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Permit
CITY OF TIGARD PERMIT F F1 DEVELOPMENT SERVICES PERMIT #: MEC2006 -00390 �•' I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/9/2006 PARCEL: 2 S 104 D C - 03200 SITE ADDRESS: 13221 SW CLEARVIEW WAY ZONING: R-4.5 SUBDIVISION: BENCHVIEW ESTATES LOT: 032 JURISDICTION: TIG Project Description: Gas outlet to NG refueling appliance. CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: NAT 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1 > 10000 cfm: GAS OUTLETS: 1 Owner: FEES RATH, MARY J Description Date Amount 13221 SW CLEARVIEW WAY TIGARD, OR 97223 [MECH] Permit Fee 8/9/2006 $72.50 [TAX] 8% State Surcha 8/9/2006 $5.80 Total $78.30 Phone: Contractor: OWNER REQUIRED ITEMS AND REPORTS Contact #: Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other 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 in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: l! c.['. r s /I Permittee Signature: _ Ca,* Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mec'ha'nical Permit Appli fi-+6itl�' Niamtk FOR OFFICE USE ONLY City of Tigard J Received g AUG 0 i 16 Date /By: 1 f Q/ 46 Permit No.: M 62,E & — 00390 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �,,�,/ Phone: 503.639.4171 Fax: 503.598.1960 l#� Date/By: CO ' 0 Other Permit: Q2,4_2906, � 1 /0 Inspection Line: 503.639.4175 d d � �''if d e' o v . Date Read /By: lur Internet: www.ci.ti ard.or.us Oda .,, 1 ° y See Page 2 for g s T� Notified/Method: Supplemental Information ', TT� � gv! j r ,: .i Print name: TYPE OF WORK ❑ New construction ❑ Addition /alteration /replacement COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ Demolition ® Other: COMPRESSED NATURAL GAS Mechanical permit fees* are based on the value of the work REFUELING APPLIANCE performed. Indicate the value (rounded to the nearest dollar) of all CA'T'EGORY OF CONSTRUCTION mechanical materials. equipment, labor, overhead, and profit. ❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Value: $ ❑ Multi - family ❑ Master builder ® Other: COMPRESSED RESIDENTIAL EQUIPMENT /SYSTEMS FEES* NATURAL GAS REFUELING APPLIANCE NATURAL GAS AND For special information use checklist. ELECTRICAL CONNECTION Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: 13221 S.W. CLEARVIEW WAY (requires site plan showing placement) 14.00 City /State /ZIP: TIGARD OREGON 97223 Furnace 100,000 BTU (duos/vents) 14.00 Furnace 100.000+ BTU (ducts/vents) 17.90 Suite /bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: BENCHVIEW Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above 10.00 Subdivision: BENCHVIEW ESTATES Lot no.: 32 Other: NATURAL GAS FUELING APPLINACE 10.00 fax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 IN•FALLATION OUTSIDE OF COMPRESSED NATURAL GAS REFUELING Gas fireplace 10.00 APPLIANCE Flue vent for water heater or gas FUELMAKER MODEL FMQ - 2 - 36 • fireplace 10.00 Log lighter (gas) 10.00 G AS (94 C T ET Wood /pellet stove 10.00 Wood fireplace /insert 10.00 0 PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00 Other: M4 /teie i_k.y. s Ofl 10.00 • Name: MARY J. RATA TRUS T Environmental exhaust and ventilatio Address: 13221 S.W. CLEARVIEW WAY Range hood/other kitchen equipment 10.00 City /State /ZIP: TIGARD OREGON 97223 o 603 (013 _ a.000 Clothes dryer exhaust 10.00 Phone: (503)579 -8443 603 - -ill' i_ Fax: (503)641 -9284 Single -duct exhaust (bathrooms, s� toilet compartments, utility rooms) 6.80 ® APPLICANT to ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Business name: Other: 10.00 Fuel piping Contact name: ROBERT S. RATH AND MARY J. RATH TRUSTEE S5.40 for first four; SI.00 for each additional Address: 13221 S.W. CLEARVIEW WAY Furnace. etc. Gas heat pump City /State /ZIP: TIGARD OREGON 97223 Wall/suspended/unit heater Phone: (503) 579 -8443 Fax: : (503) 641 -9284 Water heater Fireplace E -mail: RSRATH @PRODIGV.NET Range _ ., - ...CONTRACTOR _ , Barbecue Business name : © Z _ Clothes dryer (gas) Other: NATURAL GAS • Address: I FUELING APPLIANCE / City/State/ZIP: MECHANICAL PERMIT FEES* Subtotal Phone: (503) Fax: ( Minimum permit fee ($72.50) CCB lie.: Plan review (25% of permit fee) ,,�/ 2�� J �� L �� /o " ,‘ C State surcharge (8% of permit fee) 'It t �(/ Authorized signature: �/y//�j LL I' 'v' " r i:\Building \Permits \MEC- PcrmitApp.doc IJ03 42 "'"YA'c , ^?�` 440 -06177 it I /OJCOM/WEB) i / d iva lnJ 3 ® � Z 5 O)S 6 7/d ,cov r ,„ NYfq 41144 z,5 >10W. 1�E� Permit #: m��00� (�o 39e � �� {,� Address: 13 S Le) �1 61172 v 1. i ) �,uG itt% �,Q 0A O �IG,AFtD Issued by: ,3/� Date: BU�1 -01NG D 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: 4 / 1. "I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 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 • -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. dit4,(k--0 s--1 (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Rnformatioo'i Notice to Property Owners About Construction Responsibilitias -. • Note: This h formation Notice to Property Owners ners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 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 Department 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 ifoneofyoureniployees 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 flu lure to meetcode requirements that may be brought to your attention through inspections. ]Liability and property damage insurance: Contact your insurance agent to see ifyou 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 ourown general contractor, to coordinate the work ofrough-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