Permit I',
MASTER PERMIT
CITY OF TIGARD
PERMIT #: MST2004 -00270
L X111 DEVELOPMENT SERVICES DATE ISSUED: 11/15/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13439 SW SCOTTS BRIDGE DR PARCEL: 2S104AB -08500
SUBDIVISION: MORNING HILL NO. 5 ZONING: R -4.5
BLOCK: LOT: 114 JURISDICTION: TIG
REMARKS: Finishing attic area, adding window, (1) wall.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: 900 sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT:
VALUE: 15.000.00
OCCUPANCY GRP: R3 BDRM: 1 BATH: • TOTAL: 900 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: 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: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2.00 SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +ampe- 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 & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 388.99
This permit is subject to the regulations contained in the
SMITH, BETTY JO
SMITH, BETTY TTY JO Tigard Municipal Code, State of OR. Specialty Codes
TIGARD, S OTTS RIDGE DR and all other applicable laws. All work will be done in 97223
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.
Phone: Phone: ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Electrical Rough In
Framing Insp
Insulation lnsp
Electrical Final
Final inspection
Issued By : / •� , ■ Permittee Signature :x /
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b siness day
Building Permit Application . / FOR OFFICE USE ONLY / �7 /�
City of Tigard Ct Da
•- / � 7 4 4 Permit : t/Y 7d ,L / 6
13125 SW Hall Blvd., Tigard, OR 9 —, Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 1 0 � o o� G ' * t '-.�,!*' ' l
..,: E' _I � Date/B : Ni — /6 • O I4 Other Permit:
Inspection Line: 503.639.4175 sEP 1 .. Date Ready/By: El See Attached Checklist for
Internet: www.ci.tigard.or.us C'" Notified/Method: Supplemental Information
.. WORK - REQUIRED DATA: 1- AND RANIILl',DWELLIN,G
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
° ,eAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION. work indicated on this application 7
Jir1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ ,S l ppd
❑ Accessory building ❑ Multi- family Number of bedrooms:
t .-.
❑ Master builder ❑ Other: Number of bathrooms:
• JOB SITE INFORMATION AND LOCATION; _, ^ ',.., Total number of floors:
Job site address: 13 4-3 q S.l„3 5 c,F, \}S It . oAC L pje_. New dwelling area: square feet
City/State/ZIP: 17 1 a c" d q -7 ZZ 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: Covered porch area: square feet
Cross street/directions to job site: „ l A i) Off ��,,,,,,,* S. - 14 ...tae Deck area: square feet
5 3 3 . T ! - " gyp t rt. i ,-,.q ` ' t — lr \ k V -No (we.- "-Gnci) Other structure area: square feet
SC t CX'[ ole 'D . , & it e b / G ' sac- REQUIRED DATA: COMMERCIR:C,-USE CHECKLIST
T
Subdivision: Lot no.: 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
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 ❑ TENANT Number of stories:
Name: J.o SeM.; -r-,,, Type of construction:
Address: \ 3 43 et ) 5 kt- A3 c[ c \e xi _ Occupancy groups:
City/ State/ZIP: {ciafp& QV.-... Existing:
Phone: (5b3) $ 0 \ 9 cee Fax: ( iu,k New:
APPLICAA'T 0 CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: Sa„,4yvt a.3 'Q.42OV L 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:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR -
Business name: .-->p,,,„ 0 . "8 —n— r CS Zri_ BUILDING PERMIT FEES* .
Address:
Please refer to fee schedule.
City/ State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.:
Date received:
Authorized signature: This permit application expires if a permit is not obtained
� y ji within 180 days after it has been accepted as complete.
Print name: /. - I Date: (t 9 * Fee methodology set by Tti -County Building Industry
U /�iw� / Service Board.
i:\ Building \Permits \BtJP- PermitApp.doc 12/03 440- 4613T(1l /O2/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223
Date/By Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 4.17 /f rr I
24- Hour Inspection Line: 503.639.4175 tl I ( ❑ Electrical ❑ Plumbing ❑ Mechanical
• Internet: www.ci.tigard.or.us ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ , ❑ ❑
9 Erosion control El plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore:on and shall be shown to be a..Iicable to the .ro under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
i: \Building\Permits \One- Two - FamilyChecklist.doc 12/03
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received �� Permit No.: mamo 't .ova -•�
13125 SW Hall Blvd., Tigard, OR 97223 Da e / t� G
.ST
� nl Y r - Plan Rvie
Phone: 503.639.4171 Fax: 503.598.1960 }i. - � " Date/By: Other Permit:
Inspection Line: 503.639.4175 _ - . ! i. 1 l' Date Ready/By: lugs: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
„',` , 1, . ,. 1`r . - u_M..':'d f . _ y :. r , 4 ,� .S : 44 :4,: f.�, N t-' 'a5.::; f l
. °, :�.;'n: _'i�P.:';: P.V 4 -4 :?kr l .,.. 7 _ `•> _ - - -
;-- Y ' ' --1 . • ��,+ %, . a 4 Y.P,-,xO wO _ c9 '_ °•F.' . 4: . .t= . - 4� 1 �� # . c P ., �, - i,c� . :� -
•e� d,v .�'i+•-v'�= °1�•ys - ,�,'�,. .:��;';:.� _'��;� � e ��.- , ... : 1s� x• .��� _ ' t_.�a y�L , �•.�'��' - - + �r�__ . r .. .. . _
_ .�� .•�cl °,4%5?r- r -o..x; ,. :,. 'I�., - -a�; p,.. �: tea,'•.... -,;<A �F ��. -. "�,. ]��.
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• t « ",M. _. p , t , T - y r{ " .._ i Y - - .: p i _ i a •'.:..y°
W >` -WE ' Nip
..'` # . " :�i EG I Y .p.. . CO RLI-,."ff01 kl?'x ^ c t -w �, ; of 1 - and 2 - family dwellings 4 or more new residential
- Vii... .,.... .. i�.'r .�k ��,Z.r t' .. �a' �'aI_ • L' :...r .' � __ � 3 �ie�- 7.'. K � �t"; L.:n�
❑ 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 [Weeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
=;' -,„ •• , , ?4 ." `SOI �+��;,�.• bN i..,, . , ' s R
i ❑ ess/li tin plan V park
Job no.: Job site address: 1343 $t,t) Sew S �r• A ❑Health-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: 1 o1 2e ch. 02 it 72 Z3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: ? ::- "C + ' E'^ R ' '
Description I Qty. I Fee. I Total I ,.
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • 1
Tax map /parcel no.: Limited energy, residential 75.00 2
;.. „ .�- : ; A -, b Limited energy, non - residential 75.00 • 2
.-t- �<,; ,r te _ r-: �;�
_ .�t.�.��'� � �•. °'i= .' . � "s:k�" _,. Each manufactured or modular
- ' dwelling, service and/or feeder i 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
1`� .. e., ^ M : ,,, : t'' f , - 201 amps to 400 amps 106.85 2 •' .. I'',..:: $ ,R O BERT Y O WN ER ` , _ 4 ' - I,::7;;;... ; �. T L EAI1 r �r5
�` � s '; Yr `_ " 401 amps to 600 amps 160.60 2
Name: 13e46 Jez Sm, 601 amps to 1,000 amps 240.60 2
Address: \4-' j q ) Sts s � 3e
3 t�c 1C 2 Over 1,000 amps or volts 454.65 2
Reconnect only • 66.85 2
City/State/ZIP: f T arc c) a.- 1 C 7 Z Z3 Temporary services or feeders installation, alteration, and/or
Phone: (9:7)3 ) Sc) 0 1 C ( S. Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas en or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: c� Date: 9/(0/ C2. q Branch circuits - new, alteration, or extension, per panel
F:. , i - a*CP , plyTy, , r i :r'. ='4 a:r^ :`" : ' A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: S2_ •=1„.41,6,,e_. branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit Z 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
% � - ,., : - ° ;r -.. "'' U ... 4, 'O - , a T:r i °< � •, 7 : ^`±(5 ' -, , 3' energy panel, alteration, or
r� ` `; extension. Describe: Page 2 2
Business name: �, w . w i rr . Vt t 4.- L L
Address: 11334 S t 8-ti. A..ls.y..,.,..... Each additional inspection over allowable in any of the above
Per inspection 62.50
I City /State /ZIP: ?c le 4- \ Z.., at, 0 e. y72. 14 Investigation per hour (I hr min) 62.50
Phone: (503) Z3) - I S48 Fax: (.5 23 • 947 •T Industrial plant per hour 73.75
"'' - -KC `PE `NTITt 'Flirt *s ` ° :S7 " .
CCB Lic.: 133 0 (o Electrical Lic.: 2(,•• 13 5-C.) Suprv. Lic.: 1466
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: 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.
i:\ Building \Permits\ELC- PemiitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
•
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LINIITED ENERGY PERMIT FEES:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls •
•
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\Building\Pern \ELC- PamitApp.doe 04/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
A ECEIVED ES SSIDE ELECTRIC CO INC .
1834 NOV 1 7 2004 PORTLAND, OR 97214
CITY OF TIGARD
BUILDING DIVISION Electrical Signature Form
Permit #: MST2004 -00270
Date Issued: 11/15/2004
Parcel: 2S104AB -08500
Site Address: 13439 SW SCOTTS BRIDGE DR
Subdivision: MORNING HILL NO. 5
Block: Lot: 114
Jurisdiction: TIG
Zoning: R - 4.5
Remarks: Finishing attic area, adding window, (1) wall.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
SMITH, BETTY JO WEST SIDE ELECTRIC CO INC
13439 SW SCOTTSBRIDGE DR 1834 SE 8TH AVE
T!GARD, OR 97223 PORTLAND, OR 97214
Phone #: Pho #: 503 - 231 - 1548
Reg #: I 13306
SUP 46545
I:1.Ii 26 -135c
AN INK SIGNATURE IS REQUIRED THIS FORM
X ;L a j 6
•
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
•
1 . 4 LL90- 9ELEEOS) •03 oi,12oaj3 aptg zsam eOO :L0 b0 LI noW
Permit #: f 15T 00 a-Z
o f o
Address: 1 4%9 co e.. 0'it5 - EPA 06 e
Ni : T r : b:.; c
r► , Issued by: - Date: f t /t 570 V
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:
-e. 1. I own, reside in, or will reside in the completed structure.
Iil� ��E 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
r before or upon completion.
n 3A. My general contractor is
I 1 (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
AN 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.
Ad S...---,___.,
w //11/
(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 dei'eloped 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 stnict;iro,
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, he ruled to he 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 inure
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 most
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, .■ ou 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 he
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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 ,2j a0D4 _ 0 0.P-70
INSPECTION DIVISION Business Line: (503) 639 - 4171 W�Ci
BUP
Received Date Requested 3 —�'-- AM PM BUP
Location /� y39 Jco Suite MEC
Contact Person )ALt d e Ph ) 577 — SMD PLM
Contractor P ( ) SWR
•
BUILDIN Tenant/Owner ELC
ELC
Foundation Access:
Ftg Drain 1 , 4 r ELR
Crawl Drain �/ / v
Slab Inspection Notes: 17e SIT
Post & Beam S 5 a 9 a •
Shear Anchors v
Ext Sheath/Shear
Int Sheath/Shear
Framing i LL_ t_ i' I • 6
Insulation /� ! S � _� t ��c� —
Drywall Nailing C� j
Firewall
Fire Sprinkler
Fire Alarm S9" o l< /J L`� L�Z�D 2- o 1<
Susp'd Ceiling
Roof
O er:
47121"..1% 0 4:10f PART FAIL
P 1 BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
P PAT
( SS FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fi e Alarm
�'' T Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA • Z _ a�
Approach/Sidewalk Date S Inspector �� Ext
Other:
Final DO NOT REMOVE this Inspection record fro = job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST X00 -0o a �D
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested / —1 3 AM PM BUP
Location - Suite .P MEC
Contact Person /Lt oi4.-1 Ph ( ) _ - A PLM
Contractor Ph ( ) SWR
Y41.PiA r
BUILDING Tenant/Owner 1 3 � ° 1 N G I LLI- C \- ELC
Footing J - \ ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post -& Beam �•,
Rough -In
Gas Line
Smoke Dampers L'P
Final
PASS PART FAIL
ELECTRICAL
Service
UG/Sla
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASO PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date / �, � /� Inspecto / r Ext
Other:
Final DO NOT REMOVE this inspection reco d from th Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 03) 639 -4175 MST ` - -00 -7 D
INSPECTION DIVISION Business Line. 503) 639 - 4171
BUP
Received Date Requested // — a AM PM BUP
Location - �_ __.��� - MEC
Contact Person ( ) PLM
Contractor Ph ( ) -3 - 1. SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ,. ELC
Ftg Drain Access: Moe �iNl�. µi�L D� Cr��Kas�
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear Sr
Int Sheath/Shear 2 -C"
Framing �T♦ r� _ ► .�� � �
Insulation
Drywall Nailing lri N_ - mow'
Firewall � .1
Fire Sprinkler • k = �/A-1
Fire Alarm t .� `/ `!` — S - �� - A./
Susp'd Ceiling ��
Roof OF w/ — _ • '` —w_ r
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Bain / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Rough -In
U a b
Low Voltage
Fire Alarm
Final U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS - AIL
SITE ❑ Please call for reinspection RE. 0 Unable to inspect – no access
Fire Supply Line
r
ADA
Approach/Sidewalk Date it Z S d Inspector Ext
•
Other:
Final DO NOT REMOVE this inspection recor from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 03) 639 -4175 }}�j . a o - 00a 70
INSPECTION DIVISION Business Line: 03) 639 -4171
BUP
Received Date Requested — / AM PM BUP
Location /3 SCo Ott Suite MEC
Contact Person 1"/4V_ C C J I P ( ) 577- - 576 0 PLM
Contractor ( ) SWR
'UILDIN . Tenant/Owner ELC
g ELC
Foundation Access: N162N/n/(, /pi c_
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing Ti M /0 -' v ,4- — o ^i - 5 t t —
Insulation
Drywall Nailing
Firewall ! — S�S
Fire Sprinkler ®
Fire Alarm
Susp'd Ceiling
A
Roof �
of � �� � t✓ �
apt. r:
PASS PART al0
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
1 FAIL
AL
Service
Rough -In
UG/Slab
Low Voltage
Fire larm
SS PART (AIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE 0 Please call for reinspection RE 1j 2 nable to inspect – no access
Fire Supply Line /
ADA �SS l - s
Approach/Sidewalk Date Inspector S Ext
Other:
Final DO NOT REMOVE this inspection record from t = b site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
-5 MST °� 0
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received Date Req ested ` AM �1 ' PM BUP
Location /,3 �- , ! Suite �` MEC
Contact Person Ph
( ) 5 7 7 `S1
if � l �L.� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framin •
ns ation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
F'• -
PART FAIL
' BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date
Approach/Sidewalk U 4-- lnspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL