Permit I
. CITYOFTIGARD MASTER PERMIT
PERMIT #: MST2000 -00150
ilil DEVELOPMENT SERVICE DATE ISSUED: 06/05/2000
13125 SW Hall Blvd., Tigard, OR 97223 (50 1
SITE ADDRESS: 11125 SW 82ND AVE PARCEL: 1S136CB -01500
SUBDIVISION: RANCH VALLEY ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
REMARKS: adding onto existing house 819 sq ft PATH I SF
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 10 FIRST: 819 sf BASEMENT: sf LEFT: 13 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 33 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 16
VALUE: $ 58,124.43
OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 819.00 sf REAR: 48
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 4 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: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st WIO SVC /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:
Owner: Contractor: TOTAL FEES: $ 1,176.05
This permit is subject to the regulations contained in the
CURTIS, GENE E + NANCY J SLS CUSTOM HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
11125 SW 82ND PO BOX 1093 all other applicable laws. All work will be done in
TIGARD, OR 97223 TUALATIN, OR 97062 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rea 4: LIC 091577 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion 844 -8444 Underfloor insulation Plumb Top Out Insulation Insp Final inspection
Footing lnsp Crawl Drain /Backwater Electrical Service Rain drain lnsp Building Final
Foundation Insp Footing /Foundation Dn Electrical Rough In Electrical Final ORIGINAL
Post/Beam Structural PLM /Underfloor Framing Insp Mechanical Final
Post/Beam Mechanical Mechanical Insp Shear Wall Insp Plumb Final /
Issued B • �� ,././.7 `/ Permittee Signature ∎`I4�
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business
•
Permit #: /05 F a2 00 - DO / 5
�v F �
- te r � , Address: J //02.5 ' 5 v� ALE
97. Issued by: Date:
5
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:
I
hg? 1. I own, reside in, or will reside in the completed structure.
e ftia 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
tr
3A. My general contractor is L Ce 7°/''- ( j2 qis' 7
(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.
EXPIRED
OR
pi 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 roperty Owners about Construction Responsibilities on the reverse side of this form.
my (' ignature of permit applicant) (Date)
(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 develop 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,
you can prevent many problems by being aware 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 employer and the people
you hire will be employees. As the emplOyer, you musfcomply with the follOwing:
Oregon's withholding tax law: As an eniployer, 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 R.evenue 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 Division at the Department of Human Resources
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 if one of your employees 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 Service: As a'n employer, you itufst 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 l -800-829-1040. .
• •
OT .R-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 punctures, fire, or work that must be
redone.
Time to supervise employees: Make sure you have sufficient time to supervise your ernployees.
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 or call the Construction Contractors Bciard.(P0 Box 14140, SaleM, OW97
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.prn4
1 /94 -
CITY- PF :TIGARD Residential Building Permit Application Plan Check #5-(0 It
13f25 SW HALL BLVD: Additions or Alterations Recd By Date Recd 5 . o>,
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E.
V 503 - 639 -4171 Date to DST 5 - 1 r-o
F 503 - 684 -7297 Permit # in5 ,06PG -Gvi„
Print or Type ( � Called 5 ' °a
Incomplete or illegible applications will not be accepted
• i Etr Ille 14
Name of Project Name i
A �-J JP� OP.J te U Job ` <�RTt 5 �A 11�aJ M ailing Address
Site A ddress Architect o
Address ,.r7 3 X,L. s 1M tSPr -o e- . e--A., l k 1 a 5 � °''' - �(6A2d City /State Zip Phone
N me 1-k- lLtp,c -o ' 9 - 7 l &3 jv
0 , ev-4C it- 0 Po-lc 1 C'Vka -TIA Name
Owner Mailing Address S p,crk h-
k J `/`) %P-851
� Engineer Mailing Address
City /State Zip Phone
.fikA City /State Zip Phone
General Name J
Contractor LS C, Unpin � k c— Describe work New 0 Addition O" Alteration 0 Repair 0
Mailing Address to be done:
Prior to permit Po 1os 3 Additional Description of Work:
issuance, a copy City /State Zip Phone /OO '70 aenL or ezaig 1
of all licenses IlAir1,-,Pcnr t Ip
are required if Oregon Const. Cont. Board Exp. Date PROJECT 6(6 --
expired in COT Lic.# et '6 .11 10 i oo VALUATION $ 5 ,
database Mechanical Name NEW CONSTRUCTION ONLY:
Sub - bW AY 12 Sq. Ft. Houser / / Sq. Ft. Garage '!
Contractor Mailing Address
Indicate the restricted energy installation by the electrical
Prior to permit subcontractor in the following areas
issuance, a copy City /State Zip Phone Restricted Audio /Stereo
of all licenses Ener System Alarms
are required if Oregon Const. Cont. Board Exp. Date gy
expired in COT Lic.# Installations Vacuum Irrigation • database System System
Plumbing Name (check all that Other:
Sub - bw041-g- apply)
Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO
(check one) (check one)
Has the Subdivision Plat recorded? N/A YES NO
Prior to permit City /State Zip Phone
issuance, a copy
of all licenses are Oregon Const. Cont. Board Exp. Date
required if Lic.# I hearby acknowledge that I have read this application, that the
expired in COT
database Plumbing Lic. # Exp. Date information given is correct, that I am the owner or authorized agent
of the owner, and that plans submitted are in compliance with
Ore on State laws.
Name Sig t re f 0 ;! ner /Agent Date '
Electrical p0 Pvt.-- Contact Person e
Phone #
Sub- Mailing Address Na- S 1--a toR k -c8
Contractor FIRED
City /State Zip Phone 1 ,
Prior to permit •
issuance, a copy FOR OFFICE USE ONLY: _
of all licenses are Oregon Const. Cont. Board Exp. Date Plat #: Map #
required if Lic.# , � 3 f, CB -0500
expired in COT
database Electrical Lic. # Exp. Date Setbacks: Zone: D '11f S Solar:
Electrical Supervisor Lic. # Exp. Date Engineering Approval: Planning Approval: TIF:
el G. 05 Ltr TJ Sc o - b � S i:ldstslforms\sfaddalt.doc 11/20/98
0 k b I J`
,.. _to • , 5.-- e»,' -r 5r TL, -0-r + s A S Is .
OF TIGARD BU" DING INSPECTION DIVISION
MST G� jv
�.
our nspection Line: 63. ,175 Business Line: 639 - 4
BUP
Date Requested 7—i (( AM PM BLD
Location / // Z) t W 8 2- Suite MEC
Contact Person' 6eop Ph 6,Z- e588 PLM
Contractor Ph SWR
BUILDING Tenant/Owner 04 /1 / ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: •
- Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING •
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer EXPIRED
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL -
C 'ELECTR
Service
u hl
UG /Slab
Low Voltage -
Fire Alarm
F
PAS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for einspection RE: nable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date / Inspector .. Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site
c
Y OF --- - B I'IL ®ING INSPECTION_ DIVISION MST Gov/
-dour Inspection Line: L 4175 .. Business Line. 63S 71
BUP
- Date Requested q/ AM PM BLD
Location 1 1/ /7-5 I J G2I g2n11 Suite MEC
Contact Person Ph C -4 ege PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
•
Retaining Wall ELR -
Footing Access: A te /
Foundation � FPS
Ftg Drain
Crawl Drain Inspection es: SGN
Slab SIT -
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler - -
•
) Fire Alarm
Susp d Ceiling •
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
op Ou
a er Service
Sanitary Sewer EXPIRED
Rain Drains •
Fin
ASS PART FAIL
ANICAL _
Post & Beam
Rough In .
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date II /10 /- Ext _ Other S Inspector / /)717 /�
Final •
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BI IILDING INSPECTION DI _�I�
SIGN. MST av - Ga /J �
24 -Hour Inspection Line: . ,-4175 Business Liner' 63S /1
BUP
Date Requested q � Z/ AM PM BLD •
Location 1/1 Z-S S S' z- Suite MEC
Contact Person Gev e Ph F9 - Fg gej PLM
Contractor S�P ✓� Ph i y— f z 3r SWR
BUILDING Tenant/Owner c 1' rte )47G ELC
Retaining Wall ELR
Footing Access:
Foundation `.. ` FPS
Ftg Drain SGN
Crawl Drain Inspection , • s:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling — ��.2A111111110!17
Roof "Kg
Fina
Final
RT FAIL Ar
Post & Beam
Under Slab
at�ice
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICA EXp1R
Post & Beam R
Rough In
Gas Line
Smoke Dampers -
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please - I for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date • Inspector j P7"0 - Ext
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
• CITY OF TIGARD B' "DING INSPECTION DIVISIO'4 MST C4,_frU7s v
24 -Hour Inspection 6..., -4175 Business Line: 639• . /1
BUP
Date Requested � — AM PM BLD
j
Location 1/ / Z ?1 � Suite MEC
Contact Person Ph 577 ? 2 L' PLM
Contractor Ph L SWR
BUILDING Tenant/Owner p /i « ' r - ELC
Retaining Wall ELR
Footing
Foundation Access: �J I ,,C/, , FPS
Ftg Drain (J / ✓
- Crawl Drain Inspection tes. f SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing /
Fire Sprinkler .AWA
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
U lab
•
- er Service
Sanitary Sewer
Rain Drains
Final •
PASS PA FAIL EXPIRED
MECH L
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service -
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm.erain [ ] Reinspection fee of $ required before next inspection. , Pay at City Hall, 13125 SW Hall Blvd
r�
Cat sin
Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
\11* Date 10 Inspector W ExtLJ
\' DO NOT REMOVE this inspection record from the job site.
• ,j :cry OF -TIGAI D BI IILDING INSPECTI r
MST 700 --:0 . -
:24 -Hour Inspection t 4175 Business Line: _639 1 .
r
- _ Date Requested g� AM PM . .
BLD
Location - 1 / 1 74 CO rZ thi-Z-' _ Suite MEC •
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner , ,2,-,t_ q Z --2 ELC
Retaining Wall ELR
Fo oting ion Access: _ p( (.U�� if4g1 /11V c FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: _
Slab SIT
Post & Beam /
Ext Sheath /She. f45
IntSh -- . S. -- '44°
sul- m.
Drywall Nailing //Le ,Vi/L.&.jra ,v ir n, S'li rl..�.. 5,
Firewall
Fire Sprinkler
I Fire Alarm
I Susp'd Ceiling
Roof •
Misc: /'
Final
RT FAIL
LUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
•
Rain Drains
Final
PASS PART FAIL
MECHANICAL XPI
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL
Service -
Rough In
UG /Slab
Low Voltage
•
Fire Alarm
Final _
PASS PART FAIL
• SITE
Backfill /Grading
Sanitary Sewer •
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 9-- .,./ ari Inspector - - Ext
N\ Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF •
TIGARD P''ILDING INSPECTION - •DMSI 'I - G �} a -v
24 -Hour Inspection Line: �...9 -4175 Business Line: 639 -4171
ST
/
9
- -Date Requested �� AM' �" �j ?7PM BUP BLD
Location if / - 82- - Suite MEC
Contact Person Ph x/ 3 ) PLM
Contractor Ph SWR
11LDI ! Tenant/Owner PYG94 Ca..e/ / 7 ELC
Retaining Wall ELR
Footing
Foundation Access: S O
FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: .
Slab OtSS SIT
Post &Beam
xt Sheath /S ea �` C
rami • 1,e 0
Insulation
Drywall Nailing �✓�� ��� �-J Lo
Firewall
Fire Sprinkler ��� Cam A
Fire Alarm `
sus 'd Ceiling AN ZN/ v`" • ' L 0 . it
Roof
Misc: l ,, ) ,p t
Final V �� `�U\N i�:.7� G✓��.�� 1 c� Q��
P ASS PART AIL �
PLUMBING
Post & Beam -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final •
PASS PART FAIL EXPIRED
�fIft1�CHANI
Post . :eam
.
as ine
Smoke Dampers
74011
ART FAIL
E TRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA ./ Approach /Sidewalk Date U Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
-CITY OF TIGARD 24 -Hour
/ "` BUILDING • Inspection Line: (503) 639 -4175 w /S ^0
i f INSPECTION DIVISION Business Line: (503) 639 -4171 -
—
BUP
Received Date Requested / / / S AM PM BUP
Location / / / Z r U`-C Suite MEC
Contact Person a J24-1....e // Ph ( ) PLM
Contractor C.vje - 7, Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation R..) C ELC
Ftg Drain Access: � ff Z � ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
•
Int Sheath/Shear — & % ��
_ • G} /�i / (,')
Framing /
Insulation
Drywall Nailing
Firewall - 1 Q, 144 10
Fire Sprinkler
•
Fire Alarm r k" , / _ / 1
Susp'd Ceiling
Roof
Other:
Final :+ a . --
PASS PART FAIL aa � J , /
PLUMBING /u r v'� , (/t''� � ` e./ N tee
Post & Beam U
Under Slab
Rough -In
Water Service
Sanitary Sewer
C( Rain Drains -
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
I( Final
PASS PART FAIL
MECHANICAL
Post & Beam
Ga s Line EXPIRED
Gas Line
Smoke Dampers
O( Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
X Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
/J V . Approach/Sidewalk Date ?i Inspector `J C� Eat
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST UGr/ - G %5
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ( AM PM BLD
Location ///2-.0 56v 8 Z- Suite MEC
Contact Person 5(°G -e Ph 5 2 -3.3 PLM
Contractor Ph Z Fi�i� SWR
BUILDING Tenant/Own r Cam" C e/u2 15' ELC
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear - -
Int Sheath /Shear
Framing
Insulation
Drywall Nailing / V � -� - I 3
Fire Sprinkler i4 Q��,l/
Firewall I
P � () f ��� / -
Fire Alarm -
Susp'd Ceiling
Roof �� — /—� �C Sy:4,9 16_ — ci
Misc: ��C �"
Final
PASS PART FAIL PLUMBING , Prv � s ro A/Abe - c - 7 /AI 4
Post & Beam
Under Slab A
Top Out - V /
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final -
PASS PART FAIL
(ELECTRI
Service
(ouatai
't7G /Slab
Low Voltage
Fire Alarm
Final
PASS PART
SITE
Backfill /Grading
Sanitary Seer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 9/7/50 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
•
Permit #: /VS %o2oO0 - 00/50
OF
� `` �' Address: /// 5 - (F02 f �Y/E
N • .rrnry ; Z
Issued by: / Date:
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:
F1. I own, reside in, or will reside in the completed structure.
E 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
n 3A. My general contractor is
I (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 Prope t Owners ab i ut onstruction Responsibilities on the reverse side of this form.
I
1 — — 2000
(Signature of permit applicant)- (Date)
(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 Cemsiraction 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,
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 emplb 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 Division at the Department of Human Resources
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 subjct 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 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 failure to meet code requirements
that may be brought to your attention through inspections.
Liabilily 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 punctures, fire, or work that must he
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 lave additional questions, write or call the Construction Contractors Board (PO Box 14I40,--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
• CITY OF TIGARD BUILDING INSPECTION DIVISION MSTiioa - CO 1 5
• 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7- Z.6 AM PM BLD
Location /// 8Z • Suite • MEC
Contact Person Ph - 94 7 — f O Z- PLM
•
Contractor Ph SWR
•
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: -
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof
Misc:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab •
Top Out
Water Service
Sanitary Sewer -
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In •
Gas Line
Smoke Dampers
Final
RT FAIL
ELECTRICAL
ervicee
Rough In -
UG /Slab
Low Voltage .
Fire Alarm
Fi
AS PART FAIL •
SITE
•
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY- TIGARD BUILDING INSPECTION DIVISION MST (74&&-60 l
24 -Hour Inspection Line: 639 -4175 . Business Line: 639 -4171
BUP
Date Requested / 2- 5 AM PM BLD
Location 1/1 Z i s 8 s - Suite MEC
Contact Person Ph 94 Y 9 O y , PLM
Contractor ( )(A) r�r Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall E LR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation zE
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling & e2.0
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL •
Post & Beam
Rough In . - •
Gas Line
Smoke Dampers
Final
P RT FAIL
ELECT
ery
ough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART AI
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date 3 Inspector Ext
Other
Final
PASS PART FAIL ' O N e T REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST ?BOO -O 0 1 SO
24 -Hour Inspection' Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested V/9/00 AM PM .BLD
Location I I I 5 v Z t-eit , Suite MEC
Contact Person t�.__ e ,(�, Ph t/ 0O2 PLM
Contractor Ph SWR
(- I DC) Tenant/Owner ELC •
Retaining Wall ELR
Footing Access: •
Foundation - FPS
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: /� n n h/� /011 or
. : Be- l.�t,C.0 SIT .
• - ' ea /Shear
Int Sheath /Shear -
Framing
Insulation -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof -
Misc:
F'•-
PART FAIL
LUMBI --
ost & Be;
Under Slab •
Top Out
Water Service
Sanita Sewer
Rain D_ rai
i
P • RT FAIL
1M HANIC •
ost & Bea .►
Rough In ,
•
Gas Line
Smoke Dampers
Final •
111 PART FAIL
- RICAL
Service
Rough In
UG /Slab
Low Voltage
•
Fire Alarm
Final -
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd _
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date 6 /is/ Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING IN SPECTION. DIVISION MST 2COO 0 5 0
24 -Hour Inspection Line: 639-4175 - Business Line: 639 -4171
\/ BUP
Date Requested O g/00 AM Ye PM BLD
Location I I f 2 S D ..4C - Suite MEC
Contact Person phst q - 9 3 3S PLM ..
Contractor Ph SWR
lifUILDINSI, Tenant/Owner ELC
Retaining Wall ELR •
(Footi Access: FPS
datio7
Ftg Drain
Slab
Crawl Drain Inspection Notes: en AA 1 ` ; 00 SGT
SIT
Post & Beam ��n� ►" 6 /�
Ext Sheath /Shear _ �t,�c � r {� �r
Int Sheath /Shear
Framing / AI d _ g,—, _ 5 S.
Insulation -
Drywall Nailing /ZS - ZZ wti
Firewall
Fire Sprinkler 0 A/12. Li c
Fire Alarm
Susp'd Ceiling ' 3 0� -i i v2 C4 z .v .ri /JL CIO 5i a.i )
Roof
Misc: J.c� n [• / S
PART FAIL
• • = ING
Post & Beam
Under Slab
Top Out
Water Service -
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
•
Final
•
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Su I Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
PPy
ADA / a
Approach /Sidewalk Date — v — e Inspector Ext
Other
Final
PASS • PART FAIL DO NOT REMOVE this inspection record from the job site.
1
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