Permit e .CI I . ' TIGAKLif , 1- 1 1 E RMI T 7F -v reIST' J5`'�::' •Ll
. COMMUNITY DEVELOPMENT DEPARTMENT ' DATE,. I.SSUEI)a..0.5 /L6 795 •- _ '
13125 SW Hall Blvd: Tigard, Oregon , 97223.8199 003)' -4171 : ' ,
SITE ADD E_SS s 1.4420 L S . 9;-'ND AVE • - • .
SUBDIVISION., . •.. DOGWOOD RIDGE , : • • - • ' 'ZONING s R -4•'.- 5'
BLOCK. „ . .. ' .' .LOT . -11 . ' . .
RE ISSUE ” • • • DWELL I.NG UN I TS a 1 . BASEMENT... . ' 0 s f. • .
CLAC;C OF WORK., ;ADD - ` 'fED•Ri'1S Q:2 LATHS; c' GARAGE .. o Zt . s f _ ' .
TYPE. OF USE. 2 SF - FLOOR ARE'c S- ...__...- _1..___ . . rsUIRED SETBACKS -. -L -._ _.._.._. . ' '
TYPE OF . CONST. :,5N ' . ". - FIRST.; : 7ic+4 ; '.• s f , LEFT. o ;57 • f . ,.' 12 _ .,f i' • `
...00CUPANCY .. GRP. o RZ SECOND o 0 • ' s'
F FRONT. • RO�1T. : 0. • ft REAR',„ . e,-- f y
STORIES?. :.1:•• . F I.NBSN t EN o 0 ' - . • s f . - REDU I RED- -- •7.. -._ - -- - . . -
HEIGHT ' • �o,16.. ft• TOTAL-- ;,. , __s'f SMOKE DETECTORS.: Y.: •.
FLOOR .L.OAD o . e40 psf • VALUE. a ..'..va' 45521' ' • PARK ING SPACES...:t , -
. Renccii: 'o 704 SO, 'PT ' ADD ITION PATH I• -. _ - • -
,.- __._____ -- _.__._____ -__ - -- '' PLUill3l-NG - __-- ,- __- ...:.___ -- - __..- " . - .
• INI •C,e .. . , . • ; 0 ' FLOOR • :D RA INS.. - .. .S:0 DACvrLow `:P kE'V.NTRS..', 0 .
LAVATORIES .. e.s . - WATER HEATERS. -.. o 0 TRAPS. o d ..... 4 .. a e0 '
- TUB/SHOWERS. '... - 2 LAUNDRY TRAYS. ,: 0 ', . CATCH ' .. s 0 -. -
WATE.R ' CLOSE TSe e SEWER 1_11\1E' ( f t) v Q: GREASE TRAPS- o .. -. „ 0 '
DISHWASHERS.. „..:0 WATER LINE ( ft). ;0 OTHER FIXTURES..... a
GARBAGE • DISP. . :0 RAIN DRAIN Cft). oG •
WASH I NG ..MACH. , . ; 1 SF RAIN D i A,I N- .. a - •
FUEL TYPES__._._ - -_. -- - UNIT HT RS. . /: ; 0 -� Ype .•aincunt• .by, 'L- ..da e •r'e c pt ' .
/GAS . • / / VENTS - p 4. •.. BPRT $ : 6c..00 JD 05/26/95' '95 "265957. , •
MAX' INPS'UT ;0 - BTU 'VENT FAN 3 . • BPLC•
..'$ .'1
, 72.25' 'BO .05/2,3/95 c...:5.-2E. .
TURN' C 00K •: „'s:L'i • -.. HOODS. :.. '..;•044 B5PC •:. . • :1.?;. t5' JD 05/c6./95 95- c:65957'
FURN 7 - 1':c�:ZiR . , :0. ' ' WOODSTOV.i S'. ,T0 - - ' iY1PRT iG..• :41. 50 • JD 05/26/95: 95- ;
FLOOR FLiRN.•.'.. 11 . - CL.O : :1 NPL:C- •$ '. 10. 38..;".,:1 3 . ' 05/r:_'-6/.9! 95.- 2:6597
1-1r•`
OIL /CNP• t 3;(3, . UNI1O: CI.. 115PC• $ 2. :043 JD 05/'1....1, 957'2659.57
. - OAS • OUTLET Se0. PORT '$ '$ ' .102 D0 3D ,05/2.6'/0 95- 265'357 .
• 'Orion- e��'., .-- .___.- -- -- __._ --__ - - • • - P51 -C J ' F.... 9� '6'�i J•f 05/26/95 fit-- 265957
' DAV ID CRAIG EROS v • ' 26. 00 JD_ .05./26/9` 95•- 2E+5951,
- • 1 1 z : • 2 0 .SW'' .ND. AVE ERPC '$ • B. - 45 JD 05/26/ 95-Z:65957
G AR .. //� 1 ERPC $ 3. j$ 3 • JD '05/2.6/95 • 9.:J -C_t 5957
T t. G1'51% 4'Jr 97 O.:23
- .Contr.actor -------------------- - - -.
p'i o n'e•
------- ._.:..
..
r Cia 6 T�D`fL
This' er'G1t is issued suF,ject -t a'Pegiilatio"s containedir; the _._
- _ --_ •
l: - REQU'IRED INSPECT I Oi;NO ' ' .
•T:inari? muiicinai Cade, State-• of Ore, Spacial} y• .odes and all ^_ }tier ' F a a t i ii g .I n p F r'r rl,i n Q ; I n s
applicable laNs. .•Al/ work :ails ha donne in.. accordance vitii .Ziiprovaii F o'indat..ioen:.Insp Ins:. J ti., op Ins -• Y.:- •
plans. This .emit `EV e-xp i? 5a5i;1: is' not started i- ;nin . Po -t /iiS'r"t ii Str'%_ict ' Cyp Fl oat r''cl Insp -.
.days of issuance, Or" if 'ark, is suspended for.: nore than 1S days;;.• ' :•Post /Be-am IAechan Rain.. 'clra I. n ..I n sr.) t .
r trawl Drain Mecham ic al -. n.'ai.
'Pernii•btee S:i -1 c' •�. _ — r'LM /Jr1�,s.' 1oc,- .P 11_tmb Final
l�lect�alical Insp Blai.�lcfing ' Final
I s 1_R= D >% ._ __._.___ ` .. ' ____2._ ! _ f'1.Iar��. r T .p L�•_l Eros ion 'Ce.nt r o l.. • ,.
•
•. Cal I ,for i•n.Spect ion 639-- 41 - . .• - .. -
-
Residential. Building Permit Application . - 4 ..... ,,
a ty of Tigard ., •- -' - -.
13125 SW Hall Blvd. . "r _ •
Tigard, OR 97223 " .. ; _
- • . _ _ - -.. a ,;+ '° - .. . - •1 - 1;,. "a -: _;c -.r v�Y: •y v.
L . NZO ✓W n _ �.3i4.;:-.?:
e `
- Jo bsite Address: �ZN � • � �l�i'V E �a � t . � 1 - = -- -
• \. {ti t er 1' ` : , , :i':. ;�
, i ::.•{..y \'.Y.:nav: �ti�.Ci: i�•
. i. �:•'. i'•. ', .:;�'
DO I'
Offs Use Onl
`
D Gay o
� o I
Subdivision: �L
l� t#
� R �G
Valuation Sj� �— `;Pianck/Rec.
• Corner Lot? Y 0 . - °Permit. #P St -t 2 2 'O;
Flag Lot? Y Reissue: of "
:. : :: Map &'TL:# �::` j • t - •
• Owner: '�A\ t °1' V 1 CK 1 C R�Pt 1( :; :: . ...,::: ::::�:'::. . ,
Address: (420 Su.) 92ND PtuE .:...: . ..:...::� . : •
:Planning - .. :
TiL�Rt b (CZ 97113
Erigirteering::
- (0 2 .9 - 1530
n
Pone:
. Contractor DfivkIJ C - C, Co I f�C. :>:'Items'-Reauired '
- Address: l Z-O -• 5 W r•1 -Owe_
RS Z2
Ti GAR-D. (� �� q7
Cg
31-7-79
- - - -- -
1
Phone: .3
Contractor's License # • OG C B it S 5,S 9 : `: ` ::
(attach copy of current Oregon license) -
Contact Name & Phone: D+Au l O C i2A 1t
Subcontractors: Architect/Engineer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License) •
Phone:
JOB DESCRIPTION: 7c SO FT ADD IT % 0 Ni
(0I — 1330
CI:et.d‘-----lzp App scant Signature & Phone nu b r
Received by: %frrYVIAAS Date Received:
Permit* Account Description Amount Amt. Pd. Bal
a Bldg. Permit ; (BUILD) :: -. _ .. �b .. ✓ : .
Plumb. Permit (PLUMB) . 102. `.. ;.rl, aZ eao
Mech. Permit =' (MECH) • Ut 1.5 o i✓ g 111:51)
- 3 _
. �i 3
.:. .... :. .... ...._ -. ., .' --- - --- - � - � III
_ State Tax ( TAX ) �•�� �ZO
Plumb: 5, I D _ _ - . '._ _.:.
Mech: Z , D`6 ` � - _ •
J
Plan Check (PLANCK) ) Z •. 1p 3 25./ '5'7-)
.. Bld 112-"z
Plumb:
Sewer Connection (SWUSA) .... .. • . - . __ -.. •
_- _. .. Sewer Inspection (SWINSP) . • - • -
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF . (T1F -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) . 71 -e,° ✓ 2( .0D
Erosion Planck/USA (ERPLAN) '6 ' 'tS
Erosion Planck/COT (EROSN) % ,y q •`('
TOTALS: (,F 5 , L I tO 1 `A 5 v
J -
LS
Permit #: SST 9 S _c a
F ;r �' ! f L./Fo
a, , ; :,�, Address:
`�', T Issued b / Date: c:_5. _ TS-- _g9/
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-_313;_- -- - ___ ._ _ , -_. __
1. I own, reside in, or will reside in the completed structure.
::,.. vr „ .. .„,
2. I understand that must register as a construction contractor if the structure is sold or offered for sale ,
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
Cid' •
Z 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.
1/4,1/4_ j ...
S- 2-3 -- 9 S
(Signature of pe applicant) (Date)
(White copy to issuing agency permit file, -
pink copy to applicant) .
•
Information Notice to Property Owners
• • \ bout .:Construction Responsibilities
• Note: This Inforration.Notice to Property Owners about Construction Responsibilities '
was developed by the Construction Coniractors 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 thetax 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 oversptay, 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 additionequestions, 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