Permit CITY OF TIGARD r
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
BUILDING PERMIT
PERMIT # • BUP94 -0321
DATE ISSUED: 10/26/94
639 -4171
PARCEL: 2S102AB -00603
SITE ADDRESS...: 12099 SW LINCOLN AVE
SUBDIVISION • NO. T I GARD V I LLE ADDITION AMEND. ZONING: R -4.5
BLOCK • LOT •63
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION —
CLASS OF WORK. :ADD FIRST • sf N: S: E: W:
TYPE OF USE. ..:SF SECOND...: sf PROTECT OPENINGS?
TYPE OF CONST.:5N THIRD sf N: S: Es W:
OCCUPANCY GRP.:M1 TOTAL 0 sf ROOF CONST: FIRE RET ?:
OCCUPANCY LOAD: BASEMENT. : sf AREA SEP. RATED:
STOR.:1 HT. :8 ft GARAGE... :160 sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD • psf LEFT:20 ft RGHT: ft FIR SPKL: SMOK DET..:
DWELLING UNITS: FRNT:00 ft REAR: ft FIR ALRM: HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE. $: 2603
Remarks: 160 SQ FT ADDITION TO DETATCH GARAGE
Owner: -- FEES
RONDA WRIGHT type amount by date recpt
12099 SW LINCOLN AVE PRMT $ 38.50 JF 10/26/94 —
PLCK $ 25.03 KAR 10/20/94 94- 258001
TIGARD OR 97223 5PCT $ 1.93 JF 10/26/94 —
Phone #: 503 - 624 -0127
Contract or:
OWNER
Phone #: $ 65.46 TOTAL
Reg #..: --
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Foot /found Insp _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Framing Insp
applicable laws. All work wi 11 be done in accordance with Rain drain Insp
approved plans. This permit will expire if work is not started Final Inspection
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee Signature: . - I: \, \ _1\.*;.._�.+
1
Issued By: C.
___
Call for inspection — 639 -4175
Residential Building Permit Application
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City of Tigard j O\
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
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Contractor's License #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Architect/Engineer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
r t / .. ,1 , f i
JOB DESCRIPTION: /0 ■4 f, A.i • 0 Al f r)
Applicant Signature & Phone nu ber
Received by: id)2,t_._ ■#(----
7
Date Received:
N:WVORD\COMDEIARESAPP
Pe # Account Description Amount Amt. Pd. Bal. Due
r . ' •
1-- Bldg. Permit (BUILD) '3 � �� 3 �' CV 9149q4—.934.1 --
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX) 1 1. 3
Bldg: /,q3
Plumb:
Mech:
Plan Check (PLANCK) c 7/S. G3 2S ' o3 _
Bldg: Sr u 3
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 -O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: 65 , .1/0. 3
It
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Washington County Electrical Permit
Call 640 -3561 for inspection
Date Permit No. c••s 6r) 2 —1 j
Project Address
Permitted work
Homeowner wiring own residence
Homeowner's Signature 1
Contracting firm
Phone
• Supervising Elec. Signature
License No.
Inspection Inspector • Date
•
Underground
Service
Wall Cover ( `
Ceiling Cover I � . i L i i. 1 . _ / /•' i (
Final '�� 67- j /9
Signature of Inspector indicates approval • Not transferable
•
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350 -12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, • PHONE: 503 /640 -3470
OREGON INSPECTION REQUESTS (24 hours): 503/640 -3561 or 693 -441:
_rmit #: U5060271 Project #: P0045150 Status • APPROVED Page 1. of 2
applies. : 10/31/94 Issued • 10/31/94 Expires • 07/29/95 06/19/95 05.01
R ES ELEC
=ermit it SFR - '5LE /S.E>.VICE. 1 Cif', yip OT
)escriptian Begun:10 /31/94
:rob- Address 12099 SW LINCOLN AV TI
)weer Name INSPECTION - TIGARD Region I)
Applicant Name . WRIGHT, RONDA DMARIE , A
Phone number 291- 738K(WK) Valuation: 0 Appr <_`.le:i mss/
Approval #: APP R
- 1'�'
Inspector Comments:
•
•
REQUEST E R R O R !
•
•
•
•
•
Plumbing _ -- — , - --
•
' __ - -- _ — . — • — ___.
E l e c t r i c a l : •
Structrual: --- -'— — ^---
General
1 _ _ --
Inspected bY — � . 1 . - % Date: 61/420 / 9 C` ,
Inspect.iorl Requested:
r_ Final Electrical 049 E AP • ON IV!2
06/19/9S RI PH • -
01/26/95 RI LG a24 -0127 291 -7888
•
Permit #: 13u, Pq4-- f l
�� , �- .; � Address L ,/ / ,i ... _
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Issued b, / � Date: , •
59
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:
g 1. I own, reside in, or will reside in the completed structure.
1
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
El 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
JJ 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 Prope ty Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant)/ (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
•
•
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).
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 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 RESPONSIBILITIES AND AREAS OF CONCERN:
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 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.
prop- own.pm4
1 /94
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: S I C I 1 A.M. P.M. MST:
Location: 1 - D - - v J�-Q BUP: L 03 )___/
Tenant: Suite: Bldg: MEC:
Contractor: Phone: ` PLM:
Owner: SLR g Phone: (L! 2 L( _di 3 G / ELC:
i I ELR:
SIT:
BUILDING BLDG (con't) PLUMBING / MECHANI ! AL ELECTRICAL SITE
Site Post/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 Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk • oved Not Approved Not Approved Not Approved Not Approved
(FINAL FINAL FINAL FINAL FINAL
O Call for re' lion inspection fee of $ required before next inspection / CI Unable to inspect
Inspector: 1/2 Date: r- °� 1 1 Page / of
•
1