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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 - _ I k\ ''-r S. I' 11x i"../4 IS V _ { L s W ROYAI. PAR KµAV n V \ 15935 OR 8722 C1 K1K fi till t _' _ 1. L______ N_______, / ,, ../ - ,,,.c q ,, , k , r ,...Ck\ .,--, 'A ' \ t L ‘& \‘' -"..7:*.. : 13 E j /\, j f h `14711 1 \ ,\ \\:- \) a 0 . j I I •,J 7 4-- 3 --zi r _______-, r ' -, ) A"\- r)\\ 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.