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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005 MST2005 /8% 0055 00196 '"-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S104DA -11300 SITE ADDRESS: 12931 SW BEAGLE CT ZONING: R - 4.5 SUBDIVISION: QUAIL HOLLOW - WEST LOT: 099 JURISDICTION: TIG Project Description: Converting garage into habitable space. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SFA FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: DWELLING UNITS: THRD: sf RIGHT: VALUE: 1 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes JOHNATHAN KENNEDY and all other applicable laws. All work will be done in 12931 SW BEAGLE CT. accordance with approved plans. This permit will expire TIGARD, OR 97223 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ' ATTENTION: Oregon law requires you to follow rules Phone: 503 705 - 7176 Phone: adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 158.73 1 -800- 332 -2344. REQUIRED ITEMS AND REPORTS ... V ......._r______,______‘.. Issued By : Permittee Signature : J Call 503 - 639 -4175 by 7:00 a.m. for an inspection 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. Building Permit tiq �L� Vg �© ` * G'�.��' OFFICE( ,e._ s . City of Tigard Received Date/By: Pernut No.: Me /1 ,—.0d) 'h 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / r l / r v v Phone: 503.639.4171 Fax: 503.598.n6'Ol 0 2005 � � � '� Date/By: O Inspection Line: 503.639.4175 Date Date Ready/By: is ' 121 See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: t Supplemental Information R1 )ILDING DIVISION U `: ' ` TYPE OF " WORK ;' _, QUIRED DATA ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all XAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ' 'sCATEGORY `:OF ,CONSTRUCTJON ''';' work indicated on this application ❑ 1 and 2- family g ❑ Commercial/industrial rcial /industrial _ dwelling Valuation: $ / ®� i ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder Other: Number of bathrooms: 'f) JOB SITE <'INFORMATIO]V AND LOCATION :.: , Total number of floors: Job site address: 1 2 - 01 3 I 5 Q (. rg ems C! ( New dwelling area: 1o,j1 e � square feet C ity /State /ZIP: �^ Q � q 9- 2.z. 3 Garage /carport area: l square feet Suite/bldg. /apt. no.: 11 f 4( 4 Project name: , n l e d Covered porch area: square feet Cross street/directions to job site: , ` Deck area: square feet Other structure area: square feet REQUIRED: DATAr'COMMERCIAL =USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. l Indicate the value (rounded to the nearest dollar Tax map /parcel no.: ( dollar) of all equipment, materials, labor, overhead, and the profit for the `; DESCRIPTION OF WORK work indicated on this application. Valuation: $ Existing building area: square feet New building area: ua q re feet s PROPERTY OWNER' N • ;; ,t . ❑ TENANT ,-, ----; Number of stories: Name: 1;41 I � " rl `-1 ,-,- / R ail v Type of construction: Address: 12_ � I � ell (A— Occupancy groups: City/St /ZIP: I j a 1+Z2 Existing: Y-h1 " . ( ) C'' `�/ ( 7 2-`l g 1 % ,l New: 0; APPLICANT ;; Si - . 0 ";CONTACT`.PERSON '• h N O T ICE Business name: All contractors and subcontractors are required to " be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) E -mail: ', ' CONTRACTOR Business name: ®W (JE 4 ;BUILDING PERMIT :FEES* Address: Please refer to fee schedule. City/State /ZIP: Phone: ( ) Fax: Fees due upon application ( ) CCB ]ic.: Amount received Date received: Authorized signature: This permit application expires if a permit is not obtained s after it has been accepd as complete. Pnt name: C . Kei l rl. � Date: ( * F y J /g/ Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(1 I /02 /COM/WEB) One- and Two- Family Dwelling . +# C . .1 w... t`.a xt `` c is '+ .e .o.. 4�h` w..:.. Building Permit Application Checklist ,, 1 e o �oF F [ c> r o . , I , City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 G ^ + ^iII�,La. ❑ Electrical ❑ Plumbing ❑ Mechanical ■ 24- Hour Inspection Line: 503.639.4175 i ; Ji•6T Internet: www.ci.tigard.or.us Y"' - .'a ' '4 ❑Other. k' " u r t e - � In — � i ,;: a , Yes No ktigN/Aa ` THE FOELOWING ITE hilt RE R.O OR P.LAN#REVIEWAf �' .. - �- ++�sk���' 1� ' .l�.l _.:...}. .. _ ..�._ ,..... ,_._. .Q.... ,f._ -" -- -- .........._ ..._ _.nt .t>'{�":+1Cu�r, ia��tT.�y.�rc: 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ L , 4 Fire district approval required. Name of district: ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ g 6 Sewer permit. ❑ ❑ 7 Water district approval. ❑ ❑ 'a 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ Ti , ., 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch - ❑ ❑ J basin`protection, etc. -. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state g ❑ ❑ building codes: Lateral design details and connections must be incorporated into the plans or on a separate full -size' sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ X there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ,c and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- igr ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ -4- Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ 4 prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ -Elk locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 4- systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ IL 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ s't architect licensed in Ore:on and shall be shown to be applicable to the .ro•ect under review. ['ti r : Ifi�tT ` k,�� i .lt�c '7., u. �,. A ^§ t •;, �-r1 dflt -ir aLp5-a. �n B`°o a " 4 V �,'Y 1 f y . �_. 9: a . r.. �� yb ti a.TURISDICTIONALiSPECI;EICS� k e� Tww rna:�t..il�s- `�fs,Tt:ta�4c {� ti, ts'taiykst",`,`�s 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ !I 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ VI Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 U llECEI V z.J . Building Permit Applicati9,n ~� « " rk' + `�� {FOR OFFICE 'USE t' t v� +,- + �� c, t \! 1}' - i4rl�r:I f. 0 '. O i. l: w c; ' 7 ' { ' ! Nr Y.i. fit•, : - ;• ` P. t.t.s r '1.'? City of Tigard Received , CITY Y OF I ICiA�(d Date/By: / / * / Permit No.: a. 5 00 / 41.,. 13125 SW Hall Blvd., Tigard, OR 972.41 Plan Review Phone: 503.639.4171 Fax: 503.598.6 LDING ®IVISIC " °4:41,7-...61 of Other Per 't: Inspection Line: 503.639.4175 I II + � " ` Date Re B sin =�+ Ready /By: S p ofor Internet: Supplemental Notified/Method: � DM Su ementalntal I nformatiormationn , .i r a, ., , Fr { T Y PE OF W ORK f ,i,, , r S u"r' , } } 3 , z _ , .,.....;,e :: ,. t REQUIRED DAT 1 , 1R .. „ . « sR .- ..., ...... .... , ,. .ef :,.. ..a1<. .. xf._..1 ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all XAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the • , : sr. 4 : ' ` C ITEGORY OF C ONSTRUCTION ° work indicated on this application. El 1- and 2- family dwelling El Commercial/industrial Valuation: $ / 5.0 ID Accessory building El Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: ,- � x , r i _ ,, •,,.w.:- JO j I E I A N D LOCATION Total number of floors: < (1 X IC' it ) Job site address: f �oi 3 ! > ( IA 'g��a (A_ f •� c New dwelling area: 14/ 3 ,... square feet City/State /ZIP: T ®g, Q i 2:2- 3 Garage /carport area: 1 l square feet Suite/bldg. /apt. no.: ! !� Project name: ike-M ►7 ed Covered porch area: square feet Cross street/directions to job site: Deck area: square feet • Other structure area: square feet zREQUIRED DATA COMMERCIAL USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all : fi r r : �. a.- � equipment, materials, labor, overhead, and the profit for the Z' f.^ t ; , DESCRIPTIOY OF�2K ` SWO ,_ ry � ¢:, 4 ' _ . r= ., work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet ,r,: "T PROEERTY, OWNER . , � ry _. ' ® TENANT r 4 i. ' Number of stories: Name: / . 41 C{sry k e--4_ .J / Type of construction: Address: 12y j /i CA Occupancy groups: City/State/ZIP: l6- r 1 1 - 7..2,..3 Existing: t to ®, I 'APPLICAINT ' C f�f :� a s - t ii :... t'aP , ❑ CONTACT PE RSON r. n ` . 7 f New: lv a : . _ >y .. ,. .� k '';, l ,. `.N. €., , r .. ... . OTICE. -_%- 4 . Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons Phone: apply: bT „ [�7) ( ) Fax: ( ) /" E-mail: 110 ` °�~ a, , 4 r, f a CON - ' r , s '' - Y �/�I��(/ ... -. , : .., r ,,,,,T:-, ..., . :6 °.5;: rlix -,: Yx^ -;L y y +'' i I V O • Business name: M� 2 / � .-. _.BI}ILDI1 G PERMIT ES FE* , Address:.. City/State /ZIP: Please refer to fee schedule. Fees due upon application Phone: ( ) Fax: ( ) • CCB lie.: Amount received Date received: Authorized signature: This permit application expires if a permit is not obtained � /. ,/ w ithin 180 days after it has been accepted as complete. Print name: - 4 ,,, K ell e ?7,L Date: igio ) * Fee methodology set by Tri- County Building Industry vvv Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(1 I /02 /COM/WEB) U _ `—CCU • Electrical Permit Application FOR OFFICE USE ONLY ' City of Tigard Date/Bed Permit No.: Y: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Y /em il l Date/By: Other Permit: 2 Inspection Line: 503.639.4175 e' ' Date Ready/By: 0 Juris: See Page 2 for �.. Y Y Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information '' . E . Y' .. } , TYP �FTO$] , `„ 3{ a 1, ' . . _*, .rte . �._ �. ., • '> � ,. , a... -.... s ° ..... _. _ . s„ _ PLi�N. REVIEW . ❑ New construction d on/alteration/ placement Please check all that apply: ['Service over 225 amps, com'l Hazardous location ❑ Demolition 0 tithe Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., ' v CATEdOR' OE CONSTRUCTION $ ::` of 1- and 2- family dwellings 4 or more new residential and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more I: Multi family ❑ Master builder 0 Other: DOccupant load over 99 persons ❑Manufactured structures or ',. JOB . �-- IFo1 'iATION AND OCATION u` DE plan RV park Job no.: Job site address: ., .• , .� �sz_ � ,.. __ ..,. ._ , _ L _• -. x.. �� _,.1 ._: ..� ❑Egr /li htin lan p Z ` ' / 5 j ❑Health -care facility ❑Other: //J �C �C �� Submit 2 sets of plans with any of the above. City/State /ZIP: �/� L d CL O! n The above are not applicable to temporary construction service. / ( 3 FEE S CEED LE Suite/bldg. /apt. no.: Project name: : ' Description Qty. Fee. Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, rion- residential 75.00 2 „' s i! ;? _ ';, DESCRIPTION OF WORK' , . - r. r_, -. _ £ ii..3 Each manufactured or modular dwelling201 amps , service and /or amps feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 400 80.30 2 r - ' to 106.85 2 PROPERTYiOWNER , °„ L1 TENANT ,x a $•A. , :I d• sm - y 401 amps to 600 amps 160.60 2 Name: T C1 hCr" , N n , 601 amps to 1,000 amps 240.60 2 el Address: %� q �� -�� (Li-- Over 1,000 amps or volts 454.65 2 I / ( Reconnect only 66.85 2 City/State /ZIP: 7r — f2 C? 9- Z2? Temporary services or feeders installation, alteration, and/or Phone: ('33) c S Q I ?—,C, Fax: ( ) f J relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, le rent, o exchange, ac rding to ORS 447, 449, 670, d 7 1. es-- 401 amps to 600 amps 133.75 2 t p. Ow ner signature: s Date: �, n ff S Branch circuits — new, alteration, or extension, per panel t F APEL ANT ,:f.::' ( , ' , =•CONTAC 1 , RiSON -, t A. Fee for branch service or feeder fee each with 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit / 46 °85 � 2 Address: Each add'1 branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- ri d 1 energy panel, alteration, or f .;. ,ON <f x, extension. Describe Page 2 2 Business name: Duo tQ g---- Pa e dd eSS: Each additional inspection over allowable in any of the above Per inspection 62.50 i , /Stat. /f IP/ Investigation per hour (1 hr min) 62.50 • ' �.ne: / Fax: ( ) Industrial plant per hour 73 75 n„ �"'. ELECTRICAL :PERMIT• FEES*, ,< l ' i• • Electrical Lic.: Suprv. Lic.: Subtotal / .j am .u'.. . El trict : gna e, -quired: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: TOTAL PERMIT FEE 6o ,6o • uthor -d si: ature: / This permit application expires if a permit is not obtained within 180 / / days after it has been accepted as complete P • name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Pemuts\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDEN IAI? IV0WkilW ..ta'.8 r.,x ` k.. ii.;- Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COIVIIVIERC`IA' ,WORK UNLT' � ..: „' ITO Fee for each commercial system a $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 'Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \Permiu\ELC- PemtitApp.doc 04/03 Permit #: fi S i ADO 5 -0 0 l C (-b Address: . 29 I 5 J e_ -A:c LC C . Issued by: A 11. i 0, 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: lyi I own, reside in, or will reside in the completed structure. N 2. 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 /K 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 Proper Owners about Constru ion Responsibilities on the reverse side of this form. . • (Signature of permit appli ant) . a te / (White copy to issuing agency permit file, pink copy to applicant) - � . . Information Notice to Property Owners -. • Abo0t R=s�Cons'b' • � ' • /Vole; . This /nf/noutio/ Notice /o Property ()*nsrs about Cx/r//c//oxResponsibilities - way uere/oneil,_ the Construction Contrtictory Board /nuzoo/z6mur with ORS 701.055(5). . . |[ you - ire acting os your own contractor \o construct o new home or make x substantial improvement tnunexisdug yuu couprevcu/nnnD'pnJh|cnmbvheinguwuraobhc6oUpwingresponsihi{itiosuodmeusofdpocnrn. '' . EMF»LOYER .ES����������)��T|����� `�' |f ynu hire pemons not registered with the Construction Contractors to do labor in coosVnc1iog.or assisting in the construction urimprnrencrao[urx�duxiu|nmcNn� you wiU,inmog b ios��ozcs,e ruled rohe an employer and the people you hire will hcnmp|ovee:s.�Aithe employer; m�$ �o�comp|ywiththefhUo'/g: .;•; „ Oregon's withholding tax law: &sXnomp|dver,yooxmSt`v(lhho|Uixoomcixxcs6omcmp)oyif!e`nzgcsuYrhetimomnp|oyres are paid. Yuonii\hchub|cforth:xnpoynentscvchifyOodux1uc/uoUy"/i(hho|dthctax6omynuremployees. For more iofoxnutinn,cu||thcOregnnDc|u.nfKcvcooe 94;5-8091` '—. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages o[ all employees. For more inhonnadvn.. call UheOregon, |�np|oyinern Department t 378-3524.. 'Workers' compensation insurance: As an o:npfovei zo(6c Compensation Law, and must_ obtain *orkurs' compensation iosurancc for your nndoyees. ifymufail /o obtain workers' compcoSa`on insn/ nc c. you triuy he subfeu 10 pellalties and niUbcUnNofbraUduirricoscsi[oneofyooremp|yyucsixiniuodon/br)ub.FormnrcioFbnnat(oo, call the Workel Division at'lhe Department of and Biiiness Sc' ice� t9���7888.` y 0.S.1mtoruu/ Revenue 0orrixc:As as employer, �you must withhold federal income lax from employees' wages. You will be liable footle tax payrneni even i[you didn't actually withhold the uz.Tor more in[nrmuziou, Call the |h\cruu| Revenue Service at 1-800-.329-1040.' �` ' . OTHER RESPONSIBILITIES' AND'AREAS OF CONCERN: Code compliance: A the permit holder for this project, yuuuozsponsiNc[orrcao|vixganytxUuo:nomcetcodrrcquipcmcnts that may bc brought oo your attention through inspections. • Liability and property' damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents .un that must he re-done. � ! lGmneroaupenixuemployees: ��ak�s�ncyouh"vcSu8icicntUmcWsoiperriscyourc/hp|"vces� Expertise: Make sure von havc theexpertisetoact as vourown goneral contractor, hocoondinatz\hcnorko[vough'innndUuish tracles. and 10 orifv building OM5dul*o[{hcopprophmclimosso'thev-cxoPcrTbonthcrcqLiindiospeuohsi ��' = • .��' Ky/ have additional questions, «/ri/t the Construction Contractors Board (PO Box \4\40, Salem, Ok97]09'j052. • 503/378`462|). The.Bnurdisiucuudo17O0 Summer St. NE Suite 300`ivS»)em. � .� ' . . • ` pmp+,o.pmJ l/94 { CITY OF TIGARD ' BUILDING DIVISION PERMIT #: MST2005-00196 ST2005`001 g6 � 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 :ntlploiliiI\ Inspection Requests (24 Hrs.): (503) 639 -4175 -tar IL INSPECTION WORKSHEET FOR DATE: 9/9/2005 TIME: 7 :07AM PAGE: 26 d.Ma SITE ADDRESS: 12931 SW BEAGLE CT CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW - WEST LOT #: 099 TYPE OF USE: PROJECT NAME: KENNEDY DESCRIPTION: Converting garageint° ha►itable space_._ • OWNER: KENNEDY, JOHNATHAN PHONE #: 503-706.7176 CONTRACTOR: OWNER PHONE #: 503 • Inspection Request Scheduled For: Date: gig12005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 015301 -01 503-705-7176 .;J Corrections /Comments /Instructions: r-eFOIT g'Z - - ©S (g_S eo/ C7,1 poi' S • Illk . - e 4 SS r PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL A !ALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: . . __ �� Date: Phone #: (503) 718- ,,,iiRr.,, Y OF TIGARD BUILDING DIVISION +s PERMIT #: MST2005-00185 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005 Phone: (503) 639 -4171 ,hinivfl lli Inspection Requests (24 Hrs.): (503) 639-4175 ...44.- ='_,J.., INSPECTION WORKSHEET FOR DATE: 7/18/2005 TIME: 7:07AM PAGE: 29 SITE ADDRESS: 12931 SW BEAGLE CT CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW - WEST LOT #: 099 TYPE OF USE: PROJECT NAME: KENNEDY DESCRIPTION: Converting garage into habitable space. OWNER: KENNEDY, JOHNATHAN PHONE #: 503-705-7176 CONTRACTOR: OWNER PHONE #: 503- 475.3180 Inspection Request Scheduled For: Date: 7118/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 011613 -02 503 - 706.7176 N Corrections /Comments/ Instructions: • (SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / Inspector: - I S 0 S Date:.: —10 Phone #: (503) 718 -