Permit CITYOFTKARD
CflYOf �F'4RD
ColIA MECHANICAL
DEVELOPMENT DEPARTMENT \ �+ PERMIT
f3126 SW Hall Blvd. P.O. Box 23397, Tigaed, Oregon 97223 (603) 839 -4176 •
PERMIT # MEC92 -0279
639 -4171 DATE ISSUED: 10/27/92
SITE ADDRESS...: 15935 SW ROYALTY PARCEL: 2S110CC -03600
SUBDIVISION • ZONING:
BLOCK • LOT •
CLASS OF WORK..:ADD FLOOR FURN • EVAP COOLERS:
TYPE OF USE •SF UNIT HEATERS..:1 VENT FANS...:
OCCUPANCY GRP..:R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES •1 BOILERS /COMPRESSORS HOODS
•
FUEL TYPES 0 -3 HP • DOMES. INCIN:
: /GAS/ / '/ 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..:
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.:
FURN ( 100K BTU: <= 10000 cfm: GAS OUTLETS.:1
FURN > =100K BTU: > 10000 cfm:
Remarks: INSTALL EMPIRE BRAND NATURAL GAS WALL HEATER
Owner: FEES
FRANCIS GAVIN type amount by date recpt
15935 SW ROYALTY PARKWAY PRMT $ 25.00 JH 10/27/92 —
5PCT $ 1.25 JH 10/27/92 —
KING CITY OR
Phone #: 625 -6131
Contractor:
OWNER
Phone #: $ 26.25 TOTAL
Reg #..: 00000
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. This persit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee Signature: 2 .'
r Issued Py:
Call for inspection — 639 -4175
16
'KING CITY
wee e�e8 • 15300 SW. 116th Avenue, King City, Oregon 97224, Phone: 639.4082
COMMUNITY DEVELOPMENT .
• APPLICATION FOR BUILDING PERMIT
(Instructions an reverse)
DATE fi Z 9 Z
1. NAME OF APPLICANT: Mh./(' /.S .1 4 F(_N . Phone No. (' -.) / ,
ADDRESS: J. T � s Stu JQ f alit/ • J s ie �( /iL 6 /r
ADDRESS OF PROPOSED Tl.t
2. TYPE OF CHANGE, IMPROVEMENT OR CONSTRUCTION FOR WHICH PERMIT IS REQUESTED. -
DESCRIBE BRIEFLY — ATTACH TWO COPIES OF PLANS OR DRAWINGS OP
PROPOSED PROJECT: /Ai 57)4 if ,#7yig. 4 C tr i L /7(. -z2 ix)
f L _ L B A' _ • .I G P - r
3. NAME AND ADDRESS OF CONTRACTOR K •
PHONE NO. LICENSE NO.
•
4. NEIGHBORS WHO MAY BE AFFECTED BY TH/S PROJECT WILL BE NOTIFIED BY THE CITY.
APPLICANT OR HER /HIS REPRESENTATIVE MUST BE PRESENT AT THE PLANNING 04ISSION
MEETING NEXT HELD ON •
• REPRESENTATIVES NAME 'HONE NO. • -
(The King City Planning Commission vill co eider only those applications received at least five (5) days
prior to a weeti
SIGNAZVRE
APPLICATION RECEIVED BY a_ d a ,It) B . DATE ( -92
. APPLICABLE FEE RECEIVED $ a '— TOTAI _.C+•
PLANNING COMMISSION DECISION: Approved Denied
CONDITIONS _e. _ : _ . . . .e . a. _��•� _ .� •� � _ •
•
pp .l d� plications _ - for sir mop only
• Signature I! %i/ 4 . • ew _ Date / � C>
107E: rgon Honebuilder requires that all persons rho contract fo ork on th,.'r residence be
• i eoistered with the Builders Board shirk means the contractor is onded and maned on 'the iob site.
For your protection, be certain your contractor is registered by calling City Hall Ph: 639- 4082. •
•
NOTE: A permit must also be obtained f the City of Tigard Department of
Camaaiity Development Yes No
********** * * * *** * * *** *** * * * * ** * * * * * * * * * ** sit * **** * * * * * * ** **it**** * * ** *fi * * * **
. CITY OF TIGARD INSPECTION REPORT
-The above listed project has been inspected and Approved Denied
Date Cements
Signature
( i/se . n.6pec.tan, pega •ae. r evue. one. (1) copy ko k2ne CLty)
CD 2.81
•
OF O Permit No: in q — D Z
Address: 5 9 .33 ee
cm Issued by: /77 Date: � —2 -
5
9 FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. II I own, reside in, or will reside in the completed structure.
2 . I I I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A . I I My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B. I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I 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 understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
vSignature of ermit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
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(5),
passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substantial improvement 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 will, in most instances, be ruled to be an
"employer" and the people you hire will be "employees ". As the employer, you must comply with the following:
Oregon's Withholding 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 Department of Revenue at 378 -3390.
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 DHR
at 378 -3224.
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 may 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 DIF at 373 -7434.
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 221 -3960.
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 punc-
tures, fire, or work that must be 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 to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310 -0151
Phone 503 -378 -4621
0244J 10/24/89
5/24/00 Activities for Case #: MEC92 -00279
3:06:39 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. • Level By Updated Notes
MECA010 Plan check by 10/23/92 JH 10/23/92
MECA799 Final Inspection 11/3/92 MS PASS MRS 11/4/92
MECA060 (F) Issue permit 10/27/92 JLH PASS JH 10/27/92
MECA800 Case Finaled 11/3/92 TLP PASS TLP 11/20/92
•
Page 1 of 1
OCT- 23 -'92 FRI 10:00 ID:CITY OF KING C1TY FAX NO:503 639 -3771 11340 P02 - _
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INSPECTION NOTICE / `/ li
City of Tigard Building Dep
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Plbg. Underslab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: ) / / /' - .3 -- 9 Z . Time: AM PM
Address: 5 �_ / _...15l.-.-.er P: 12/ - 62-71
Builder: r / I '
THE FOLLOW CORRECTIONS A RE REQUIRED:
../
Inspector: 9
/ Date: //-- j 1
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.