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Permit
* ' CITY OF TIGARD 1 , ,„/ COMMUNITY DEVELOPMENT DEPARTMENT er MASTER PERMIT 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639-4171 � � PERMIT #.......: MST94-0395 639-4171 =~ / DATE ISSUED: 10/17/94 �r 03600 � PARCEL: 1S135DB *�� _ SITE ADDRESS...: 11480 SW 92ND AVE SUBDIVISION....: DOGWOOD RIDGE ZONING: R-4.5 BL8CK.. .. .. .. .. : LOT.. .... ...... . :9 --- --- BUILDING ---- — REISSUE: DWELLING UNITS:1 BASEMENT........:0 sf CLASS OF WORK.:ALT BEDRMS:0 BATHS:0 GARAGE..........:0 sf TYPE OF USE...:SF FLOOR AREAS REQUIRED SETBACKS TYPE OF CONST.:5N FIRST ^0 sf LEFT..:0 ft RIGHT.:60 ft OCCUPANCY GRP. :R3 SECOND... :0 sf FRONT. :0 ft REAR.. :0 ft STORIES.......:1 FINBSMENT:0 sf REQUIRED— — HEIGHT........:21 ft TOTAL :0 sf SMOKE DETECTORS.: FLOOR LOAD....:40 psf VALUE.....$: 2500 PARKING SPACES..:0 Remarks: ALT OF ROOF ------ ---- PLUMBING — — — SINKS,.,,,,.... :0 FLOOR DRAINS. ... :0 BACKFLOW pREVNTRS.. :0 LAVATORIES.....:69 WATER HEATERS...:0 TRAPS..............:0 TUB/SHOWERS....:0 LAUNDRY TRAYS...:0 CATCH BASINS.......:0 WATER CLOSETS..:N SEWER LINE (ft>.:0 GREASE TRAPS.......:0 DISHWASHERS....:0 WATER LINE (ft).:0 OTHER FIXTURES.....:0 GARBAGE DISP...:0 RAIN DRAIN (ft).:69 WASHING MACH...:0 SF RAIN DRAINS..:0 MECHANICAL — -------- FEES FUEL TYPES UNIT HTRS..:0 type amount by date recpt VENTS . . . . . :0 BPRT $ • 38.50 JF 10/14/94 94-257806 MAX INPUT:0 BTU VENT FANS..:0 BPLC $ 25.03 JF 10/14/94 94-257806 FURN < 100K ..:0 HOODS......:0 B5PC $ 1.93 JF 10/14/94 94-257806 FURN >=100K ..:0 WOODSTOVES.:0 FLOOR FURN....:0 CLO DRYERS.: 0 BOIL/CMP ( 3HP:0 OTHER UNITS:0 GAS OUTLETS:0 Owner: ----- — — --- TERRY SMITH 11480 SW 92ND AVE TIGARD OR 97223 Phone #: 684-1460 Contractor: -- — OWNER • Phone #: Reg #..: -- — $ 65.46 TOTAL This permit is issued subject to the regulations contained in the ------- REQUIRED INSPECTIONS Tigard Municipal Code, State of Ore. Specialty Codes and all other Framing Insp applicable laws. All work will be done in accordance with approved Insulation Insp plans. This permit will expire if work is not started within 180 Gyp Board Insp days of issuance, or if work is suspended for nore than 18N days. Rain drain Insp Building Final Permittee Signature: _ Erosion Control Issued By: _ -- . ` Call for inspection — 639-4175 . Permit #: OF Address: .i : Z Issued by: Date: 1 85 9 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: N1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale ' I before or upon completion. El 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 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 Property Owners about Construction Responsibilities on the reverse side of this form. Z� Lid 10 �t3� (Signatur of rmit app i t) (Date) (White copy to issuing agency permit file, pink copy to applicant) ' . Int. r0ation Notice t 'wro erty ,Vners b()Wt C(cnstruct^on 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). 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. EMPLOYE RESPONSIlzILITIES: 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 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 subject toyenubiooundp/iDhe!iub|eforol|cluinzoommif0000fynorenop|oyecoiui jured 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 1-000-829-1040. OTHER RESPONSIBILITIES AND AP OF CONCE , N: Code compliance: As the permit holder for this project, youmeromponuib}eforresolving 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 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 or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 |/94 i Residential Building Permit Application City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639 -4171 Jobsite Address: \ HBO S. W . q2 [ j q , Office Use Only Subdivision: �\ '1 Subd i '®�t�i WO ©D FBI �t Lot # ,� D Valuation: � P ermit #<::?:.;:,Q:,;;;:::;::.: Corner Lot? Y 0 R ei ssue of .. ............... Flag Lot. Y N Map &?TL # >:Jt f 6 Owner: r �o y � _ � G. . , � � c� W �l l � � Ad 61 L? r F, ress: 1 � �, � fi d l � :::: >::::;:::: 7 1 ; aos 3 ......:.......................... ..................:.....:.:..:. Engineering U U I 0 Phone: � �3 I Contractor: �.,o �rzsr' n n 2¢�UyI Q I > >; `s Required ` ' >`` >'': " <.< <: >< >:':`.'::: Items Address: Tru Details Phone: Othe.:: r' Contractor's License Lic (attach copy of current Oregon license) �P � m Contact Name & Phone: rr�I �i'\- 3 --A-\'- Subcontractors: Architect/Engineer: ( Y t Plumbing: Y\crr .a Address: Mechanical: (attach copy of current OR Contractor's License) Phone: JOB DESCRIPTION: — Applicant Signature & Phone number v Received by: f 9.7�I — Date Received: / ( ( N: \WORD \COMDEV\RESAPP �" Permit # Account Description Amount Amt. Pd. Bal. Due 1p51 Bldg. Permit (BUILD) 37 ry 1 : _ Plumb. Permit (PLUMB) Mech. Permit (MECH) 3 State Tax (TAX) f / 4 1 3 Bldg: / .9 3 Plumb: Mech: Plan Check (PLANCK) � G e03 Bldg: 6 .2 j • '3 Plumb: • Mech: Sewer Connection (SWUSA) Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Storm Drainage Chg (SDSDC) Residential TIF (TIF -R) Mass Transit TIF (TIF -MT) Commercial TIF (TIF -C) Industrial TIF (TIF -I) Institutional TIF (TIF -IS) Office TIF (TIF -O) Water Quality (WQUAL) Water Quantity (WQUANT) Fire District (FIRE) Erosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) TOTALS: fo5 " 7 g/ l0 v 5/18/00 Activities for Case #: MST94 -00395 4:52:53 PM V 0 1 I Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA007 Application received 10/14/94 JF PASS BLT 10/17/94 MSTA010 Plan check deposit paid 10/14/97 +JF PASS BLT 10/17/94 MSTA020 Plan check by 10/17/94 10/17/94 RT PASS BLT 10/17/94 MSTA030 Check for prcl. restrict. 10/17/94 10/17/94 RT PASS BLT • 10/17/94 MSTA725 Framing Insp BLT 10/17/94 MSTA740 Insulation Insp BLT 10/17/94 MSTA745 Gyp Board Insp BLT 10/17/94 MSTA755 Rain drain Insp BLT 10/17/94 MSTA799 Building Final BLT 10/17/94 MSTB706 Erosion Control Insp 844 -8444 BLT 10/17/94 MSTA092 (F) Issue combination permit 10/17/94 RT ISSU BLT 10/17/94 MSTA110 Void Permit 5/26/95 JF 5/26/95 • • • Page 1 of 1