Permit CITYOFTW - 1 „--------
�,
CITY0f WARD
COMMUNITY DEVELOPMENT DEPARTMENT \ORES+ MECHANICAL
/ PERMIT
ig'Zr125 SW Hall Blvd. P.O. Box 23397, Tigard, Oregon 97223 (503)639 -4175
PERMIT # e MFt'9P-- t7rP9A
639 -4171 DATE.ISSUED: 11/09/92
SITE ADDRESS...: 11100 SW 78TH AVE PARCEL: 1S136CA- 00700
SUBDIVISION • ZONING: R -4.5
BLOCK LOT ...... ... °....
CLASS OF WORK..:ADD FLOOR FURN ° EVAP COOLERS:,
TYPE OF USE SF UNIT HEATERS..: VENT FANS...:
OCCUPANCY GRP..:R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES •1 BOILERS /COMPRESSORS HOODS °
FUEL TYPES 0 -3 HP DOMES. INCIN:
: /WOD/ / / 3-15 HP • COMML. INCIN:
MAX INPUT: BTU 15 -30 HP....: REPAIR UNITS:
FIRE DAMPERS ?..: 30 -50 HP.....: WOODSTOVES..:1
GAS PRESSURE...: 50+ HP CLO DRYERS..:
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.:
FURN < 100K BTU: <= 10000 cfm: GAS OUTLETS.:
FURN )=100K BTU: > 10000 cfm :
Remarks: Wood Stove
Owner: FEES
PAUL VOGT type amount by date recpt
11100 SW 78TH AVE PRMT $ 25.00 JH 11/09/92 —
5PCT $ 1.25 JH 11/09/92 —
TIGARD OR 97223 -0000
Phone #:
Contractor:
OWNER
Phone #: $ 26.25 TOTAL
Reg #..: 00000
REQUIRED INSPECTIONS
This persit 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 perrit will expire if work is not started
within 180 days of issuance, or if work is suspended for ■ore
than 180 days. •
Permittee Signature: eh
Issued By: ,- i/k--
Call for inspect ion — 639 -4175
I
Permit No: fYj e 4 Z^ 62-/14,
OF O
Address: /1 O D A 7 a --
H i •rte__ - .� O
Issued by Date: 2-.
59 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 aeplicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: •
• /.
1 .. I own, reside in, or will reside in•the completed structure. •
2. 1 1 .I understand thatI 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. ROI I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construe-
. - 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 , •about Construction Responsibilities on the
reverse side o is for .
/1 ? - 7
Signa ure of Permit Applicant Date •
CONSTRUCTION CONTRAC TORS. 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 faxes 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 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 . - . •
INSPECTION NOTICE
City of Tigard Building Depart ent
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec- O- Phhone):,639- 44l755 Business Phone: 639 -4171
Inspection: l 0(1 S � " ` `—
Footing' Plbg. Underalab 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: t \ `�� Time: AM PM
Address: Woo 16 Permit 1: Mel( 7 Z -62 -1‘
Builder: ` �IAMX ( / ? 5 S T
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: , ,�/11 Date: //`'
!/ APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.