Permit CITY OF TIGARD MASTER PERMIT
2.. COMMUNITY DEVELOPMENT Permit #: MST2009 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/27/2009
Parcel: 251040)06400
Jurisdiction: TIG
Site address: 13632 SW WHITE CEDAR PL
Subdivision: Lot:
Project: PELISSIER
Project Description: Creating storage area in crawl space.
BUILDING
Floor Areas Required Setbacks Required
Stones: Bedrooms: First sf Basement sf Left. Parking Spaces
Height: Bathrooms: Second: sf Garage sf Front: Smoke
Dwelling Units: Third: sf Right: Detectors:
Total sf Value: $0.00 Rear.
PLUMBING
Sinks Water Closets. Washing Mach: Laundry Trays Rain Drain: Catch Basins:
Lavatories. Dishwashers Floor Drains: Sewer Lines. SF Rain Drains: Other Fixtures:
Tubs/Showers. Garbage Disp. Water Heaters. Water Lines.
Bckflw Prevntr
MECHANICAL
Fuel Types Air Conditioning: Vent Fans Clothes Dryers
Heat Pump: Hoods Other Units:
Fum<100K• Vents: Woodstoves: Gas Outlets:
Fum > =100K.
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0-200 amp 0 -200 amp: W/ Svc or Fdr.
Ea addl 500 sf: 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr
Limited Energy: 401 -600 amp: 401 -600 amp: Ea addl Br Cir:
601 -1000 amp: 601 +amp -1000v
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo HVAC. Secunty Alarm: Vaccuum System Garage Opener. All
Other: Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr. Occupancy Group: Square Feet:
Owner: Contractor. Required Items and Reports (Conditions)
DANIEL PELISSIER OWNER
13632 SW WHITE CEDAR PL
TIGARD, OR 97223
PHONE 503 - 539 -4433 PHONE:
FAX:
Total Fees: $110.63
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days _ I ENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 r 10 through • - : 95 -Ill-011s. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800.332.2344.
Issued , / 4 / v 0 • Permittee Signature: yrI
'Building Permit Application
,Residential RECEIVED rou OFFICE. USE ONLY
City of Tigard Received
I Ili l� i 13125 SW Hall Blvd., Tigard, OR 97223 p � I • _y e - D ■ 1 ��� 1 `�
Phone: 503.639.4171 Fax: 503.598.1960 JAN 2 2009 : i ela� r ®q other Permit: •
T c. n a D Inspection Line: 503.639.4175 Date Ready ly: rms: ® See Page 2 for
Internet: www.tigardor.gov CITY OF TIGARD Notified/Method :.& Og 1) 1 ( G Supplemental Information
BUILDING DIVISION LtY1 co r O W nit 8 cx. rr = c.{.:3d'P rn V" -
TYPE OF 'WORK REQUIRED DATA: I-AND 2-FAMILY DWELLING
IS New construction I 0 Demolition P fit fees" :are lbased on the value tofdhe moil pedo>med.
Indicate the value (rounded to the nearest dollar) of all
le Addition/alteration/replacement I I►_i Other: Concrete sla equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. •
10 1- and 2- family dwelling 0 Commercial/mdustrial Valuation: $1200 •
0 Accessory building I I❑ Multi- family I Number of bedrooms: 0
0 Master builder 0 Other: I Number of bathrooms: 0 •
JOB SITE INFORMATION AND LOCATION Total number of floors: 0
Job site address: 13632 SW White CEdar Place New dwelling area: • 0 square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: 0 square feet
Suite/bldg. /apt. no.: Il Project name: Pelissier Residence Covered porch area: 0 square feet
Cross street/directions to job site: Benchview Deck area: 0 square feet
Other structure area: 0 square feet I
REQUIRED DATA: COMMERQAL-USE CHECKLIST
Subdivision: Hilshire Estates I Lot no.: 64 Remit fees* are based (on ahew,alneoftheunit performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION 'OF WORK nvorlcanf icatedwnt his:app'Iicaticm.
Slab on grade in exiting "crawl space." Valuation: $$1,200.00
Existing building area: 5081 square feet
New building area: square feet
® PROPERTY •OWNER '❑ TENANT Number of stories: 2
Name: Daniel R Pelissier Type of construction: Wood
Address: 13632 SW White Cedar Place Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone: (503)539.4433 I Fax: ( ) I New:
® 'APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: Daniel R Pelissier I licensed with the Oregon Construction Contractors Board
I under ORS 701 and may be required to be licensed in the
Address: 13632 SW White Cedar Place I jurisdiction in which work is being performed. If the
City/State/ZIP: Togard, OR 97223 I applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 539.4433 II Fax: : ( ) I none - by homeowner
E -mail: drpelissier@comcast.net
, CONTRACTOR i 1
•
Business name: none I BUILDING PERMIT FEES*
Address: o (Please refer ro fee schedule)
�` "� 1 Structural plan review fee (or deposit): 140. t
City/ State/ZIP:
Phone: ( ) IJ F ax: ( ) I FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature: jl ,��
V r r u�6 / his [Pmmiit apPTrerr&am expires If a Fertmii ns mot (01:dai�d
Print name: Daniel R Pelissier I Date: I within 180 days after it has been accepted as complete. • • Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Perrnits'BUP -RES PermitApp.doc 11/6/07 440- 4613T(l l /02/COM/WEB)
•
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCI3# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X] I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
DAN /EL R ?EL /5S/E72
Print Name of Permit Applicant
Ja,tt,-�.s./ 444.cat 0q �0 9
Signature of Permit Applicant Date
Permit #: PA cV't Z, C1 O Q. O O 00 S
Address: I 3 (03Z. SLc) LOP ∎It
; C .�n4 (f? q 7 22. 3 "'
I ��/
Issued by: ; Da 51a / tai
This Copy for Permit Offices
J
v,. '> Information Notice to Owners About
' C onstruction Responsibilities
� ,,_ 1 (ORS 701.055 (5))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers 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 Department of Revenue at
503 - 378 -4988.
• • Unemployment Insurance Tax: Employers 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 503 - 947 -1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to
http: / /www.oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503 - 947 -7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough -in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052
Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007
Website Address: www.oregon,gov /ccb
f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant