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Permit ' � ��� O PLUMBING PERMIT ~ ��-�~� � l� ��-� � � PERMIT # ^ PLM96-0171 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/25/96 1u1osm* Hall Blvd. Tigard, Oregon e722308199 (503) 639-4171 PARCEL: 2S109BA—HS005 SITE ADDRESS...: 13917 SW LEAH TERR SUBDIVISION....: HILLSHIRE SUMMIT ZONING: R-7 PD BLOCK..,.....'.: LOT ^005 CLASS OF WORK..:ADD GARBAGE DISPOSALS.: 0 ' MOBILE HOME SPACES.: 0 TYPE OF USE....:SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1 OCCUPANCY GRP..:R3 FLOOR DRAINS ^ 0 TRAPS ^ 0 STORIES........ : 0 WATER HEATERS.....: 0 CATCH BASINS...... . : 0 FIXTURES --- LAUNDRY TRAYS ^ • 0 SF RAIN DRAINS.....: 0 SINKS..........: 0 ' URINALS ^ 0 GREASE TRAPS ^ 0 LAVATORIES • 0 OTHER FIXTURES ^ 0 TUB/SHOWERS....: 0 SEWER LINE (ft)...: 0 WATER CLOSETS..: 0 WATER LINE (ft). .. : 0 DISHWASHERS ^ 0 RAIN DRAIN (ft)...: 0 Remarks: Installing backflow prevention device • uwner: — FEES MICHAEL HAGEL type amount by date recpt 13917 SW LEAH TERR PRMT $ 15.00 B 06/25/96 96-280990 5PCT $ 0.75 B 06/25/96 96-280990 TIGARD OR 97224 Phone #: 590-0E45 Contractor: OWNER __________ _____ Phone #: $ 15.75 TOTAL Reg #'.: 'REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the RP/Backflow Prey __ Tigard Municipal Code, State of Ore: Specialty Codes and all other Final Inspection ___ applicable laws. All work will be done in accordance with ' ' approved plans. This permit will expire if work is not ted ' .............. __� within 180 days of issuance, or if work is suspended fir `e _ I . ___ than 180 days. - Ji Permittee Si ature 1 \X••-' / ��i - — _ . ______ Issued By: O AttAXV11-1( "---/ __� -- f --_ _ . _— . .Call for inspection — 639-4175 ' _-- . _ -- • ' __ City of, Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # - 13125 SW Hall Blvd. Permit # 't A to -O("7 Tigard, OR 97223 (503) 639 -4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE Name of Development • New Single Family Residences Only Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00 Job /3q/7 S' 3 Ceff� 1, ."- ❑ 3 BATH HOUSE $225.00 Address City/State ao / Fee includes all plumbing fixtures in the dwelling and the first 100 feet 776797-0 Pa_ 972aL / • of water service, sanitary sewer and storm sewer. See fees below. Name (or name of Business) FIXTURES QTY PRICE AMT AO U"/ - I /( M✓©e4C Sink 9.00 Mailing Address /,, J r 11*pA' '- Phone Lavatory 9.00 / Owner 73,/ 7 SW }} (&4/7 C Tub or Tub /Shower Comb. 9.00 City /State ZIP Shower Only 9.00 1760402 j2 (' /Z 17-2_2A Water Closet 9.00 Name (or name of business) Dishwasher 9.00 Garbage Disposal 9.00 Occupant Mailing Address r ��f Phone Washing Machine 9.00 . 4t " Floor Drain 9.00 City /State Zip Water Heater 9.00 Laundry Room Tray 9.00 Name Urinal 9.00 Other Fixtures (Specify) .9.00 Mailing Address Phone 9.00 Contractor 9.00 City/State ZiP 9.00 Sewer 1st 100' 30.00 State Registration No. City Bus. Tao No. Sewer - ea. Addit. 100' 25.00 Water Service 1st 100' 30.00 I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00 information given is correct, that I am the owner or authorized agent of the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00 I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00 number given is correct. (If exempt from State registration, please , give reason below.) Mobile Home Space 25.00 / ate Back Flow Prevention / Device or Anti - Pollution Device 9.00 Signature (owner or agent) /� Any Trap or Waste Not G/ Connected to a Fixture 9.00 Describe work new' addition 0 - Iteration 0 repair 0 Catch Basin 9.00 to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00 /hr Specially Requested Inspections 40.00 /hr Existing use of Rain Drain, single family dwelling 30.00 building or property /1-.6:VVLA-- Residential backflow prevention devices ( 15.00 / 5.0 Proposed use of building or property • (Except resident backflow prevention devices) NOTICE *Minimum Fee $25.00 SUBTOTAL 15 bV PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE , / CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED ' FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS - -- - - -COMMENCED. - ------ PLAN_REVIEW 25% OF SUBTOTAL _ TOTAL IC . IC Special Conditions Date issued by Permit #: (1M 16 -Cfl( Address: ( J 1' i--ZC v -T if l( Issued by: ! , M) L Ltk.1 Date: (- is 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 'r She appropriate blanks and initial boxes 1 and 2, and either box 3A. or 3B: Itk 1. I own, reside in, or will reside in the completed structure. ./ t 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 work on the structure must be registered with the Construction Contractors Board. \, OR 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 withrthe CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the abov in o t matio s correct and that I have read and do understand the Information Notice to Proper Owners o t onst ction Responsibilities on the reverse side of this form. - - - (Signa ure -.. ►ermi applicant -- (D te) (White copy to issuing agency permit file, pink copy to applicant) Information Notice to Property Owners About Construction Responsibilities Note: This InfOrmation Notice to Proper° Owners about Responsibilities developed by the C�nstruction Contrators Board in accord with developed by the Construction Contrcktors 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. EMPLOYER RESPONSIBILITIES: 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 incornetaxes from employee wages atthetime emploves 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 Department at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mus uhtain workers' conopcuaarioninsurance for your employees. |f you fail to obtain p/orkoo'con�pcnou\ioninsurance, you may be subject to penalties and will be I iable for all claim costs i f one of your employees is injured nuthe'ob.Fornoorcinformo¢ion, call the Workers Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: Asan employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even ifyou didn't actually withhold the tax. For more information, ca II the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: Asthe perm it holder for this pr jccl,youurcrespuusih(c[orresn|viognnyfa(k/o:tomcctcudcrequircments that may be brought to your attenti |' on�bnou�inmpcc{ionx. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage Fo accidents and omissions such as falling tools, paintoverspray, 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: Mak.e 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 |4l40, Salem, ORq7}09-50j2, 50}/378'4621). l'he Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 • CITY OF TIGARD BUILDING INSPECTION DIVI•SIO : MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BLD Location /39/7 S , ��ir�i / ✓�e� Suite MEC Contact Person Ph PLM Contractor Ph SWR • BUILDING Tenant/Owner /17/a74,,/ :¶9)f9/5 — ELC Retaining Wall ELR Footing Ai Foundation ,NOT REQUESTED. 43, F> FPS Ftg Drain FOUND RESEARCH SGN Crawl Drairi Ir No- IN Sllab I INSPECTION(S) IN FILE SIT Post & Beam at Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler .;nfiw Fire Alarm .1 o. Susp'd Ceiling -'.. (- Roof Misc: Final _ PASS PART FAIL PLUMBING • Post & Beam T' Under Slab . Top Out, Water Service Sanitary Sewer Rain Drains Final• °S PA PART FAIL MECHANICAL Post & Beam ' Rough In Gas Line • Smoke Dampers Final PASS PART FAIL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE 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 Approach /Sidewalk i`/ , ' �; J • Other Date . •: • , Inspector 6'' Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. /:' —