Permit CITE wonK
PERMIT
CITY D PERMIT
OF TIGAR
DATE ISSUED: 07/23/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639-4171 PARCEL: 281 13B--008@0
/SITE ADDREss...: 4-64ara5-sw 74TH AVE
SyBDIVISION....:404r6 ZONING: I-P
BLOCK .... ...... LOT
T'PE OF WORK: NEW PAVING? Y RESO. NO.:
EXCV VOLUME: 0 cy GRADING? Y VALUE...$: 27815
FILL VOLUME: 0 cy LANDSCAPING? : Y
ENG FILL? Y SITE PREP?......: Y
SOILS RPT REQD?: Y STORM DRAINS?...: Y
IMPERV SURFACE: 14389 sf
Remarks: Grading permit
"SITE"
Owner. FEES
JOHN DUNCAN type amount by date recpt
16055 SW 74TH AVE EROS $ 80.00 JDA 07/23/96 96-281951
ERPC $ 26.00 JDA 07/23/96 96-281951
TIGARD OR 97224 ERPC $ 26.00 JDA 07/23/96 96-281951
Phone #: PRMT $ 184.00 JDA 07/23/96 96-281951
5PCT $ 9.20 JDA 07/23/96 96-281951
Contractor. PLCK $ 119.60 JSD 07/23/96 95-270998
OWNER SWM $ 545.04 JDA 07/23/96 96-281951
Phone #: $ 989.84 TOTAL
Reg C.:
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Erosion Control
Tigard Municipal Code, State of Ore. Specialty Codes and all other Excavation Insp
applicable laws. All work will be done in accordance with Grading Insp
approved plans. This permit will expire if work is not started Strm Drain Insp
within 180 days of issuance, or if work is suspended for more Structural mason
than 180 days. Engineered gradi
Final Inspection
Permittee Signature: -
• "
Issued By:
Call for inspection - 639-4175
I\
Commercial Building Permit Application
-
City of Tigard '
13125 SW Hail Blvd. t- ---
4 / ( f7
Tigard, OR , 97223
1(503) 639-4171 J 1
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1 Sqq,)
(1 Jobsite Address: S. W. 74th/
Tenant: Suite # *[:: Office:•tiiikOniv
.--- :... F.iancktRec::#i.
.00 7 (Pi —
Valuation:
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Permit # ;4 :1 .1 ' - ' -,1 '''
John Duncan • ' . :':'''" . ( >1 . 4306 :77C0 0 1 . : :i•C, : :i::: . •
\ Owner: .•:::-Map & IL #.:%::,--
Address: 16055 S. W. 74th :: Approvals:Recall!
Tigard, Oregon 97224 ' ':';V7;456j::c?'". ' ' : ''' ''''' ' :•:::
-:::• Planni ::::::•: . ::. .., . .,. :. .,::
Phone:
:-:
Other
Contractor:
Address: /U//
Type of const: N/A
Occupancy class: N/A
Phone:
Sprinklered? Yes No
Contractor's License #
(attach copy of current Oregon license) Sq. ft. of project:
Contact name & phone: Story (1st, 2nd, etc.)
• Proposed use:
Architect/Engineer: Nicoli Engineering
Previous use:
Address: P. 0. Box 23784
Note: Plumbing & mechanical plans .
Tigard, Oregon 97281 must be submitted at time of
building permit application.
Phone: 620-2086
JOB DESCRIPTION.
• &A.1,41V.PeNi..t` 7 i c\b
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Applicant Signature & Phone number
-",„ A'
Received by: Date Received: ,
\
Permit # Account Description Amount Amt. Pd. Bal. Due •
Bldg. Permit (BUILD) qv /Pt/
Plumb. Permit (PLUMB)
Mech. Permit (MECH) /
State Tax (TAX) 9 ? . V 0 � -
Bldg:
Plumb:
Mech:
Plan Check (PLANCK) 1 / 9 ✓
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
I Office TIF (TIF -O)
l . Water Quality (WQUAL)
Water Quantity (WQUANT) 5 V
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) (PO '
Erosion Planck/USA (ERPLAN) ✓
Erosion Planck /COT (EROSN) 0 26"
TOTALS: 6(6P qid
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9( 0)
. Permit #: IT 93 — (,b3 5
1 Sqq
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Address: )4: :S 7 T
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. S Issued by: � °7 Date: 2 Y/9,6
.
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, . : -ither box 3A or 3B: -
�
di. I own, reside in, or will reside in the completed structure.
e. k
Et,,/ P . I understand that I must register as a construction contractor if the structure is sold or offered for sale
Y‘ before or upon completion.
M , I A. My general contractor is
Y (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
I
r . C . 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. ,-(0
141/4 "TAP ir-- ''(/1/1"C-911"----- - 7 III (Signature of permit applicant) (D
(White copy to issuing agency permit file,
pink copy to applicant)
•
, ~
Information Notice to Property 0 e rs
About Construction Responsibilities
Note: This Information Notice to Property Owners about C'onsiruclion 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,
youcxnprevuntmaoyprob\emohvhoiugoymrcofthefb||owingrcsponsibi1dicmxudurcusofcnnceru.
EMPLOYER RESPONSIMLITIES:
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 witi be employees. As the ernployer. you rnust comply with the followiiig:
Oregon's withholding tax law: As an employer, you tnust withhold income taxes froni 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
inforrnation caII the Oregon Dept. oFRcvenue at 945-8091.
Unemployment insurance tax: As an employcr, you are required to pay a tax for unernployrnent insurance purposes O!i the
wages of all ernployees. For more information, caH the Oregon Eniployrnent Department at 378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workerst compensation insurance for your employees. Ifyou fail to obtain workers cornpensation insurance, vou may
be subject to penalties and will be liable for all claim costs if one of your employees is injured outhcjob.Foronoreinformutioo,
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 thetax paymentcven ifyou didn't actuallv withhold the tax. For more inforrnation. call the lnternal Revenue Serviee.
at 1-800-829-1040.
OTHER RESPONSIBILITIES ANIt AREAS OF CONCERN:
Code compliance: As the perm it holder for this project, ynuurcm:sponsih!efhrreuu|vingunyfui|un:tomectcodcrcquincmects
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 ornissions such as falting tools, paint overspray, water damage froni pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficienttime to supervise :'our employees.
Expertise: Make sure you have the expertise to act as yourown 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.
Ifyou have additional questions. write or calt the Construction Contractors Board (PO Box |4l40, Salem, OK97309-5052,
50J/370'462|). The Board is located ot70U Summer St. NE Suite 3O0.inSalem.
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