Permit CITY OF TIGARD MECHANICAL
II� DEVELOPMENT SERVICES PERMIT
!� = 13125 SW Hall Blvd., ligard, OR 97223 (503) 639 -4171 PERMIT # • MEC98 -1002
DATE ISSUED: 10/21/98
PARCEL: 2S1O2CA -00940
SITE ADDRESS...: 13520 SW VILLAGE GLENN DR
SUBDIVISION • VILLAGE GLENN ZONING: R -4.5
BLOCK LOT °040 JURISDICTION: TIG
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 HF' - 0 DOMES. INCIN: 0 •
3 -15 HF' • 0 COMML. INCIN: 0
MAX '•INPUT: 0 BTU 15 -30 HF' : 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30 -50 HF' • 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HF' : 0 CLO DRYERS..: 1
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: bas piping and new gas furnace.
Owner: FEES
CHINMAYA SHRIVASTAVE type amount by date recpt
13520 SW VILLAGE GLENN DRIVE • • PRMT $ 25.00 GEO 10/21/98 98- 310170
TIGARD OR 97223 5PCT $ 1.25 GEO 10/21/98 98- 310170
Phone #: 620 -3566
Contractor:
OWNER
•
$ 26.25 TOTAL
•
Phone #:
Reg #..: 000000
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 Final Inspection
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 more
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 may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
1 4/ Issue By: /ni�! Permittee Signature:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Plan Check #
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 l Date to DST
Print or Type `i Permit #/i* '9- /o(
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
1 35 OcSw V i (...t--4 c a zi L&L NDir Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# A) Permit Fees 10.00
1) Furnace to 100,000 BTU
Address including ducts & vents / 6.00
Bldg# City/State Zip 2) Fumace 100,000 BTU+
i I K /722.3 including ducts & vents 7.50
Name (or name of business) 3) Floor Furnace
Owner «j I N141, y, .Vgtti - ,S1 -iRI LAC/AO/ including vent 6.00
Mailing Address 4) Suspended heater, wall heater
� d�, �� or floor mounted heater 6.00
/ I ' �f 5) Vent not included in appliance permit
City/State Zip Phone 3.00
CHECK ALL *Boiler 'Heat Air
Name (or name of business) THAT APPLY: _. or Pump Cond Qty Price Amt
Comp
6) <3HP;absorb unit to
Occupant Mailing Address 100K BTU - 6.00
7) 3-15 HP;absorb unit
City /State _ Zip Phone - 100k to 500k BTU - - ' 11.00
8) 15 -30 HP; absorb .
Contractor Name
unit .5 -1 mil BTU 15.00
.56/._. !' 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. Cord. 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 O- Repair 0 Replace with like kind: Yes 0 No 0 - - 7.50
Residential 0 Commercial 0 18) Commercial or industrial type incinerator
30.00
Additional information or description of work: 19) Repair units .
4.50
20) Wood stove
4.50
21) Clothes dryer, etc.
/ 4.50
Type of fuel: oil 0 natural gas 0 LPG ar electric 0 22) Other units .
4.50
I hereby acknowledge that I have read this application, that the information - 2 Gas piping one to four outlets
given is correct, that I am the owner or authorized agent of V _ - - / 2.00
the owner, that plans submitted are in compliance with Oregon State laws. 24) More than 4 -per outlet (each).
.50
Signature of Owner /Agent Date - , -
Minimum Permit Fee $25.00 SUBTOTAL " ,.
- X `‘ .12/" '" --/L . - 10)211 K 5% SURCHARGE
ontact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL # .
�� ,_
‘.2.o'- 7 (' Required for ALL commercial permits only ,�` �' .�
ii <-��
3S TOTAL
i�
*State Contractor Boiler Certification required
14.) 2 ay / f. -72 ,P3 "Residential NC requires site plan showing placement of unit
l:irnechperm.doc rev 07/20/98
Permit #: Are 9 5 - /00
• ,
,,, �' Address: /3Sa 6 Sa V/L �
G 4—e0-/Q4—e0-/Q4—e0-/QA) Pi?
In a.
T • Issued by 6i Date: /0 -2 9 • I =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:
1 4 1. I own, reside in, or will reside in the completed structure. �j
n 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
l I before or upon completion.
n 3A. My general contractor is
I I (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
rx1 3B. I will be my own general contractor. \v.
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.
Z I4 f il e--c f/2/1/A---1---,/&-- /0/2-7/
- - • - - - _..• (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
•cr
Information Notice td Property Owners
About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities" .
was depeloped - 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. .
E6]PL�'YER RESPONSlBfL!`flES:
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.
I
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 inform ation,
call the Workers' Compensation Division at the Department of Consumer and Business Services at945 -7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax front 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. V .
OTHER RESPONSIo LUDES 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 additionaltquesZions, write or call the Construction Contractors Board (PO'Box .141-40; Sale'm;.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
Date Requested /. X 30 - 8 AM X PM BLD
Location r 5 Zc) Le Vida fe 6z2,4 Suite MEC
f_
Contact Person 1 11 Ph PLM
Contractor 1M a 9,h Ph R c Li '' O SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain 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
PA SS RT FAIL
ANICA
Post & Beam
Rough In
Gas Line
Smoke Dampers
inal
d • - T 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 /Z-30— q i
Approach /Sidewalk D / d Inspector ector " Ext
Other p
Final
\ PASS . PART FAIL DO NOT REMOVE this inspection record from the job site.
' 1