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Permit _ ^ CITY OF TIGARD SITE WORK DEVELOPMENT SERVICES PERMIT � � P ERMIT # : SIT96 0052 --� /3/2��N/��0BA«1 Tigard, 8�3 �8�4�7/ ^ ^ ^ ^ ^ ^ ^ - - � ' DATE ISSUED: 10/14/96 PARCEL: 2S104CA-02700 SITE ADDRESS. .. : 13543 SW LAUREN- LN SUBDIV HILLSHIRE ZONING: R-7 PD BLOCK..........: LOT— ..........:027 ~ ���� TYPE OF WORK: l�� �~~o- PAVING? ^ N RESO. NO. : EXCV VOLUME: 0 cy GRADING?........: N VALUE...$: 0 FILL VOLUME: 800 cy LANDGC PING' ` ^ Y ENG FILL?... . . . : N' • SITE N SOILS RPT REQD?: N STORM DRAINS?... : N -' IMPERV` SURFACE:, , . ` 81 sf Remarks: 800 cubic yards of fill in backyard for landscape purposes. No structu re an site. ^ ' Qwner: --_ FEES MOHSEN TORABI type amount by date recpt 13543 SW` LAUREN LN '' ' PRMT $ 25.00 JDA 10/14196 96-285138 5PCT $ 1.25 JDA 10/14/96 96-285138 TIGARD OR` 97224^ - ' • ` ~ ' • . EROS $ , 26.00 JDA.10/14/96 96-285138- Phone #: 524-5694 ERPC $ 8.45 JDA 10/14/96 96-285138 ERPC $ 8.45JDA 10/14/96 96-285138 Contractor: ------ - OWNER _ Phone #: $ 69.15 TOTAL Reg #.. :' OWNER , - - REQUIRED INSPECTIONS - 'This pormit is issued subject to the regulations contained1n the -Erosion Control - � / . Tigard Muoicipal Code, State of Ore. Specialty Codes and all other Fill Inspection applicablo''law��^ All' work- will be done in accordance 'with' • ' . Final Inspect ion 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. _ Permittee Signature: `.' ' . •____�__� ' - . Issued By: _ - Call for 639-4175 ^ ' -- - -- - '----- - -' ---- • ' CITY-or TIGARD Site Permit A licati Plan check # PP on Recd By , -,j am , 13125 SW HALL BLVD.. Private Grading, Paving, Site Accessibility Date Recd+ lt7ar' TIGARD, OR 97223 Retaining Structures, Utilities and Related Work Date to P.E. (543) 639 -4171 X344 - -- Date to DST ' Permit # i 7 g@- 06(73- ._ __ _ _ - - Called . Print or,Type . -- - -- - Incomplete or a will not be accepted - Project Name / l�1 ' Utilities ( Complete all that apply) Job j,( 7) .5w' {/�1w e I .6 / . - Address Address /� 7 Storm Sewer / /7 i72-1) e, 2 ?- 3 Linear Ft. Name Sanitary Sewer / \,T 5 / e ) - Linear Ft. Owner Mailin s / / 4 / r�, , �� / A7 Fresh Water %35 Addre 5 k G &?d 1 .. Linear Ft. City/S sate - Zip P,t on Catch Basins Name Clean Outs Mailing Address Describe work to be done: General . New❑ Addition❑ AlterationD RepairD Contractor City/State Zip Phone . Additional Description of Work: Attach State Const. Cont. Board Lic. # Exp. Date 6 ya t v_ /4 ID - copy Se Or of current COT Business Tax or Metro # Exp. Date licenses Name tt i� Project S Iv Valuation Architect Mailing Address Plan Submittal: (3) sets containing each of the following, must accompany this application: City /State Zip Phone Site plan with Vicinity Map Parking (including Showing ADA compliance ADA) & Lighting Plan Name r Grading Plan and details Landscaping Plan Engineer Mailing Address Erosion Control Plan and Retaining Structures details including calculations City/State Zip Phone Site Utility Plan and details Soils Report (showing connection to (if required) approved system) Excavation Volume ' t hereby acknowledge that I have read this application, that the (Soils report required for >5,000 cu. Yards •information given is correct, that I am the owner or authorized Cu. yds. agent of the owner, and that plans submitted are in compliance with Oregon State laws. Fill Volume Signature of O r /Agen Date (Soils report required for >5,000 cu. Yds.) l9 cu. yds. `\' ` ) Will the fill support a structure Contact Person Name Phone (Engineer required if answer is yes) _ .. _ YES❑ NO `, _ Retaining structure? (check one) DRock - • FOR OFFICE USE ONLY-- - 1 D CMU Notes: 0Concrete DOther Total new impervious area including all Land Use Case # • .. Map/TL# i buildings, sidewalks, and paving 1c Sq. Ft. ± . i:ldstslsiteapp.doc - _ - 8196 , • Permit # Account Description Amount Amt. Pd. Bat. Due Build. Permit' - - (BUILD) a,5.Oa A' (9 Plumb. Permit .... . -- . . - . -- (PLUMB) - - Mech. Permit (MECH) ELC /ELR Permit ( ELPRMT) State Tax (TAX) Bldg: Plumb: Mech: ELC /ELR: Plan Check . Build: _ ( BUPPLN) Plumb: (PLMPLN) Mech: (MECPLN) - CDC Review (LANDUS) Sewer Connection (SWUSA) . Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Commercial TIF (TIF -C) Industrial TIE._ (TIF -I) Institutional TIF _ _ (TIF -IS) Office TIF (TIF -O) Mass Transit TIF (TIF -MT) .• Water Quality • - - • (WQUAL) - Water Quantity (WQUANT) Erosion Control Permit (ERPRMT) c,?,o_ pO Erosion Planck/USA (ERPLAN) K C, L5 Erosion Planck/COT (EROSN) cr/ ( Fire Life Safety (FLS) _ - TOTALS: Permit #: r 7--- OF 4 v�R +'ty / Address: ( � 3 S LO l d a,e-e4,—' ` . Issued by: A.-e--01.21./.1"---Date: / f f �a �8 5� 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: till 1. I own, reside in, or will reside in the completed structure. SI 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. n 3A. My general contractor is I (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 II 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) D a e) (White copy to issuing agency permit file, pink copy to applicant) --+ Rnlormeam Mace Prfoperty Owners Abonit CenmtmM�n) nespa,nsiihMes Note: This information Notice to Property Owners about Construction Responsibilities was developed by the Constraction Contractors Board in accordance with ORS 701.055(5). If you are acti as, your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent rnany prob;erns by being aware of the following responsibilities and areas of concern. EMPLOVE.P1 RESPONSEI;IUTTES: 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 vviKhino3dling tax Kar*: As ai cmployer, 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'. irnuoanue ta‘,7.: : As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, o.all the Oregon Employment Division at the Department of Human Resources at 378-3524. 'Workern^comzpe.suu2021 ii/zSOLMIllec, AS ar. employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cnmperoadnn insurance for your employees. If you fail to obtain worers' compensation insurance, you may be subject to penalties and wiI be liable for all claim costs i[ one of your employees im injured ootbo'oh. For more information, call the Workers' Compensation Division at the Depalment of Consumer and Business Services at 945-7888. 0.�.Dlterrani: Revenue Se�r!.cc; As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even fyo didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER MESPONS20LIITHES AND !, OF CONCERN: Code compliance: As the permit holder for this project, youmeoespoosibleh) resolving any failure to meet code requirements that may be brought to your attention through ins iono. Liability and prwp:arty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling too|a, paint overspray, water damage from pipe punctures, §o:, 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, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. pmp'nwu.pm4 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Date Requested q AM PM BLD Location 1 9I „,, .,,1 Suite MEC �,I 11 (L Contact Person n Ph Ci? 2( -- 7Z2 PLM Contractor Ph SWR Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Claw Crawl Drain Inspection Notes: Red 20 /� � d Red SIT qW 000ca Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation r Drywall Nailing ` ��� — ' - 41 y �_ _ Firewall < :. Fire Sprinkler Su Alarm s �'� "7 Susp'd Ceiling - A'h.�t/ /-)/ /-mot / e „ Roof Misc: Final PASS PART FAIL PLUMBIN Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL ` } "%= F Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICALS `>> ry •. °x µ a ,; y ” Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date 7 - L- 2 . Inspector s Ext A ss PART FAIL DO NOT REMOVE this inspection record from the job site.