Permit .
• CITY OF TIGARD PE I U LDING PERMIT 0100
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/14/95
13125 SW Hall Blvd. Tigard. Oregon 97223`8199 (503)'839;4,17,1'
PARCEL: 1S135DD -00600
SITE ADDRESS--; •-f13-315W 5W PACIFIC I -IWY .
SUBDIVISION • HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK • LOT - • 40
REISSUE: t --- -
/ FLOOR AREAS- -- - -`
n ' - EXTERIOR WALL CONSTRUCTION -
CLASS OF WORK. :per FIRST sf N: S :1HR E:1HR W:
TYPE OF USE... :COM SECOND,.. :1080 sf PROTECT OPENINGS ? - - -- - --
TYPE OF COIVST.: N THIRD • sf N: S: E:Y W:
OCCUPANCY GRP.: 52 TOTAL 1080 sf ROOF CONST : B FIRE RET? 'y
OCCUPANCY LOAD: BASEMENT.: sf AREA SEP. RATED:
STOR.: E HT.: 2J2' ft GARAGE...: sf OCCU SEP. RATED:
BSMT? : N MEZ Z? : N REDD SETBACKS- - -. .REQUIRED----------- --
_ -_-
FLOOR _CD .... > 40 psf LEFT: ft RGHT: ft FIR 'SPKL : N SM0K DET..: N
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM:N HNDICP ACC:Y
BEDRiY'C: BATHS: IMP SURFACE:00 PRO CORR :Y P(RKING:
VALUE. $: 0
De
Remarks: molition of existing residence. Sanitary sewer line must be capped a
nd
inspected.
O w n e r : _____________ - - -- - __ -- -- FEES -- _______ •
ROBERT DEUTH type amount by date recpt
1:831 SW PACIFIC HWY PRMT $ 25.00 JD 04/14/95 95- 264220
SPOT $ 1.25 JD 04/14/35 95- 264220
TIGARD OR
Phone #:
Contractor: - - - - -- -•
CONTRACTOR NOT ON FILE
Phone #: $ 26.25 TOTAL
Reg #.. .
REQUIRED INSPECTIONS --
This permit is issued subject to the regulations contained in the Cap sewer line _ ____
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection _ _____ ___
applicable laws. All work will be done in accordance with Final Inspection _ _
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 Si. ._' pure: - `G�C-eci- yr _ 6 `i '� "— �,e1 -,Z _ _ . _�. —__ ^-
or Issuer' By: ___4 00111r.° . ____ ' ;;e% - - __. _ ________--
Call for inspection -- 639 - 4175
Cpyo oierc r a1i
uilding Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
Y OUNCas 1'uNElzAl. NOM
Jobsite Address: I I e30,1 ' w. PACIFIC, HwY • .
Subdivision: Lot #
Office: Use'Only
Valuation: - 1 1 °DO 2 Pla ck/Rec
Corner Lot? N
Perm gO - 1 15 - 0 ( 0
Reissue of
Flag Lot? Y N
Map &:TL
Owner: Approvals Required
Address: I I $31 e-2. L0 Nw•• Planning.
TIAA1z12 , C7rz. 9122.5 Engineering
Phone: (03 - 1 20 Co t h
Other :. :, : .
Contractor: 1. 41444 O 14 t-I Items Required
Address: : Subcontractors:::
Truss Details
Phone: Other . .
Contractor's License #
(attach copy of current Oregon license)
Contact Name & Phone: .I'M AI-kbR - .kih 6 tILOI,I eN(
(old- 2O$(1
Subcontractors: ArchitectlEngineer: I60L -1 Eist&II. EE.f2_1t4 &
Plumbing: Address: F..o . 13ox 23i P 4
Mechanical: b 4 b h 1L UAA2D OC - ' 1 81
(attach copy of current OR Contractor's License)
Phone: 1p2v- 2 5 (.0
JOB DESCRIPTION: LITI OF �XtSTI•Z.vI IZESIDEPIG_E-
`5)d)t 6j
Applicant Signature & Phone number
Received by: Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
% Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH) ,✓
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
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 Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: -2-(1
Permit #: � 9 S- C') V
• F \
,AW 9, Address: � —5
:;:,:: • 0171/44R
•,.��►,.• Issued b� i Date:
99
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:
El 1. I own, reside in, or will reside in the completed structure.
n 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
I I before or upon completion.
LI 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 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 ' • : ty • wners a o Constru tion Responsibilities on the reverse side of this form.
1L(,( . 4 11 •g5
(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 quetions, 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