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Permit
ury OF TIGARD MASTER PERMIT PERMIT #: Ifitillf*A DEVELOPMENT SERVICES DATE ISSUED: 5/6/2004 - 00130 --�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 • SITE ADDRESS: 09567 SW JUBILEE CT PARCEL: 2S111 BA -07600 SUBDIVISION: JUBILEE PLACE ZONING: R -4.5 BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: 108sf. addition. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 108 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 10,680.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 108 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 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: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1.00 SIGNAL /PANEL: 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: $ 355.38 This permit is subject to the regulations contained in the PASERO, MARK G + SHARON M OWNER Tigard Municipal Code, State of OR. Specialty Codes 9567 SW JUBILEE CT and all other applicable laws. All work will be done in TIGARD, OR 97224 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. Phone: Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Res #: rules are set 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', ,,r Slab Insp Electrical Final Final inspection '\ li , Issued By . ■ . ..,�- _ / [�! i Permtttee Sig nature : �(�G . . .. Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business'day �VE t Building Permit A ; I1:Catl,On FOR OFFICE USE ONLY • 1 ;, .' U U L . . City \ c i f Tigard R e c e i v e , i i f y , • Permit N.. i t �r� i ;o 13125 SW Hall Blvd., Tigard, OR 97223` L3) : ' ) 0 04 Plan Revie ' Phone: 503.639.4171 Fax: 503.598.1960 1 6 ' ') L ' b op ° .W Date/B : �� vi - O� Other Permit: Inspection Line: 503.639.4175 Ready/ By: Read 8 See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGAI�D ---• Notified/Method: 1 Supplemental Information BUILDING DIVISION „r,. a . ..,,�..^_: 9... . "' �' : ^Fury .i`. ,`;. ;, F .: x'.`�'ak's� �:yc -' ,��,:, �":a" z ,,, p TgY .E O W ,, , ` .,.s g f REQ.i7I D " DATA,I A . 2 FAMII;YD, a� w >�;' .,�;� ^, �`�,ti�; ,a_ »3�'�s.� w,��u� ^ , .§„4 i�- :��U�.:a.`�l°.:� 3,,. � "r��rRr:.;� � _ -c� �:. ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. . Indicate the value (rounded to the nearest dollar) of all [v] Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the C y,,. =; = ' ,w = ` ' "` y 3 r, work indicated on this application. . ? „„ .«,i � CATE OF C ,fV A .. IC`TION . < vk,> � .i. ., v,••,'3: / Valuation: $ ! G 6/0 [v]p1- and 2- family dwelling ❑ Commercial /industrial / LI Accessory building ❑ Multi- family Number of bedrooms: 7 ❑ Master builder El Other: Number of bathrooms: ".. „� - .,,,a E ' x t _'€ °s Ca . „. „ �,; , . air k : ,. .44 Total number of floors: - g d S 7c-i e3TI ON`Arrz 7 L ,- ate. - . �. ��,�,� a � ��„ r aa .... >m a " ��� , ��. , � -. s.� .” v . W .,.., . Job site address: 5;:4-‘y sw fu6i er e". New dwelling area: /08 square feet City/State /ZIP: 7/ G p , . e?„!' D,/p 977% f / Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: X3 C4' ` rote Aow4./.4,,, Deck area: square feet . Other structure area: square feet $` REQUfED ATA COMMER USE'CHECKLIST Subdivision: 7, , e# Lot no.: 9 Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: ZS / Ni', -076 :- �..:���.:��.�:.3, - _�- �� ^xs.�;�, ;� :,�':<,,�;.u.;•.�„ f; =,�, -�_ .°�.>,�: _ . ,�,,� 5� �-- �w: =';: -x= equipment, materials, labor, overhead, and the profit for the work indicated on this a t _'to DESCRI tfatOF WORK,. . ,z." Y application. 9,l' /2 --(A/" ...f.": -.4/4.- ,CP ' Valuation: $ T o N - /_o r�u�w l�vrL Existing building area: square feet New building area: square feet 'A A ct �°^ Px a i , , 7r T % ka= -' i ' PROPERTY OWNER f ps T ENANT ; a .— Number of stories: "a�a w,. . <x. _ -mom _ .�� .��a . . < �. s ;4 ...,. � ., .d Name: je /a�� A �j1 ,4<,,eH f�`c p Type of construction: • Address: 9.567 Ste/ tT�,6 /!-t, . 4/7 Occupancy groups: City/State /ZIP: j94,,,,��; �/f "711/ Existing: Phone: 0 e) , ,g e _ S3� g Fax: ( ) New: '; nom.„ . ";ir "' ' «e ; '.., ^. .- ..a aF •;e`. $ 1; :c_ i 6., p_ m : ., .r l: i ;✓� ,II,. ,,,= LICAN Ot "� ; ,, g "` c ( C�' p , a a' as C ; ,,^ , ez, Business name: All contractors and subcontractors are required to be Contact name: A ' / /? (" / - ��,.fejr, licensed with the Oregon Construction Contractors Board �' under ORS 701 and may be required to be licensed in the Address: 9567 . - , /Te:rj /ZC/ ,7 jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons n /y 4c r�i O/ 7711 apply: Phone: ( 6;70. c' S31 �7 g Fax: ( ) - 4- 9(0 • (q E -mail: 6 9, 1 a j A. T� t :: °' 8 4,1 x'%74 . RWPrM t ', :.1 `� a.,x ON TRt1CTOR F...:..:'. s ; i•;4 . ,. O.C'3,. t4 Business name: ` � -, :, Y ;w >':. „;_ ,,..., :, . .. . <; ,.. Q l Pr icy- _d`, �S c � , ,', g BUILDING �PRMI2°°FE S* . Address: ��� . ..,, ; -.: /�D� / Please refer to fee schedule. City/State/ZIP: ai ,,,rfl G ` l ' . 7/ a � - �- Fees due upon application Phone: ( f3 ) .3S - - V • ) CCB lic.: i 6j9 ..- Amount received Date received: Authorized signature: s /,/ ,-- Ly �� " -aK This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri - County Building Industry Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11/02/COM/WEB) One- and Two - Family Dwelling Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Date/By: e ve Associated permits: Permit No 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Oy,� to I i i 24- Hour Inspection Line: 503.639.4175 gi I CI Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us �` ❑ Other: THE FOLLOWING ITEMS ARE_ REQUIRED FOR PLAN REVIEW , Yes No INIA I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One- Two - FamilyChecklist.doc 12/03 • ct. st Electrical Permit Application .FOR OFFICE U •ONLY, City g Received Af " ©OJ O Cit of Ti and p pED Permit �t.T/ tr ('� l3 �!% Date /B 13 s'S SW Hal) Blvd., Tloard�OOR' 9, 2�-- o u ,� vs _ Plan Revte Phone: 503.639.4171 Fax: 503.598.1960 ' � i' ,f�l�_ Date/By: Other Permit. Inspection Line 503.639 4175 )) c r � Date Ready /B> lwls El See Page 2 for Internet: www.ci.tigard.or.us G. 8 2004 ""' F,,i t\ Notified \lethod Supplemental Inlurntation C ITY GYP E IOF {t�i'tORK PLAN REVIEW ❑ New r'^innt Please check all that apply. hew construction 3UIL " ,.Add'itiofialterat *ton /repl acement ['Demolition ❑ Other: ❑Service over 225 amps. comm ❑ hazardous location ❑Service over 320 amps — rating ❑ Butdng over 10,000 sq ft.. CATEGORY OF CONSTRUCTION of 1- and 2- family d■\ellings 4 or more men residential [ "l and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi family ID Master builder ❑Other: ❑Occupant load over 99 persons ❑ Manu lac tured structures or JOB SITE INFORMATION AND LOCATION plan RV park ❑Egress /hehung Job no.: Job site address: ❑Flcalth -care facility ❑ Other ?5'17 f�v , /L � r I I Submit 2 sets or plans with any of the above. City /State /ZIP: ��a , O/? ���� The above are not applicable to temporary construction service 1 Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE Description Qtr. Fee 1 Total Cross street/directions to job site: 9� /'� z �IAyRL�- New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. It or less 145 15 4 Subdivision: ��1 ;j , ,, . Lot no.: 7/ Ea. add') 500 sq ft or portion 33 40 I / Limited energy, residential 75.00 2 Tax map /parcel no.: �Sy /ri - 0 7 ,,ae, , Limited energy, non - residential 75 00 _ DESCRIPTION OF WORK Each manufactured or modular dwelling^ service and /or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 I I 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 Z 401 amps to 600 amps 160 60 Name: ,/1:/:`^- / X - -r /� 601 amps to 1,000 amps 240.60 Address: ,...4.;(7. j ��� / � e / Over 1,000 amps or volts 45 t.65 Reconnect only 66.85 2 City /State /ZIP: ii,a,vi. O/, 771iV Temporary services or feeders installation, alteration, and /or (/, relocation Phone: ( 1) /.2 - s� ,ig Fax: ( ) 200 amps or less 66 85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 I 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel [APPLICANT CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 Business name: branch circuit B. Fee for branch circuits Contact name: 1yek" /�f «o (,...:.- „ ey-5, Qe,,t4e-ree.) without service or feeder fee, -/ 46.85 2 _ each branch circuit Address: / 9, 6 Sw ` fu / /K"/ /r Each add'I branch circuit / . 6.65 City/State/ZIP: Miscellaneous (service or feeder not included) y 7ya/ 4 D// 7 7 1, z y Pump or irrigation circle 53.=10 2 Phone:) (Ae, • 6 Fax: : ( ) Sign or outline lighting 53 40 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe. Page 2 2 Business name: - Q�brR Address: ,/' Each additional inspection over allowable in am of the abuse , . , — Per inspection 62.50 City /State /ZIP: i` . . 2': ,. Investigation per hour (I hr thin) 62.50 Phone: ( �) Fax ( ) Industrial plant per hour 73 75 - 'f ELECTRICAL PERMIT FEES* CCB Lie.: i / Electrical Lie.: Suprv. Lie.: Subtotal Suprv. Electrician signature, required: Plan review (25° of permit fee) State surcharge (8%, of permit tee) Print name: Date: TOTAL PERMIT FEE f/4 Authorized signature c?"' G • /���J� 1 ®_47 This permit application expires if a permit is not obtained ssithin ISO trays after it has been accepted as complete Print name: Date: " Fee methodology set by Tri- County Building Indu,try service Bomd - Number of inspections per permit allovv'ed i ABuildingA Permits \ELC- PermuApp doc 11 440- 4615T110,ii CO.Ai /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: Audio and Stereo Systems* Burglar Alarm n Garage Door Opener* Ti Heating, Ventilation and Air Conditioning System* Vacuum Systems* • n Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems Ti Boiler Controls Clock Systems Ti Data Telecommunication Installation n Fire Alarm Installation n HVAC Ti Instrumentation Ti Intercom and Paging Systems Ti Landscape Irrigation Control* n Medical Ti Nurse Calls I Outdoor Landscape Lighting* I I Protective Signaling Ti Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i.' 13,didm \Pernuts\ELC- PerrnitApp duc 04103 r�Pr �av• `• '004 4 OlP�1 WATER SERVICES 503 6814439 TO: - 50368po.Jl3U4 P. 1 P.2 . � rile Number CleanWater Services air Con,n.at111011T �9 ����r. Sensitive Area Pre- Screening Site Assessment Jurisdiction 17"7-42.e.? Date y ;r - Map & Tax Lot ..z..5:///0 - 4, tro4 Owner , 17 1 JS44,2.41 /*j o _ Site Address 914"7sr/ C7" • � ' rfir 4.q 9r /J'/ Contact Z.<17 ..I w ,ter -r {.4 t7 Proposed Activity d`�e0 /e,41.4 es Address Phoned ,io 4 ff, 'a tr ()Sao' use only below this line Y N NA Y N NA '.4 D Sensitive Area Composite Map ❑ Stormwater Infrastructure maps Map Z QS# j Locally adopted studies or maps Q ❑ Other Specify Specify d to Z q orb ��rG Based on a review of the above Information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order Nor 7 L] Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. No SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: 1 O7 ,i, rkx/S5 r Q pw.04. -:, .: car r,/ he i P- %dam e Iii4L3 Nom. r ; C-417111114 Reviewed By: ehle _ , ..r , Date: __�7 / Returned to Applicant Post-le Fax Note 7671 Date v p f a of Be i f Mail Fax Counter To `` 4' From /g Ld • jj , Date By� Co./Dept. Co. c Phone # Phone # Fax 5- 7629-.70-0 Fax # s) , , ' f • Permit #: RSI PIp ° '( --oo /5 Ad•' - • `Q ■ S lLE-t Is ed by: L 1 % 0 _L,'• Date: S & /e 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: grd 1. I own, reside in, or will reside in the completed structure. I,4 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale `� before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who on the structure must be registered with the Construction Contractors Board. OR IM 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 officeissuing 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. 5-% Signatu of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) • information Notice to Property Owners About Construction Resloons'b !Vote: This InfOrmation Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with O.RS 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 RESPON8kBILIl[UES: 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 wi Lin most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must complywith the following: Oregon's withholding tax law: As an employer, you must withhold income taxesfrom employee wages atthe time employees are paid. You kVill be liable for the tax payments even if you don'tactually 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 arc required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department 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 employes. lfyou 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 nnthc'ob. 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 theinternal Revenue Service at 1-800-829'1040. OTHER RESPONSIBILITIES AND.AREAS OF CONCERN: Code ummmpliumem: /\s1he permit holder for this project, youurercsponaih|eforreso|vinguny[uikuvctnmeetcndoreqxi,cmcntn that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see i f 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 superviseemployecs: Make sure you have sufficient time to supervise yourernployees. Expertise: Make sure you have the expertiseto act as your own 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. ([you have additional questions, write orcalt the Construction Contractors Board (PO Box 14140. Salem, OR 97309-5052, 503/]78-4621). • The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION' Business Line: (503) 639 -4171 MSTo --(mil C BUP Received /; P Date Reque ted 5 3 `Qci AM PM BUP Location 'J T,9 7 Suite MEC Contact Person /'pr Ph (5) b 2-0 " 23 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab <-- G t Inspection Notes: I ® )44.1.A. Post & Beam Shear Anchors Ext Sheath/Shear , ∎ %N ° Ina Sheath/Shear Vim. � -- P L� 01F-15 - R- t/AT - I:0 Oki Ly Framing Drywall Nailing Firewall Sp rinkler Fire pO Br<S Sprinkler Fire Alarm Susp'd Ceiling Roof e d � ' 04 (c TMASS J PART FAIL I11(BING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains A ft...- Catch Basin / Manhole Storm Drain Shower Pan Other: 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 Reinspection fee of $ required before next inspection. Pa; at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: III • - ble to inspect – no access Fire Supply Line FDA Approach /Sidewalk Date `3' ® Inspector Ar : � — Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL