Permit CI1YOFTIGARD • MASTER PERMIT
D R I3 T
PERMIT #. ° .. ° ..: MST9 3 -0583
COMMUNITY DEVELOPMENT
.�� dF N DATE ISSUED: 12/02/93
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1S133DC- 15500
SITE ADDRESS...: 12923 SW LAURMONT DR
SUBDIVISION.. °.: VILLAGE AT SUUMMER LAKE PARK ZONING: R -12
BLOCK LOT °10
—•— BUILDING
REISSUE: DWELLING UNITS:1 BASEMENT... ..... :0 sf
CLASS OF WORK °:ALT BEDRMS:2 BATHS:0 GARAGE ..... .... °:0 sf
TYPE OF USE°. °:SF FLOOR AREAS REQUIRED SETBACKS
TYPE OF CONST °:5N FIRST °0 sf LEFT. °:0 ft RIGHT.:0 ft
OCCUPANCY GRP° : R3 SECOND... :1000 sf FRONT. :0 ft REAR..:0 ft
STORIES...°° ° °:2 THIRD....:0 sf REQUIRED
HEIGHT°°°°°°. °:30 ft TOTAL :1000 sf SMOKE DETECTORS.:Y
FLOOR LOAD°° °.:40 psf VALUE $. 1500 PARKING SPACES..:0
Remarks: COMPLETING UP STAIRS
PLUMBING ---
SINKS :0 FLOOR DRAINS °.. °:0 BACKFLOW PREVNTRS °.:0
LAVATORIES °0 WATER HEATERS...:0 TRAPS °0
TUB /SHOWERS °0 LAUNDRY TRAYS°° °:0 CATCH BASINS °°°°. °.:0
WATER CLOSETS. °:0 SEWER LINE (ft).:0 GREASE TRAPS °0
DISHWASHERS -0 WATER LINE (ft) °:0 OTHER FIXTURES.... °:0
GARBAGE DISP ° °.:0 RAIN DRAIN (ft).:0
WASHING MACH.. °:0 SF RAIN DRAINS. °:0
MECHANICAL FEES
FUEL TYPES UNIT HTRS. °:0 type amount by date recpt
VENTS ° 0 BPRT $ 25 °00 JH 12/02/93 —
MAX INPUT:0 BTU VENT FANS. °:0 BPLC $ 16.25 JH 12/02/93 —
FURN < 100K ° ° : 0 HOODS -0 BSPC $ 1.25 JH 12/02/93 —
FURN ) =100K ..:0 WOODSTOVES.:0
FLOOR FURN °0 CLO DRYERS.: 0
BOIL /CMP < 3HP:0 OTHER UNITS:0
GAS OUTLETS:0
Owner: _ _ -----
MARK WOLD
12923 SW LAURMONT DR
TIGARD OR 97224
Phone #: 503- 692 -5445
Contractor: - --
OWNER
Phone #:
Reg #° . : -- -•
$ 42.50 TOTAL
This permit is issued subject to the regulations contained in the REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Framing Insp
applicable laws. All work will be done in accordance with approved I n s u l a t i o n Insp
plans. This permit will expire if work is not started within 180 Gyp Board Insp
days of issuance, or if work is suspended for more than • . d: s. Building Final
Permittee Signature: �.it // ,+
Issued By:
Call for inspection — 639 -4175
Residential Building Permit Application
City of Tigard
1:3125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
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Phone: tcontractors
Contractor's License #-
T ss D tail : :.. .::...: : .. :::. .
attach
co of o current Oregon -
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license) PY
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Subcontractors:
Plumbing:
Mechanical:
(attach copy of current OR Contractor's License)
Architect/Engineer:
Address:
Phone:
-
COMMENTS: -- . • • - -• .. . -.°
- • ica ' Signature & Phone number
Received by: r . /� Date Received: ` — g' ,
Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) C t ' V � j , 0 v
Plumb. Permit (PLUMB) a
Mech. Permit (MECH)
State Tax (TAX) [ c �S
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
•
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
Office TIF (TIF -0) -
Water Quality (WQUAL
Water Quantity • (WQUANT) • . ` .
Fire District (FIRE) .; Y
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TOTALS 2L . 2 5 '
•
o F a Permit No: •
Address:
H n ' �' = i Issued b Date:
•`,` • •'
1 •• •• - . FOR OFFICE USE ONLY
• - STATEMENT: -
' 'INFORMATION NOTICE TO PROPERTY OWNERS • • - . '
ABOUT CONSTRUCTION RESPONSIBILITIES . • .' • •
• ..Note: -Oregon Law, ORS 701. 055 (4) -,. requ,ires::residential construction pe • • '
.applicants .who are not registered with the Construction Contractors Board to
• sign the following statement before the building permit can be issued. This state-
. men,t:.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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
• '1 . `. 4. I own, •reside •in,, or will reside - in the :completed structure. . •
2 . W I: understand "that I. must register as a constr.uction.contractor if the structure is sold • .
" . or offered-for sale before or upon completion.
• 3. A. I . My.. general contractor is ,
- Contractor registration number - .
• . I Will instruct general contractor that all subcontractors who work on the struc- . .
lure must be registered with the Construction Contractors Board. •
• OR
3. B. (4i:fa I will be my own general contractor.
. . - If.l"hire subcontractors I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor,. I will
. , . contract with a contractor who is registered with the Construction Contractors Board .
. and I 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 understand
. the Information Notice to Property Owners about Construction Responsibilities on the -
.. reverse side of this form.
•
• i ure of e rmit Applicant Date - •
CONSTRUCTION CONTRACTORS. BOARD -
0244J 8/91 "
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I 4
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
. NOTE: This Information Notice to Property Owners About Construction Responsibilities -
was developed by the Construction Contractors Board in accordance with ORS 701.055(5), • -
passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substantial imptOvernent to an •
existing structure,, you can prevent many problems by being aware of the following responsibilities and areas •
of concern. •
E-. ESPONSB OLOTOES:
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 b "employees ". As the employer, you must comply'with the following:
Oregon's Withholding 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 Department of Revenue at 378 -3390.
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 D_ Division DHR
at 378 -3224.
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 DIF at 373 -7434.
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 221 -3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCEr N:
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 accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, 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 time so they can perform
the required inspections. - - , - ' - . •
•
- If you have additional questions, write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310 -0151
Phone 503 -378 -4621
0244J • 10/24/89 - - ' .
1 m ,
- CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 •
Date Requested: S I (e 1 q1 A.M. P.M. MST: 7 3 0513
Location: I g- C 7 Z "--z2z,LA .1J L_ BUP:
Tenant: Suite: Bldg: MEC:
Contractor: Phone: PLM:
Owner: Phone: ELC:
. % /4 gl L / _ _ t l.. ELR:
� SIT:
BUILDING � B D con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site ost/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof . UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab -
Shear /Sheath Fire Spk1r /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not A roved Not Approved • Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
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if: .-7
- - - 0- Call -for reins. • • , 0 ' - -. • do -/of $ - - required before inspection O Unable to inspect --
Inspector: ,_ � 1 4 D ate r (6 -q 7 Page of
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