Permit 4,5� i
rTY 0 IGARD ce,gv SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT # : SIT2001 -00017
W all 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/3/01
SITE ADDRESS: 09729 SW LANDAU PL PARCEL : 1S125CD
SUBDIVISION: LANDAU WOODS ZONING : R - 4.5
BLOCK: LOT: 005 JURISDICTION : TIG
CLASS OF WORK: OTR PAVING ?: N RESO. NO:
TYPE OF USE: SF GRADING ?: Y VALUE: 1,900.00
EXCV VOLUME: 45 cy LANDSCAPING ?: Y
FILL VOLUME: 90 cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: N
SOILS RPT REQD ?: N IMPERV SURFACE: sf
Remarks: Fill for drainfield.
Owner: FEES
SEELY, ROBERT W AND SHALEE A
9729 SW LANDAU PL Description Date Amount
TIGARD, OR 97223 [BUILD] PrmtFee -Valu 8/3/01 $62.50
[TAX] 8% St Tax -Valu 8/3/01 $5.00
Phone: [BUPPLN] Pln Ck -Valu 8/3/01 $40.63
. [BUILD] Misc. Fee 8/3/01 $15.00
Contractor: [ERPRMT] Erosion Cntl 8/3/01 $80.00
DAVE COX [ERPLN] Ersn Plck - USA 8/3/01 $26.00
12115 SW SPRINGHILL RD. [EROSN] ErsnPlck - COT 8/3/01 $26.00
GASTON, OR 97119 [HRBLD] Hourly Buildir 10/6/03 $58.41
[HRTAX] Hourly Rate T. 10/6/03 $4.09
Phone: 503 - 475 -3180 Total $317.64
Reg #: LIC 129661
Required Inspections
Fill Inspection
Grading lnsp
� Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow s adopte• : the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 thro gh OAR 952 -001 -0 z0. You may obtain co ies of these rules or direct questions to OUNC by
calling (503) 246- 699. C--'
I ued By: 2 b,„__ febief tap 014 1 1 '
IrAlfrAli
Permittee Signature: y
Call (503) 639 -417 by 7:00 P.M. for an inspection nee e d the next business day
CITY TIGARD SITE WORK PERMIT
4 **tilr DEVELOPMENT SERVICES PERMIT # : SIT2001 -00017
'�' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/3/01
SITE ADDRESS: 09729 SW LANDAU PL PARCEL : 1S125CD -06800
SUBDIVISION: LANDAU WOODS ZONING : R -4.5
BLOCK: LOT: 005 JURISDICTION : TIG
CLASS OF WORK: OTR PAVING ?: N RESO. NO:
TYPE OF USE: SF GRADING ?: Y VALUE: $1,900.00
EXCV VOLUME: 45 cy LANDSCAPING ?: Y
FILL VOLUME: 90 cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: N
SOILS RPT REQD ?: N IMPERV SURFACE: sf
Remarks: Fill for drainfield.
Owner: FEES
SEELY, ROBERT W AND SHALEE A
9729 SW LANDAU PL Type By Date Amount Receipt
TIGARD, OR 97223 PRMT CTR 8/3/01 $62.50 27200100000
5PCT CTR 8/3/01 $5.00 27200100000
PLCK CTR 8/3/01 $40.63 27200100000
Phone: MISC CTR 8/3/01 $15.00 27200100000
Contractor: EROS CTR 8/3/01 $80.00 27200100000
ERPU CTR 8/3/01 $26.00 27200100000
OWNER ERPC CTR 8/3/01 $26.00 27200100000
Total $255.13
Phone:
Reg #:
Required Inspections
Fill Inspection
Grading Insp
Final Inspection {
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification CenteJ.ose rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -ei :0. ou may obtain copies of these rul -s or direct questions to OUNC by
calling (503) 246 -1987.
P-ermittee_Signat
Issued IV ,6, i NM,
By: / _.6e2 .,� .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
, . g II 1f9/0/
Building Permit Application
Date received: 7" 26 p Permit no.:s`f, Ll'QD /7
, "'` lir City of Tigard
- ^:_.. Project/appl. no.: Expire date:
City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By fl Receipt no.:
Fax: (503) 598 -1960 (O Case file no.: Payment type:
Land use approval: — 1 &2 family: simple Complex:
fi 4" TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm Et 1 ` t (
JOB SITE INFORMATION
Job address: ✓ 4 1 _ ram � Bldg. no.: Suite no.:
Lot: Block: Subdivision: m _ ,, „ram-Tax map /tax: lot /account no.:
Project name: -I • `. • A . Wi, a s M .
Descri 1 tion and locatio t of work on premises/special conditions: C.f l'et. t vi � 1 • 5 -* h,Lu 9 I a, II •14 . .' 4 - 1
C,i lrf.r
. . OWNER FOR SPECIAL INFORMATION, USE CHECKLIST . 0
• IMII 4 4.� \ g ' 1 (Floodplain, septic capacity, solar, etc.) •
Mailing address: q 0 (,) `/IrarnliElMVIM 1 & 2 family dwelling: \.-
IIMIMAMPTIMMIMEDZEM ZIP: 6 Valuation of work $ / d0---
Phone: $ f, d' • E -mail: s t.. j v - w ,ii No. of bedrooms/baths
r Owner's representative: 4 ha , &O+' Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
_ -, .: ._ APPLICANT Garage/carport area (sq. ft.) .
Covered porch area (sq. ft.)
Name: SA a . s JIP e
Mailing address: Deck area (sq. ft.) •
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
t :
CONTRACTOR Valuation of work $
e� � Existing bldg. area (sq. ft.)
Business name: , •
Address: New bldg. area (sq. ft.)
Number of stories
City: State: ZIP:
— Type of construction
Phone: Fax: E -mail:
CCB no.: Occupancy group(s): Existing:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.: • .d*,s;�'(j
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ .
Address: Date received: -
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. -
attached checklist. Al 'ro ions of laws and ordinances governing this ❑ Visa Ci MasterCard
work will be compli d � ' i he . •1 fr s e erein or not. Credit card number: /
s / ( — Expires
- — - - -
f Authorized s' ure' i " ' -. /. Date: /--'2 i / Name of cardholder as shown on credit card
Print name: 6 e i . f • , - e / y Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within '180 days after it has been accepted as complete. 4 (6/03/COM)
SITE WORK PERMIT CHECK LIST
Commercial, Multi - Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
Excavation Volume: cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) �� cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) 6 d cu. yds.
Retaining structure?
UKConcrete (Check one) Rock
❑ CMU
�.so`'n e
. ID Other
a .'1 I� ,�r( -e �
*Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Site UtilitiesPlumbing Work:
Complete the "TAN" Plumbing Perm Application for site utilities plumbing work.
,Pl R eq u r e d See , S i t ekW L ork P e r m , = . i t u A pp l r ie at io Pl an Sub i tt a l�
Requireme att ®wfmg m, t acco appli '
c ation r,
j,. ▪ Sit P laniwithivici t 9 Map 5 f Parking'(including ®A) an ,
AY A ®A com pliance� z --fightin l l -, ; � ,,
Grading P l-.919::#9.,t,,,,:: d details �Lan Plan � =
., 4Erosion lnanddetail _, ,. ; >, .;R etainingStructur es� i f •
° Si te Util it y,�Pl a n and details :. ;` :Soils R eport (i f required) �,,:
▪ a' . , a , e5 , - . s Y om, # �. g4 ' '; 3 i „
.(sh:owi con to approved , . ,,
,,.. h _ system) ,a , .r �:; a K w r.�..: g m : . .� .., ..
*Doe not applyto,1 and 2- family dwellings.
is \dsts \forms\sitechecklist.doc 05/31/01
r
Permit #: -1 `, 0® / _ OC OJ 7
4 -- ,c �:�! Addr s: ► ' 9 j K.✓a-�J
gr Issue' by: /1i EL bate: • e5
�85�
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:
,;sa . 1. I own, reside in, or will reside in the completed structure.
t
PP S 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 ` i At Ylr : +i1
4 I I I 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 cer ' • t the above information is correct and that I have read and do understand the Information
Notice t • ' ropert --
/ wn e l s abo Con ' uctio `Responsibilities on the reverse side of this form.
l_i►i'Mi �— 3" /
(Si of pe z . pplicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
linITorrmaUon NotIce Prr Ownsres
Ahowl Construction FiesponsrtMos
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.
ElitO.PLOYHR RESPONISMLMES:
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 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 RESPONSFEHLMES AND AREAS OF CONCERA:
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
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 (PO Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
p rop-own. pm4 •
1 /94
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Liner (503) 639 -4171 MST
/ BUP
Received ` 2 - 2 % 2-7 D ate Requested ``4 - AM PM BUP
Location g 2 � J /frtd T (L PL- Suite MEC
Contact Perso — ] --- Ph ( ( O 3 4S 2 - 5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection p SIT 2 — d C.) O ! 7
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear $ -
Framing
Insulation
Drywall Nailing
Firewall 11)
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL l MIMV
PLUMBING ' /i�, //� /.�i �
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Ma. ole
Storm Drain
Shower •
in
%` '• S PART FAIL
CHANICAL a
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. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 11 Please call for reinspection RE: ❑ Unable to inspect - no access
- Fir`e Supply Line ,
A DAoach /Sidewalk Date ' ( Inspector E7rt
PP
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL