Permit CITY OF T I GA R D MASTER PERMIT
PERMIT #: MST2005 -00063
Y �y , DEVELOPMENT SERVICES DATE ISSUED: 3/9/2005
�= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 1 S135CD -09800
SITE ADDRESS: 09991 SW PIHAS CT ZONING: R -12
SUBDIVISION: JACOB COURT LOT: 006 JURISDICTION: TIG
REMARKS: Remodel
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 'MP sf RIGHT:
VALUE: 2 00000
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf . REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 1 0 • 200 amp: W /SVC OR FDR: 00 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 • 400 amp: 1st W/O SVC/FOR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps•1000v. MINOR LABEL:
1000. amp /volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/1RRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: This permit is subject to the regulations contained in the
KOLAR, KELLY OWNER Tigard Muniapal Code, State of OR. Specialty Codes
2121 NE TERRITORIAL RD. and all other applicable laws. All work will be done in
CANBY, OR 97013 accordance with approved plans. This permit will expire
if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503 266 - 4088 Phone: 503 475 - 3180 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
Reg #: 952- 001 -0080. You may obtain copies of these rules or
FOTAL FEES: $ 466.37 direct questions to OUNC by calling (503) 246 -6699.
REQUIRED ITEMS AND REPORTS
I��� I / - l
Is ued By !R • i i_ P ermittee Signatures( ∎ 1 i ,� r • k
�-- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business .. .
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r i
y. E►C EIVE� •
Building Permit Atop! bit
O FOR OFFICE USE ONLY
Received gg ,Q
City Of Tigard Received e?d c/b Z fS Permit No.: ZLa-D •
13125 SW Hall Blvd., Tigard, OR 97223 MAR 0 2 20) Plan Revi
Pam
Phone: 503.639.4171 Fax: 503.598.1960 ..440t 's:�n r. ' ( ,t\ Date/By: fie '
Inspection Line: 503.639.4175 � ,'! 1 „ Date Ready/By: , _ ruris:. El See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF TI' •• Notifted/Method;} �� J (,,� Supplemental Information
BUTT DING DIVISION \ -e - VN-e. s,r
TYPE OF WORK REQ IRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
;ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. /'�/�
x 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ L i' C ICJ nD
❑ Accessory building ❑ Multi- family Number of bedrooms: r ]
❑
❑ Master builder Other: Number of bathrooms: I
JOB SITE INFORMATION AND LOCATION Total number of floors: I
Job site address: a g I sco RI ha s an -
New dwelling area: square feet
City/State/ZIP: 154Cird . t Oy - q - 7 cc) 3 Garage/carport area: square feet
Suite/bldgiapt. no.: Project name: Covered porch area: square feet
Cross street/direcctions.to job site: Deck area: square feet
C y v v4 . 4 9 d in \ � 41` Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision ) f K/ (12•Ght- I Lot no.: (p Permit fees* are based on the value of the work performed.
Tax map /parcel no.:. (��� • Indicate the value (rounded to the nearest dollar) of all
�CJL equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
,
PROPERTY OWNER I t ❑ TENANT Number of stories:
Name: ZQ ( t J /�, ,i-c.,L r e ) C r i/1, ,r- Type of construction:
Address: j i Ai € ^ -For( ' • , , 1e i nP ` �'/ Occupancy groups:
City/State/Z 0� � . q--7 O / Existing:
Phone: (5 i=440,;,6, / O `f
r i= 44 0 , ; ,6, Lib Fax: (503) a (, o2g6 ti New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be `
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 "and may be required to be licensed in the
Address: jurisdiction in.which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply: kv'L3-0
Phone: ( ) Fax:: ( ) 4 10. 10
E -mail:
1 5
CONTRACTOR , O • 13
Business name: CnN W BUILDING PERMIT FEES`
Address:
Please refer to fee schedule.
City/State/ZIP: -
Phone: ( ) Fax: ( ) Fees due upon application
CCB lic.: Amount received
Date received: •
Authorized signature: 14/04 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: k' I It I Date: )40 • Fee methodology set by Tri-County Building Industry
G /01(1.4/— Y ✓ �{ Service Board.
i:\ Building\ Permits\BUP_PerrnitApp.doc 12/03 440- 4613T(1l/02/COMTWEB)
Plumbing Permit Application FOR OFFICE usF ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: /r` � Tp� 9-07,1)6,3
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i#, ht, ‘ e , Date/By: Other Permit No.: •
24 Hour Inspection Line: 503.639.4175 , t �� I J
i - Date Ready/By. Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For speciesl information use checklist
Description I Qty. I Ea. I Total
,ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AM) LOCATION Site utilities
Job site address: q q q `
( SW � t 1 l 0\..s n . Catch basin or area drain 16.60
City/State/ZIP: -TT (s J� 1 ar G�' �3 - Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Pro ject name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: CAS2/24-1(, ,� , t� �lh Manufactured home utilities 110.00
-° (± Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: !Iao ( h Lot no.: / �, Water service (no. linear ft.: ) Page 2
5 7 �!/ Fixture or item
Tax map /parcel no.: x l Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
[)(ft A D , k lA ,/ 4 pJ( [ 6, A Backwater valve 16.60
(R 0. 494. -R� t hot f�atiJ� Ram /f _ 4 Clothes washer I 16.60
kid 0+4,/ `Th t O or 1 t � Dishwasher f 16.60
1d���y`"y'�`�' I ❑ TENANT Drinking fountain 16.60
' ROPERTY OWNER O� g
Ejectors/sump 16.60
Name: Zap „ n px-S air p4_ • I y Expansion tank 16.60
Address: , 1 9.1 NE_ -T-52,,,r- r , , f t j ( J Fixture/sewer cap 16.60
City/State/ZIP: C 02, t ( cn () 1 3 Floor drain/floor sink/hub 16.60
Phone: (5)3) c aw, (4 C D Fax: ( 5)3) 704 q q S6, Garbage disposal I 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory a., 16.60
( ) Fax: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet t 16.60
Business name: P) Le-DtP Water heater I 16.60
Address: Other.
City/ State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature:
State surcharge (8% of permit fee)
1/C)5, TOTAL PERMIT FEE Print name: K,e1 �^ j nth_ I Date: This permit application expires if a permit is not obtained within
�l-' 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is\ Building \PermitAPLM- PermitApp.doc 12/03 440- 4616T(10fO2KOM/WEB)
Electrical Permit Ap i� I roll orrlc us l : ONLY .� :. EVE - P 8
x, Rece ived / ‘,/0-- 603
Ci of Tigard Permit No.:
`7 g Date/B : i/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 MAR 0 2 20 i ° "' "4' ' e'I I i� DatDate/13 : other Permit. -
Inspection Line: 503.639.4175 �� Date Ready/By: Juris: ® See Page 2 for .
Internet: www.ci.tigard.or.us TY OF TIGARD Notified/Method: Supplemental Information
9.
]DI V I S I O N PLAN REVIEW
❑ New construction K: eratlo replac e ment Please check all that apply:
❑ Demolition ❑Other: DService over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
�
1 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
'❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
:Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION .' Egress/Iighting plan RV park
Job site address: C (, "H ealth -care facility ❑Other:
Job no.:
I Gq q 5 �1 I )Q ) (1 Submit 2 sets of plans with any of the above.
City/State/ZIP: I 1 ` t (�i/�, / 4 , - — 9 1 D- 3 The above are not applicable to temporary construction service.
��' ^' ` C
FEE* SCHEDULE
Suite/bldg. /apt. no.: I Project name:
Description I Qty. I Fee f Total • •
Cross street/directions to job site: C New residential single- or multi- family dwelling unit.
A u Includes attached garage. I
1,000 sq. ft. or less c5 (p t' f L-- 4
Subdivision: la atAr J `iA':1 I Lot no.: (40 Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: cy--) Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
^ dwelling, service and/or feeder 90.90 2
(//
5 ' U I Services or feeders installation, alteration, and/or relocation
200 amps or less j...../ 80.30 g p, lr 2
APROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 70.E ��Xc��'r1 p r - _ K l I J <(i�` 601 amps to 1,000 amps 240.60 2
Address: a J j ' T C i a._Q / Over 1,000 amps or volts 454.65 2
r^ Reconnect only 66.85 2
City/State /ZIP: CL 1 () q V � � Temporary services or feeders installation, alteration, and/or
Phone: (j(3) c ..( p �
Fax: ) ''-9.' U relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is no 201 amps to 400 amps 100.30 2
intended for sale, tr ent, or exch c, accor ing to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature .°d— ` r Qb1 > 0/614 , Date: 3:4/11.5___ Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT `�• I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
•
Each add'I branch circuit 1 ( 6.65 - /04 yo 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F es; : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 • 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: v
,rq Up extension. Describe: Page 2 2
•
Address: • Each additional inspection over allowable in any of the above
. • Per inspection 62.50
City/State /ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Ele al Lic.: Suprv. Lic.:. Subtotal itt 10
Suprv. Electrician signature equircd: Plan review (25% of permit fee)
Print name: Date:
State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized si IA . • This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
. •• Number of inspections per permit allowed.
is\ Building \Pennits\ELC- PermitApp.doe 12/03 440- 4615T(10 /02/COM/WEB
Mechan Permit Application FOR OFFICE USE ONLY . •
City of Tigard Recei DateB ved : Permit No.: 5 l y- ° 3
13125 SW Hall Blvd., Tigard, OR 97223 R E , y ��
Plan Review Other Permit:
Phone: 503.639.4171 . Fax: 503.598.1960 iu� ,I p��
Inspection Line: 503.639.4175
1- Ready/By: kris: See Page 2 for
Internet: www.ci.tigard.or.us MAR Da Rea Notified/Method: Supplemental Information
TYPE I 1pF TIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El New construction X Add it9tfriY�ft i 9aPrrIen I S 10 N Mechanical permit fees* are based on the value of the work
❑ Demolition ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ )
1- and 2 -famil dwellin RESIDENTIAL EQUIPME k iCV,01
/ SYSTEMS FEES*
2-family dwelling ❑ Commercial/industrial builder ❑ Accessory building
- Multi - family 0 builder For special information use checklist.
❑ Other: Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Gig - (� n Air conditioning, or hcat pump
Job site address:
11 ( s Y V QS Cow* (requires site plan showing placement) 14.00
City/State/ZIP: t y i a r_ ( /t� 9a ;9,9;9,9,3 .3 Fanlike 100,000 BTU (ducts/vents) 14.00
' Furnace 100,000+ (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Ductwork 14.00
9) & 1 — n H-� Hydronic hot water system 14.00
021 I - 4r) ` iC? F 1 0 Residential boiler (radiator or
o hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: (�, Lot no.: Flue/vent for any of above
Other: 10.00
C�� lX� 10.00 _
Tax map /parcel no.: CI (Z/f Other fuel appliances -
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellei'stove 10.00
Wood fireplace/insert 10.00
PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: _ 10.00
Name: m t p /t (� 49X.. � K )91 t t I e P /- E mental exhaust and ventilation
Address: � r7 � I`-cC an . e hoo they kitchen
I tP.�r 1 d 16Y IGI-Y equipment I 10.00 0.CC)
City/ State/ZIP: Q I9•(� t 3 ' 97O /3 Clothes dryer exhaust 10.00
�•, Single -duct exhaust bathr ms
Phone: (5 ) cg(0ia �t � Fax: (� h ) )/ `� _ 9b l toilet compartments, It rooms pt 6.80 1 3, Li)
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name:
Other: 10.00
Fuel piping '
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump.
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heatei
Fireplace
E -mail: - Range g
CONTRACTOR Barbecue
Business name: O toi3 Clothes dryer (gas)
C.• Other:
Address: MECHANICAL PERMIT FEES*
City/ State/ZIP: Subtotal * 0
Phone: ( ) Minimum permit fee ($72.50) 1a , 5-
( ) Fax :: Plan review (25 % of permit fee) •' I
CCB lic.: . State surcharge (8% of permit fee) I
TOTAL PERMIT FEE .7' -
Authorized signature: kiribian_.., This permit appGcatiou . expires if a permit is not obtained within MU
days after i has been accepted as complete.
Print name: 1-{ e l l (, K -) Date: ,..1g.---10.5 " methodology set by Tri County Building industry Service Board
i:\Building \Permits \MEC- PermitApp.doe 12/03 440-4617T (11 /02JCOM/WEB)
CITY OF TIGARD
13125'S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GRAND PRIX PLUMBING CO RECEIVED
10723 SW 82ND AVE APR 4 205
TIGARD, OR 97223
CITY OF TIGARD
BUILDING DIVISION
Plumbing Signature Form
Permit #: MST2005 -00063
Date Issued: 3/9/2005
Parcel: 1 S135CD -09800
Site Address: 09991 SW PIHAS CT
Subdivision: JACOB COURT
Block: Lot: 006
Jurisdiction: TIG
Zoning: R -
Remarks: Remodel
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing
permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing
Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
KOLAR, KELLY • GRAND PRIX PLUMBING CO
2121 NE TERRITORIAL RD. 10723 SW 82ND AVE
CANBY, OR 97013 TIGARD, OR 97223
Phone #: 503 - 266 -4088 Phone #: 503 - 516 -9915
Reg #: LIC 157775
PLM 34 -432PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
/i b or
m ature of Authorized Plumber
If you have any questions, please call 503.718.2433.
Permit #: al 0, — . 1 �(Q3
Address: g4'11 d A( Hiv-,
Issued bC t epZ�7�u11,1 .1 Date: 4 /6 —
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:
W 1. I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold or offered for sale
4 2.
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
Nii,--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. OS
$ /CO ____. -- S / 9 (S' . t re of ermit applicant) • (Da i
_' )
(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 Department 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. I fyou fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs ifone ofyour employees is injured on the job. Formore 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 i fyou 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 perm it holder for this project, you are responsible for resolving any fai lure 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
CITY OF TIGARD .
II BUILDING DIVISION PERMIT #: MST2006.00063
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 0/1 0/2005 TIME: 7:05AM PAGE: 6
SITE ADDRESS: 09991 SW PIHAS CT CLASS OF WORK:
SUBDIVISION: JACOB COURT LOT #: 006 TYPE OF USE:
PROJECT NAME: KOLAR
DESCRIPTION: Remodel. 4/4/05, per Grand Prix Plumbing they are only doing rough -in.
OWNER: KOLAR, KELLY, PHONE #: 503266 4088
CONTRACTOR: OWNER PHONE #: 503- 475 -3180
Inspection Request Scheduled For: Date: 8/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013274 -02 503-704 -9456 Y
3qo\ - PLQM %i05(
Corrections /Comments/ Insttictions:
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#2 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GTA ► \' Date: a l b' Phone #: (503) 718- 2 M4b
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005-00063
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2005
Phone: (503) 639 -4171 I„ r g Triiii i l(j,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/10/200 TIME: 7 PAGE: 7
1 SITE ADDRESS: 09991 SW PIHAS CT CLASS OF WORK:
SUBDIVISION: JACOB COURT LOT #: 006 TYPE OF USE:
PROJECT NAME: KOLAR
DESCRIPTION: Remodel. 4/4/05, per Grand Prix Plumbing they are only doing rough -in.
OWNER: KOLAR, KELLY, PHONE #: 503-266-4088
CONTRACTOR: OWNER PHONE #: 503-475-3180
Inspection Request Scheduled For: Date: 8/10/2Q05 Pour Time:
Code # Inspection Description Confirm # Co - . Message
299 Final inspection 013274 -01 503.704 -9456 Y
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Corre ions /Comments /Instructions: - 0I32S3' O(
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IlliielliPMErs! ,
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL INSPECTION ❑ ADDI IONAL FEES ASSESSED
Inspector: 1 `� Date: •
. V 0 Phone #: (503) 718 -
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