Permit CITY O TIGARD MECHANICAL
.. 1 � ��a .:� g, DEVELOPMENT SERVICES PERMIT
� i
= --. 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 12 / 1 1 / 98
PARCEL: 2S1O2BC -05700
SITE ADDRESS...: 12615 SW PATHFINDER CT
SUBDIVISION • YOLO ESTATES ZONING: R -4.5
BLOCK • LOT •006 JURISDICTION: TIG
CLASS OF WORK..:OTR FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:R3 VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS ° 0
FUEL TYPES 0 -3 HP • 0 DOMES. INCIN: 0
. 3 -15 HP • 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP • 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30 -50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP • 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 1O0K BTU: 1 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =1O0K BTU: 0 > 10000 cfm: 0
Remarks : Install new furnace and gas piping.
Owner: FEES
CHRIS YURJEVICH type amount by date recpt
123615 SW PATHFINDER PRMT $ 25. GEO 12/11/98 98- 311483
TIGARD OR 97223 5PCT $ 1.25 GEO 12/11/98 98- 311483
Phone #: 620 -5247
Contractor:
OWNER
$ 26.25 TOTAL
Phone #:
Reg #.. .
REQUI RED INSPECTIONS
This per.it is issued subject to the regulations contained in the F�in Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other n Gib.
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 sore
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 -001 -0010 through OAR 952-001 -0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)245 -9187.
Issue By• P ermittee Signature, �i1
++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ / + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Plan Check #
CITY OF TIGARD Mechanical Permit Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit# l e6ro6 - 0 5:.�
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
Job Street Address suite# A) Permit Fee 10.00
++ 1) Furnace to 100,000 BTU
Address 1 t jj P 5 gill /N ( including ducts & vents / 6.00
Bldg# City/State Zip 2) Furnace 100,000 BTU+
-- 1 - 10 6 X f2v-3 including ducts & vents 7.50
Name (or name of business) 7 3) Floor Furnace
Owner {'is y (/ 47 vicAi including vent 6.00
Mailing Address ( 4) Suspended heater, wall heater
4 4 51 _i n5i7/ f /A/ G T Vent floor included heater 6.00
�/ 5) Vent not included in appliance permit
City /State Zip 3 Phong�- 3 3,00
T 7 4 e 626 ^S�.t'7 CHECK ALL *Boiler Heat Air
Na a (or name of business) THAT APPLY: or Pump Cond Qty Price Amt
J Comp
* 6 fr i 6) <3HP;absorb unit to
Occupant Mailing Addreg ,�,, �C 100K BTU 6.00
V v 6 7) 3-15 HP;absorb unit
City/State Zip Phone 100k to 500k BTU 11.00
8) 15 -30 HP; absorb .
unit .5 -1 mil BTU 15.00
Contractor Name 9) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 22.50
Prior to permit Mailing Address 10) >50HP; absorb unit
issuance, a copy >1.75 mil BTU - 37.50 •
of all licenses City/State Zip Phone 11) Air handling unit to 10,000 CFM
are required if 4.50
" expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 12) Air handling unit 10,000 CFM+
database 7.50
Architect Name 13) Non - portable evaporate cooler
4.50
Or Mailing Address 14) Vent fan connected to a single duct
3.00
15) Ventilation system not included in
Engineer City/State Zip Phone appliance permit 4.50
16) Hood served by mechanical exhaust
Describe work to be done: 4.50
17) Domestic incinerators
New$ Repair 0 Replace with like kind: Yes 0 No 0 7.50 1
ResidentiVe Commercial O 18) Commercial or industrial type incinerator
30.00
Additional information or description of work: 19) Repair units
4.50
,r/givii-co / 7 - 4 - ( � 20) Wood stove
/ 4.50
(r 4'S 21) Clothes dryer, etc.
7 4.50
Type of fuel: oil 0 natural gas( LPG 0 electric 0 22) Other units
4.50
I hereby acknowledge that I have read this application, that the information 23) Gas piping one to four outlets
given is correct, that I am the owner or authorized agent of 2.00
the owner, that plans submitted are in corn • liance with Oregon State laws. 24) More than 4 -per outlet (each)
.50
Signature of Owner /Agent Da
,
�� l , Minimum Permit Fee $25.00 SUBTOTAL
/ 5% SURCHARGE / g C---
Conta4rson N. r(�" Phone PLAN REVIEW 25% OF SUBTOTAL
Required for ALL commercial permits only
•
TOTAL
CHRIS yrr,- 7 - Errk-Ar 5?e -5-1,.7 PVC
*State Contractor Boiler Certification required
"Residential NC requires site plan showing placement of unit
I:\rnechperm.doc rev 07/20/98
Permit #: FG2 9-0 707 / / QS- -0
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:59
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
it 1. I own, reside in, or will reside in the completed structure.
I
Eli 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
111 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
r 4 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction R onsibilities on the reverse side of this form.
(Si re o it applicant) (Da e)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note: This Information. Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(
If you are acting as your own contractor to construct a new home or make a substantial imp! o\ ement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you win, in most instances, be ruled to he an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's w ithholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945 -8091.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378 -3524.
•
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you ,nay
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1- 800 - 829 -1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must he
re -done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052,
503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop- own.pm4
1 /94
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
217070 Date Requested I, — �-,� — 9 Je AM PM BLD
Location 1 (5 LJ P Suite e [ 0 -055`5
Contact Person C. AA.lA Ph (n4 -S2 '17 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation ct a �i 1.p /2 _ FPS
Ftg Drain mot/' SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL _
/MECHANICAL. )
Post & Beam
Rough In ✓�`a �O►/`�"�► / 7 - 7 - 1
Smoke Dam rs
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
. CITY OF TIGARD BUILDING INSPECTION DIVISION'
MST
- 24=Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
. BUP
Date Requested , , AM PM BLD •
• Location • % ` ` - // Suite - "✓ • MEC ,
Contact Person 1 Ph - PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing .,'r'~1:= 5 - rY �, �',4: `� ' ? r ., , r• �_. • , � �.� FPS
; '• ' - dy� ;:. r -.. ,�- '. r','a •
Foundation 1 ti + : n. y .�: !% r , -
• Ftg Drain , _Z.�. k.: •� -. >> .. �-;�.._ .r- ;�..,.,,•...,1 ;zL•:; _._7§ ?)')
SGN
' Crawl Drain Inspection Notes: .
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear •
Framing .
Insulation
Drywall Nailing
Firewall
, Fire Sprinkler . /I
Fire Alarm '' / _ �/ -
Susp'd Ceiling . i ■ ./ – ` , / /.L, __
Roof / ,V//7 ' . . ,
7 i
Misc: -
Final `' ( /
PASS PART FAIL •
PLUMBING •
-_---:,• Post& Beam
' Under Slab .
Top Out -
t Water Service
. „ • Sanitary Sewer 7 . C
Rain Drains at • / 6 J -
-, Final'
PASS PART FAIL
MECHANICAL
Post & Beam
Rauch In - •
Smoke Dampers .
•
— CAS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage •
Fire Alarm - -
Final `
PASS PART FAIL.. _
SITE
Backfill /Grading ' •
Sanitary Sewer
Storm Drain • [ ] Reinspection fee of $ ' - - • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: • ' [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date I -' 1, Inspector Ext Tt
Final
PASS •PART - FAIL. • - DO OT REMOVE this inspection record from the job site.