQUIPMENT, GASES NOT BEING VENTED, HEAT ONLY. EXISTING 2 STORY W /COMMON BUILDING VENT. 14. PROVIDED FLOOR DRAIN FOR INDIRECT WASTE ON SHEET P1. 15. ADDED CIRCUIT VENTING FOR DENTAL SINKS SHEET Pl. 16. REFERENCE NOTE 21. ON SHEET P1. 17. THERE IS NO WASHING MACHINE. 18. THERE IS NO WASHING MACHINE. 9. PROVIDE FOR EMERGENCY EGRESS ILLUMINATION OF MINIMUM 1fc FOR ALL COMMON AREA'S AND PROVIDE THAT BOTH THE EMERGENCY EGRESS ILLUMINATION AND THE ILLUMINATED EXIT SIGNS ARE ON NON SWITCHED CIRCUIT AND BOTH HAVE MINMUM 90 MINUTE BATTERY BACK UP. 10. THE MEDICAL GAS REQUIRES 3RD PARTY MEDICAL GAS INSPECTIONS BY CERTIFIED MED. GAS INSPECTOR. 11. MEDICAL GAS ENCLOSURE, VENTED DIRECTLY TO EXTERIOR OF BUILDING, ENCLOSURE TO MAINTANE A NEGATIVE PRESSURE AT ALL TIMES TO INTERIOR OF SUITE. PROVIDE NECESSARY MECHANICAL INFORMATION ON PLANS PROVIDING FOR THE CONDITION. 12. MEDICAL GAS ENCLOSURE / SYSTEM THAT EXCEEDS MAXIMUM ALLOWABLE QUANTITY'S PER FIRE CODE REQUIRE TO MEET ALL REQUIREMENTS OF SECTION 502.8 THRU 502.9.11 OF THE 2006 I.M.C. 13. THE VENTING FOR MECHANICAL ROOM SHOWN TO BE A COMMON VENT SYSTEM WITH BATH ROOM, SYSTEM MUST MEET SECTION 403.2 -403.4 OF THE 2006 I.M.C. 14. STERILIZATION EQUIPMENT TO DRAIN BY INDIRECT WASTE TO AN APPROVED SANITARY WASTE RECEPTICLE AND VENT SYSTEM FOR STERILIZATION SYSTEM TO BE SEPARATE FROM GENERAL SANITARY VENTING SYSTEMS. 15. CICUIT VENTING WILL BE REQUIRED FOR THE 2" WASTE LINES SHOWN FOR THE DENTAL SINKS. 16. ALL APPARATUS, DEVICES, APPURTENANCES AND / OR APPLIANCES CONNECTED TO WATER SUPPLY SYSTEM TO HAVE INDIVIDUAL BACKFLOW PROTECTION DEVICES. 17. PROVIDE FOR HOT WATER SUPPLY TO SINKS AND LAUNDRY WASHER MACHINE. 18. PROVIDE FOR STANDPIPE PER 2006 I.P.C. FOR WASHER DRAIN SYSTEM. REVISIONS: 03/19/13 '0 17-11, CITY OF GRAPEVINE TEMPORARY ELECTRIC RELEASE Temporary electricity has been requested for the purpose of construction, remodeling, addition or improvement to the following described property. It is understood that this release in no way authorizes occupancy of the building. It is further understood that this temporary release is for a thirty (30) day maximum time period and the undersigned releases all claims that may occur through accidents or spoilage of any type resulting from said electric power being turned off at the end of the thirty (30) day maximum time period. ADDRESS LOCATION OF TEMPORARY ELECTRIC RELEASE: ADDRESS: 11�tI PERMIT NUMBER: 15 CONTRACTOR INFORMATION NAME OF APPLICANT: p av CrA e- rv: c s ADDRESS OF APPLICANT: 0,� CITY, STATE, ZIP: TELEPHONE NUMBER: 0 INSPECTIONS FOR TEMPORARY POWER MUST BE REQUESTED AT (817) 410 -3010 ************************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** SIGNA ff4 (� �3 PRINT NAME: DA E: BUILBQNG OFFICIAL SIGNATURE: O:FORMS \DS CONTRACTOR FORMS \TEMP ELEC.doc 10/12/00 Revised: 4/10/02 DATE: JUN 2 6 2013 ENERGY CONSERVATION INSPECTION NCERESIDENAAION FORM (ALL OCCUPANCIES EXCEPT SI L, i 1 -1,A, 'T Project Name: Address of Inspection:/ Name of Company Performing Inspection: Name of Certified Inspector Performing In ICC Energy Code Inspector Certification - 74I - spection: � _ N � umber: In accordance with State Law (Senate Bill 5 enacted the aboveeeferenced Legislature struct the State that of Texas), I hereby certify that I have mspecConservation Code and any Amendments it complies with the International Energy adopted by the State of Texas and / or the City of Grapevine. hg n ure o I pector Development Services Department The City of Grapevine X P.O. Box 103012 � www grapevinetexas.gov9 * (817) 410 -3165 Fax ( ) - - O1EORMSIDS ENERGY CODE RELATED\Commarcial Completion Cert Energy Code.doC 3- 2007:Rev.2 -12 BLD& JUN 2 6 2013 '*TO BE REMOVED BY BUILDER ONLY***NO REMOVER'` Commercial Energy Code Inspection,' nspection i Notification hdaress, City, _ veto !Fire- dll"Final Yp, Ins chart Of F--- Ddte of Ins' -tus 4aY! Copeland 5220382 -77 Inspector ICBO Certificate # The original inspection report, which encompasses aA areas of the inspection, will be left with the builder after the Final Inspection. ' N i Notes- Inspector Signature Contact Information: Texas Home Energy Professionals Jay Copeland (940) 312 -2117