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Permit fe ITYOFTIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #t !EC96- -0051 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 DATE ISSUED: 02/20/96 PARCEL: 2S103AA -00500 . SITE ADDRESS...: 12130 SW TIEEDEMAN AVE SUBDIVISION - NORTH TIGARDVILLE ADDITION ZONING: R - -4.5 BLOCK LOT CLASS OF WORK..:ALT 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 WOODGTOVES..: 0 GAS PRESSURE...: 50-i- HP.... : 0 CLO DRYERS.. : Q' NO. OF UNITS - - -- AIR HANDLING UNITS OTHER UNITS.: 0 FURN ( 100K BTU: 1 (= 10000 cfm: 0 GAS OUTLETS. : 1 FURN > =100N. BTU: 0 ) 10000 cfm: 0 Remarks: Install new furnace Owner: ----- - FEES RICHARD PICRAR type amount by date recpt 12130 SW TIEDEMAN AVE PRMT $ 25.00 JMH 02/29/96 96-276503 5PC1 $ 1.25 JMH 02/29/96 96 -- 276503 TIGARD OR 97223 Phone #: Contractor : -- '---- -- - - -- CONTRACTOR NOT ON FILE Phone #: $ 26.25 TOTAL Reg #.. . REQUIRED INSPECTIONS ------- This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp applicable laws. All work will be done in accordance with Final Inspection approved plans. This permit will expire if work is not started within 180 days cf issuance, or if work is suspended for more than 188 days. • Permittee Signature: 2€16/14ei . _ .111-0.1a/,t_. _ Issued By: c Call for inspection - 639 -4175 ' / % - .. l ,, .......-_-_______________ _ City of Tigard MECHANICAL PERMIT Planck/Rec. # 13125 SW Hall Blvd. APPLICATION Permit # /G96- OV.1 Tigard, OR 97223 (503) 639 -4171 - Name of Development Description L Table 3A Mechanical Code QTY PRICE AMT Lm Job 12130. s U) 776 b6 fc a n (mi.. 1) Permit Fee -0- -0- 10.00 Address �Gtyi,tote 1 ► a le z / O e 47 2Z 3 2) Supplemental Permit 3.00 Name name of busmen Furnace to 100,000 BTU p Q4 0 L g. X /,, 2 0 _ /o r 1) inc I . ducts & vents 6.00 tang Rd eta 2 / 3 0 S O 7/C t1 t &�„ VI AV E. Furnace 100,000 BTU + Owner . r t t im. 2) incl. ducts & vents 7.50 `� e Floor Furnance e l a p j Q k 9727-3 3) incl. vent 6.00 nem of n i Suspended heater, wall heater • ► c M.K 16 L. P, c, K ak ( 1 iO S _ 4) or floor mounted heater 6.00 o eon a Vent not incl. in eo n Z� n S w TiCp cvlQUt 5) appliance permit 3.00 s Repair of heating, refrig. 1 / y AR h / t) n P2-23 6) cooling, absorption unit 6.00 Boiler or comp, heat pump, air cond. 7) to 3 HP; absorp unit to 100K BTU 6.00 Mme Address Phone Boiler or comp, heat pump, air cond. Contractor 8) 3-15 HP; absorp unit to 500K BTU 11.00 cdy /State 7a Boiler or comp, heat pump, air cond. 9) 15-30 HP; absorp unit .5-1 mil BTU 15.00 State RepsiMien No. Gty eua. tax No. Boiler or comp, heat pump, air cond. 10) 30-50 HP; absorp unit 1 -1.75 mil BTU 22.50 I hereby acknowledge that I have read this application, that the Boiler or comp, heat pump, air cond. information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50 agent of the owner, that plans submitted are in compliance with Air handling unit to State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50 Board, that the number given is correct. (If exempt from State Air handling unit registration, please give reason below.) 13) 10,000 CTM + 7.50 • Non portable 14) evaporate cooler 4.50 Vent fan connected 15) to a single duct 3.00 Ventilation system not iii4AVIIIIO 2-211.-Y- 16) included in appliance permit 4.50 Hood served by 17) mechanical exhaust 4.50 Descnbe work new 0 addition 0 alteration 0 repair Commercial or industrial to be done residential 0 non - residential 0 18) type incinerator 30.00 Existing use of Other i.e., woodstove, water building or property 19) heater, solar, clothes dryers, etc. 4.50 — Proposed use of 20) Gas piping one to four outlets 1 2.00 building or property ,,,�,//// 21) More than 4 -per outlet (each) 2.00 Type of fuel - oil 0 natural gas (p LPG 0 electric 0 NOTICE Minimum Fee $25.00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL AFTER WORK IS COMMENCED. TOTAL Special Conditions Date issue N by ...2-7.2 H. LLOGINIDSTSVAECHPMT • Permit #: I /tee I U- 00 5 l i I Ar �� � � Address: - ,:c ``� Issued by: Date: D 7 \ I 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: Ell 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ri 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 V 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 Responsibilities on the reverse side of this form. /;e 4 &PI 2Z F (Signature of permit applicant) (Date) (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). 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 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 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 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 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 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 4 CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639 -4175 Business Phone: 639 -4171 Footing Rain Drain Cover /Service FINAL: Foundation Water Line Ceiling - Plumb. Post/Beam Mech. Shear /Sheath Framing PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect. Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg. San. Sewer`' Appr /Sdwlk Reins. Other: GG Date: f 1 ((c)'( - 1 ( to &P Entry: Address: f aZ / -50 �c Tenant: Ste: MST: BUP: Con /Own: MEC: PLM: ELC: aE FOLValG e CORRECTIONS ARE REQUIFjED: 0 ,7"5 1 S 1 `;`i 8 .- , t ' vt "LC c-- 41.4r. , -: . i . rU\) - ( -)Z., <5 U L (6 c s - ‘ EI_Q..,o 0-)i .- 6 P-P- C (g; Z,1 p.._ , ,,A-s2_, ,.-,,,-/ . Inspector: 1� Date: t ( ' 44 _APPROVED X DISAPPROVED /CALL FOR REINSP. CF CO am 4 I, mEc 9c0(s1 1-9, ,esdo ro )s -* 1a13 , (-1 r e 10) 6 1e 6 V h�-e'