Permit .
A, CITY OF TIGARD
!,
-, .
,fto. DEVELOPMENT SERVICES MAST7R PERMIT
13125 SN/ Hall Blv� Tigard, gR97223 (503)639-4171 P���7.7" i- .. ^ ^. ^ : MS797
7\ AT:: 7.SSUFED; 03/31/97
'
PQRCEL: 2S1T4
ETTF (-111DPESS...:12845 SW KPTHERINE Sr
7..ij57)P/:SIC.. . :BELLUOC[) 3 Z:NI4S: R-4.5
BLDCK ......... LOT......'......:115 JURISDICT�ON' TM
�narks; Converting dining room into a bodronn
— ----- BUILDING -
RElSSkEt STORIES.......: @ FLOOR AREAS BASEMENT...: 0 sf REQUIRED OET8ACKS--- 0EQUl9ED
CLaS3 OF KDqX.:PLT VEIGqT....,...; 0 FIRST....: LNN sf GARAGE--; 0 sf LEFr..........: 0 SMDK[ GETECT9S: Y
TYPE [F USE ..:SF FLOOR LOAD...,: 0 SECOND...; 0 sf P8UI:T.........; 0 PARKlA SPACES: G
TYPE OF CONST.:5N DWELLING UNITS: 0 FlNBSM8NT: N s[ HDGHT ...,....: 0
OCCUPANCY GHP :S3 BUM: 3 BATH: 0 TOTAL : 180 sf VALUE -$: 1100 REAR........-: 0
----------- --- ----------- ----- PLUMBING -----------'-------- ---
GlNKS...,....,: @ WATER CLOSETS.: N WASHING MACH..: 0 LAUNDRY TRAYS,: 0 RAIN DRAIN ft: 0 TRAPS.„....„; 0
LAVATORIES--; 0 DISHWASHERS...: 0 FLOOR DRAINS-: 0 SEWER LINE ft: 0 SF RAIN DRAINS; .41, CAT:4 BASINS--; 3
TUB/SHOWERS...: 0 GARBAGE DISP../ 0 HATER HEATERS.: N WATER LINE ft: 8 BCKF[X PREYKTR; 0 GFEASE TRAPS..; @
OTHER FIXTURES: Q
- ---- -- ---- MECHANICAL -- -
FUEL TYPES--------- FDRQ ( 1821( ..; Q 8OlL/SKP ( 3HP: 0 VENT FAIE.,...: 0 CITHES ;AYERS: 0
ELE FURK )=l8ell. ..; 0 UNIT REATERS.., N HCODS ..,.....: N OTHER-UMlT3...: 0
MAKINP.: 0 BTU FLOOR FURNACES: W VENTS.,.'...../ 0 WOODSTOVES,..,1 0 GAS OUTLETS...: 0
- --- -------------- -------- ELECTRICAL ------------ --'--
--RESIDENTIAL UNIT--- ---SERVlCE/F[E0ER---- --TFr:` SRJC/FEE3ERS-- --BRANCH CIEUlTS-- --MISCELLANEOUS-- --A)D`L INSPEC`IENS�-
mi SF OR LESS: W 0 - 280 orp..: Q N - 200 app..: 0 W/SVC OR FD8..: 0 PUMP/IRRIGATION; 0 PER INSPECTION: 0
E4 A5D`L 500SF.: 0 201 - 400 asp..: & 281 - 1 10 aop.,: S 1st 8/]SVC/FDR: 1 SIGN/OUT LIN LT: 3 PER HOUR......: 0
LIMITED ENERGY.: 0 001 - 600 amp..; 0 401 - 600 app..: 0 BA ADDL BR CIR: 0 SIGNAL/PANEL.,.; 0 IN. P:P7....'.: J
lArF HM/SVC/FU8: 0 601 - 100Z amp,; 0 631+aups*-1800 v: 0 MINOR LABEL -10: 0
1800+ app/volt.: 0 PLM REVIEW SECTION
Reconnect only.; Q )=4 RES UNITS..: SVC/FDR}=225 A': } 6,30 V NOMINAL: CLS QREA/SPC Gat
- ----- -- ELECTRICAL - RESTRICTED ENERGY ----------
A. SF RESIDENTIAL-------- - B. :OPERC[AL-------------'--------------- -------- -----------'
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO � STERM: FIRE ALI1R.....; INTERCOM/PAGING: OUTDOOR LNOSC LT:
BURGLAR ALAFA.: OTH: :: BOILER...,.....; HVAC..,..... ' L#MUSCAPE/lRRlG; oBUTECTIVE SlGO -:
GARAGE OPENER..: CLDCK..........: INSTRUMENTATION: MEDICAL........: OTP9: ;;
uVAC...........; DAT4/`ELE C071 : NURSE Co. S....; TOTAL # SYSTFMS: Q
One: -- --Contractor; -----------• TOTAL FEES:$ 119.25
LIGIA 0 S1NA OWNER
12845 SW KATHERINE ET • • •
- {GQRD OR 97223
Pore #: 579-0121 Phone 8: . .
Reg 0.,/
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This 7er:it is issued subject to tho regulations contained in the Tigard Mxnicipai Code State of Ore. Specialty Codes and all other
applicable laws. Al? wc~; will be done ir acccrdance with *roved plans This perrit will excbe if work is not started within 180
days cf 1s»ance, 2r if work 'is suspended for lore than 180-days.
-------------- REQUIRED lNSPErT1CNE-- -
5.1cctrica} Roxlh ___ � _
Fran :nc !n» _______ , ____ __ . ____
5',rtricl: F,^a'
cira: insppctio- ______ ' - __-,- --. '
____ __ ____ _
r7. P. `�:'.t S i r7 - c>c-°~<z'°-" __ ___ __..... Is=op By; !^ t° ��_��______
Call for ':nsoectinr - 4 ;39-4175
•
Plan Checks O 3 - 69 0 t
" % Y OF TIGARD t Residential Building Permit Application Recd By Z'
. SW HALL BLVD. New Construction Additions or Alterations Date Recd o3/9
.LARD, OR 97223 Single Family Detached or Attached (Duplex) _ _ Date to P.E.3 -1 1
c73- 639 -4171 � Date to DST •
503-684-7297 /A `/ `�1 Permit # M5C - 11— !,1771
V P rint or Type Called C'S 31 `7' / ato✓+ -•- -
Incomplete or illegible applications will not be accepted 11 . v L/ - 1 2 ?
Name of Project _ ' Name
Job CO.VveRT 2)/N/U /NQ R/7- /n/TO cDkcx2.y
Address
Site Address Architect Mailing Address
/.2e4 S) 144-THE•C/NF .5-r. T/r,¢E'p
Name City/State Zip Phone
4 /a4f. o. S'i/N,¢
Owner Mailing Address Name
/.ze'4/5 sw K-4T7-/F,e /4,/F - . 9
City/State Zip Phone Engineer Mailing Address
. 7 /he.) o/ L 979 - 0%e /
Name City/State Zip Phone
General D us/NEA. Describe work New 0 Addition 0 Alteration 0 Repair 0
•ontractor Mailing Address to be done:
. Additional Description of Work:
City /State Zip Phone -
Oregon Const. Cont. Board Lic.# Exp. Date .
:ach Copy of
Current COT Business Tax or Metro # Exp. Date PROJECT
Licenses VALUATION $ //cc . w 0
echanical NEW CONSTRUCTION ONLY:
Sub- Mailing Address Sq. Ft. House: Sq. Ft. Garage
Contractor Corner Lot YES NO Flag Lot YES NO
City/State Zip Phone (check one) - (check one)
Oregon Const. Cont. Board Lic.# Exp. Date Restricted Audio /Stereo Burglar
�.ttach Copy of Energy System Alarm
Current COT Business Tax or Metro # Exp. Date Installation Garage Door HVAC
• _ Licenses Opener Systems
:lumbin Name (check all that Other. -
9 apply)
Sub- Mailing Address Will the electrical subcontractor wire for-all YES NO
°ontractor - - restricted energy installations -r
City/State Zip Phone Has the Subdivision Plat recorded? N/A YES NO
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST #: Solar Compliance
•inch Copy of (Calculation Attached)
Current Plumbing tic.* Exp. Date I hearby acknowledge that I have read this application, that the
Licenses
COT Business Tax or Metro # Exp. Date information given is correct, that I am the owner or authorized
agent of the owner, and that plans submitted are in compliance
Name with Oregon State laws.
t Signature of Owner /Agent Date
Electrical Vc//VE/2 — q 8x/9
Sub- Mailing Address V, Contact Person Name Phone #
Contractor 1\, o�%u -cam $ ,5 -0/e/
City/State Zip I Phone FOR OFFICE USE ONLY:
Plat #: . hlap/Tl:
Oregon Const. Cont. Board Lic.# l Exp. Dat ! v A` I 2b 7-13'q - 9 Hob
",,:tch Cop of Setbacks: Zone: Q S ��
Solar
Current Eiectncal Lic. # Exp. Date I V r r — y r
Licenses
Engineering Approval: Planning Approval: TIF k
COT Business Tax or Metro # Exp. Date N I PC
rlsfapp.doc (dst) 1/97
Permit # Account Description - Amount Amt. Pd, Bal. Oue
5i 9
MST. Permit == (BUILD) F- 6,°13 , c ,,w
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT) ` c . — 3G7 0 7-.)
State Tax (TAX) T oz) 3. LTh
Bldg: /- - C c
Plumb: •
Mech:
ELC /ELR: /- 7c
Plan Check
MST: (BUPPLN) 1 1�� . C( q;
Plumb: (PLMPLN) -
Mech: (MECPLN)
CDC Review G (L NDS)
Sewer Connection (SWUSA)
Reimbursement District ( )
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS: I i� /(, C 1(4
i:lsfapp.doc (dst) 1/97
Permit #:O"! 7- ()O7'
1
OF O
Address:
y
N ` z Issued by: V , l'��/1�:.J/ l(10 X L-- Date: - 7 '- �' - qi
859
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:
j GS 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
v p 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.
���--c -cam CF 3- .3/ - 9 2
° (Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Erdorma`on=ce Properly Owners
'
Note.' This Information Notice m Owme��m����m�o
� Responsibilities
' was de by the Construction Contractors Board in accordance wit/i 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 RESPONSIB(IUTES:
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'o wfithilwkiiing 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 evbn 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 to penalties and will be liable for allclaim costs if one of you: employees is i 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. nternxllRevenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable forthe 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 MESPONSOBILOTOES AND AREAS OF CONCERN:
Code co ipliance: As the permit holder for this project, ynuouevc»pouaib|e 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
accident.; 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 (P0 Box 14140, Salem, OR 97309-5052,
503/378-4021). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own .y,n4
\/94
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation -Elec
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bid
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 5 / /5
- 1 A.M. P.M. Entry:
Address: A
Tenant: Ste: MST: 7706 77
51 BUP:
Con/ w D � �" � MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
l %
A r Inspector: +I' Datd:
ED _ DISAPPROVED /CALL FOR REINSP. F CO