Permit -
'�, _ � CITY OFTIGARD
DEVELOPMENT BUILDING PERMIT
«n»�"°" SERVICES PERMIT #.......:
�4�■ "�it /J/25SkKM (503)639-4171 BUP97-0103
� Tigard, DATE ISSUED: 02/26/97'
PARCEL: 2S111CB-01702,'
. SITE�ADDRESS...:'15165 SW 100TH AVE '
SUBDIVISION..— HOOD VIEW ' , ZONING:R-3.5 .
BLOCK. . . . . . . . .. : LOT. . . . . . . . . . .. . :1
_ _ __ _
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION—
CLASS OF WORK.:DEM FIRST....: 0 sf N: . 5: E: W:
TYPE OF USE...:SF SECOND...: 0 sf PROTECT OPENINGS?-----
TYPE OF CONST. :5N ` /_ � .,~ : 0 . sf Nt � .S: E: W:
, OCCUPANCY 8RP.:S2 TOTAL------: 0 sf ROOF CONST: FIRE RET?:
OCCUPANCY.LOAI>: 0_ , _ NT011:, ..� 61 sf,,~^;_.AREA,5Ep.` RATED.:
STOR.: 1 HT: 12 ft GARAGE...: 900 sf OCCU SEP. RATED:
BSMT?: ' MEZZ?: . . REQDSETBACKS. _ `' ~�- _REQUIRED_
psi:
FLOOR LOAD....: 0 psi: LEFT: 0 ft RGHT: 0 ft FIR SPKL: SMOK DET..:
DWELLING UNITS: 0 . FRNT:, 0 •ft REAR: 0 .ft :FIR ALRM: HNDICP ACC:
BEDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0
VALUE.$: 10
Remarks: 900 SO FT BARN TO-BE REMOVED LOCATED AT WEST END OF LOT.. NO PLUMBING
OR SEWER. ELECTRICAL IS EXTENDED FROM HOUSE. REMOVE ALL DEBRIS.
Owner: — — FEES ------ --
— ' ' -
KATHLEEN ULWELLING type amount by date recpt
15165 SW 100TH' ' , ' PRMT $ 25.00 JMH 02/26/97 97-290936
5PCT $ 1.25 JMH 02/26/97 97-290936
TIGARD OR 97223 • EROS $ 26.00 JMH 02/26/97 97-290936.
Phone #: 639-3909 EROS $ 8.45 JMH 02/26/97 97-290936
ERPC $ 8.45 JMH 02/26/97 97-290936
Contractor: ---- — — —
OWNER
.
_ ____
Phone #: $ 69.15 TOTAL
Reg #..:
� ' .. . REQUIRED INSPECTIONS
This permit is -issued sobect�tn -the '[eUylations, contained iutho , ` Misc. . Inspection ^ ' .
Tiard Municipal. Code.. State of Ore. SpeciaRy Codes and. aLl qthe'.. ` ' . '
applicable laws. All work will be- done. in. accordance with • . ' Final .Inspection
approved plans. This permit will expire if work is not started
within 180 days of issuancei or if work is suspended for -Bore ` ..________ ___
than 18N days. ' ' _
_____ _ _
,. __ . —__�
__
�'
Permittee Sign-at « ____
. __
'
Iss By: .�J ____
r � Call for inspection..— 639-4175. .
',4,Ic7/-0-0 6‘ 7...
Commercial Building Permit Application
City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223
(50.) 639 -1171
Jobsite Address: L 14:5 S t m - OFFICE USE ONLY
Tenant: if, IN � 1 Suite # Planck/Rec. #
Valuation: iO Permit #
t Map &TL#
Owner: lD 0 S P)7r - k - 1' - U LI TELt - ,I 0
Address: t (pS 4 ,� . k - -- BDrovals Require
i 69 a1-2� Planning
/ . . ..:.
a q Engineering
Telephone: `• O"? — t 1 - t O
Other
Contractor: .eantet -v ,
Address:
- Type of constr:
Telephone: Occupancy Class: �1
Contractor's License # Sprinkler? Yes No
(attach copy of curren • regon li • - nse)
Sq. Ft. Of Project: ' cbt
Contact name & telephone:
7 Story (1st, 2nd, etc.):
Architect & Engineer: A. ...6)
Proposed Use:
Address: N , 8 J
Previous use:
Note: Plumbing & mechanical plans must
Telephone:
/
\ be submitted at time of building permit
application.
JOB DESCRIPTION: /�� ?ZI v `- (.ICJ X co 4atAili I
ct/(,QA 1/ —� i/ / k
a /
J'e JZi ,'', 1 / •
Applicant Signature & Telephone Nu •er)
Of � lib.. oa 7'7
Received by: , Date Received:
I:'CCMPER.DCC 'OS ' • 96
PERMIT# Account Description Amount Amt Pd. Balance Due
Building Permit (BUILD)
Plumbing Permit (PLUMB)
Mechanical Permit (MECH)
State Tax (TAX)
Bldg.
Plumb.
Mech.
Plan Check (PLANCK)
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-1)
Institutional TIF (T1F -IS)
Office T1F (TIF -O)
Water Quality (WQUAL)
Water Quanity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit '' (ERPRMT)
>5 6()f Erosion PlancklUSA ' (ERPLAN)
Erosion Planck/COT a/ (EROSN)
TOTALS: q, (,)
1 :'.COMPER.DCC DST) 10/96
' — i ' 03 v
Permit #: _ i A i
oQ � , Address: l (a W : I /r I A
a t
-� � � 9
N X Z Issued by ��/ � � � ate: ,2
18-59 I �`�E0 I
lar
ir
Statement: Information Notice to 6 roperty 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 1. 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
before or upon completion.
ri 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
r i 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.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
,
• '�
• �» ��KD8� K����8���~Dn~U��es
- - -� - '__'
Note: This Information Notice to Property Owners about Construction Responsibilities
Was develop ed by the Construction Contractors Board in accordance with ORS 70.055(5).
f ou are acir1g as your own contractor to construct a new home or make a substantial improvement ement to an existing structure,
you can prevent many problems by being aware of the followi responsibilities and areas of concern.
.EMPLOYOI RESPOM-r-TABILITDES:
If you bbeyersono not regkstaed 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 ',lire will beennloyeen. As the employer you must comply with the following:
Orugon'avvithlcolelag tax 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 u,g45-809l.
0nmmrlo1000n'k'. ineuranme.tcu`Auuo employer, you are required Uu pay o tax for unemployment insurance purposes on the
`
wages of all employees. For roox information, cal! the Oregon Employment Division at the Department of Human Resources
at 3'78-3524.
•
Workers' compemaatlort inscrt As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' couqponxajuc izyoronoo for your employees. If you fail to obtain workers' compensation insurance, you may
be subject tnpeontiuouodvvillbo)iulUeforu1!o|ainucooLmifnnuo/yuureonpinyeosixi jured on the job. For more information,
call the Workers' Compensaion Division at the 3epartment of Consumer and Business Services at 945-7888.
VJ.S.Ertterma: Revenue ge:,—.6ec; As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment ::rt.ri if yo didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-808-829-1040
OTMER RESPOMMEMMES AK) AREAS OF COMCERN:
CodecorsnpDianlee: As the permit holder fo this p ject.youmrncuynnoih{cforrcyolvingumybxUuccto/neotundenoquirementy
that may be brought to your attention through inspections.
Liability and pnoy.)eotydamoageinauranom: Contact yaw 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 s 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 (P0 Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
pmp'ovn.nm4
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