Permit | ' |
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� . . ` � � . � •
,tASTEQ PERMIT ~
PERMIT #.......: M 3-W481
COMMUN�YDEVELOPMENT' DATE ISSUED: 09/17/93
141,us Hall Blvd. Tigard. Oregon 9722308199 (503) 639-4171 ,
' PARCEL: 1S134CD
SITE ADDRESS...: 11755 SW SUMMER CREST DR .
SiJBD:VISION....: BijRLWOOD NO.3 , , ZONING: R-4.5 .
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :14 '
-------' ---------- .---- BUILDING ------ ---------------------
REISSUE: DWELLING UNITS: 1 BgSEMENY. . . . . . . . :(B sf 1
CLS:iSS OF WORK. :ADD . BEDRME|:2 BATHS:2 GARAGE. . . . . . . . . . :21W sf
TYPE OF USE. . . :SF FLOOR AREAS-7-------- REQUIRED SETDAC|<S----------
--- TYPE OF CONST. :5N - FIRST '..; .:687' sf LEFT. '^ft RIGHT. :0 ft ' '
OCCUPANCY GKP. :R3 SECOND... :323 ' sf FRONT :0 ft REAR., :41 ft
STORIES....... :2 . THIRD.. .. :0 sf REQUIRED-------- ---
HEIGHT.. . . . . . . :26 ft TOTAL------:1010 sf SMOKE DETECTORS. :Y `
' FLO8RLOAD...,:40 psf VALUE.....$: 50240 PARKING SACES..:0 ``
Remarks: pat/i I addition of 1220 sq ft •
'--------- ----------- PLUMBING - -- ' -------------
.
' SINKS.. .. ,.. . .. :0 FLOOR DRAINS. . .. :0 BACKFLOW PREVNTRS.. :0
LAVATORIES... ..:3, WATER HEATERS.. :@ TRAPS..............:N /
TUB/SHOWERS. . . . : 1 • LAUNDRY TRAYS. . . : 1 CATCH 8ASlNS. . ., . . . :0 .
WATER.CLOSETS.. :2 SEWER LINE (ft)':0 GREASE-TRAPS ~0
DISHWASHERS....t0 WATER LINE (ft).:Q OTHER F%XTURES.....:6
GARBAGE DISP...x0 RAIN DRAIN (ft).:0
` WASHING MACH,^ SF RAIN DRA2NS..:1 .
� ----------.---�- - MPCUA%ICAL --r----. -------------- FEES ----- ----- ~
• FUEL TYPES---- UNIT HTRS..:0 type amount by date recpt
/GAS/ / / ' VENTS ~....:6 BPRT $ 286.00 JH 09/17/93 �
. MAX INPUT:0 BTU VENT FANS. . :3 BPLC $ 185.90 JLH 09/09/93 93-24+054
FURN'< 100K �.:0 HOODS....6:0 B5PC $ 14.30 JH 69/17/93 -:
FU RN >=160K .'.,t0. . 0
' WOODSTOVES. :0 MPRT $ 50-.'50 JH 09/17/93 -
FLOOR FURN. . . . :69 CLO DRYERS.: 1 MPLC $ 12.63 JH 09/17/93 -
DOIL/CMP ( 3HP:0 . OTHER M5PC'$ 2.53 JH 09/17/93 - GAS OUTLETS:0 PPRT ' $ 75.00 JH 09/17/93 -
Own�r: ----------------------------------P5��� $ 3.75 JH 09/17/93 —
'DAVID AND TREESA OLSEN � �
11755 SW SUMMER CREST DR ' . ' '
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TIGARD OR. 97223 - . ' ' ' '
Phone ���: 590-8002 ' ' .
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Contractor:, -- ----------------- •
C OWNER ' � ` �
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' Pbone,4:. . '
Reg ��. . : 00000 ---�-�---- ' � . _______ '
. $ 63Q� 6� TOTAL ' ` '
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� This percit -subject to th/ regulations contained in the , ----�- , - REM I RED INSPECT IONS ----- .
Tigard Municipal Codp -State of Ore. Specialty Codes ed all other ' Foot/fbmnd Insp ' Gyp Board InSp '
. applicable-Jaws. S drain �!�ca�la��. A�l work will be �un� in accordance wi th approved P ost/Beam Struct � Rain ra n I nsp
' ` plans. This percit will' expire . if work inot, started within 180 Post/Beam Mechen Mechanical Final
b s y, of' issuance, or if work is'suspended fnr core than 8� PLM/Underfl o or ' Plumb Final
�J Mechanical Insp Building Final
Permitteo Signature : �� Plumb Top Out Erosion Control' '
.
, Framing Insp Crawl Drain '
Issued By: ~~ Insulation Insp __ ^ _
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�� Call for inspection - 639-4175 � _
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• 13125swHaU[lna PLNCK /RECT # y � /7{�
CITY OF TIGARD Tigard. 91223
PERMIT # M51g3 00/
COMMUNITY DEVELOPMENT DEPARTMENT
(503)639 -4171 DATE ISSUED
JOB ADDRESS: 55 J e e r S I A , n P 1 ^ e . P ea lr C I J r TAX MAP /LOT /5 / 3 tic d •" 0 S 4/ 0
SUB: r -\lWFP , i79. -3 LOT: I LAND USE:
VALUATION: 1 r)
OWNER pp SPECIAL NOTES
NAME: l °to.l�k�\ 0 e' tt (37. 4,4 ISQ vim. REISSUE OF:
ADDRESS: 1 \ 7 5 5 _c /&) 1 Akvi 1/14. rnref,7 r o LAST REISSUE:
46 FLOOD PLAIN/
PHONE ,5q0 SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: 69i/2 h , P /Y PLANNING:
ADDRESS: - ENGINEERING:
FIRE DEPT:
PHONE: - - OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS:. PLUMB: LIST /SUBCONTRACTORS:
MECH: 6 7z-e,z . - BUS TAX: - -
ARCH /ENGINEER CALCULATIONS:
NAME: :.TRUSS DETAILS:
ADDRESS: - OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS: /, ;/71l -- / X11 �
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6A SIGNATURE
Received By: Date Received: 9 _9 ��
PERMIT # ACCT # DESCRIPTION AMOUNT /AMOUNT PD. BAL. DUE
#15f9-n0E 10 -432 00 Building Permit Fees GIcF6! aftord
10 -431 00 Plumbing Permit Fees 10,p0 i'
10 -431 01 Mechanical Permit Fees So, SC) / 5,
10 -230 01 State Building Tax (5 %) 070.5T / do . .
Building /4 /
Plumbing
3? )
Mechanical a ) 3
3-3 /97-- O . f
10 -433 00 Plans Check Fee / / 9�. o,
Building (95.
Plumbing
Mechanical )241 /
10 -230 06 Fire
30 -202 00 Sewer Connection
30 -444 00 Sewer Inspection
25- 448 -02 Commercial TIF Fees
25- 448 -04 Industrial TIF Fees
• 25- 448 -06 Institutional TIF Fees
25- 448 -03 Office TIF Fees
25- 448 -01 Residential Traffic Fees
25- 448 -05 Mass Transit TIF Fees
52 -449 00 Parks System 0ev Charge (PDC)
31 -450 00 Storm Drainage Syst Dev Chrg - --
(SSOC)
24- 445 -01 Water Quality (Fee in of)' --
24- 445 -02 Water Quantity (Fee in lieu of)
C7 I
TOTAL 630,6( 1q7� 853.0
nm/3587P.WPF -
V
p F Permit No:
•
R� Address:
in '" ="k : z Issued by Date:
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5g • FOR OFFICE USE ONLY
STATEMENT:
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INFORMATION NOTICE TO PROPERTY OWNERS
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ABOUT .CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to .
• sign the following statement before the building permit can be issued. This state-
ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. G- G":1": I own, reside in, or will reside in the completed structure. •
2 . I. I. understand that l must register as a construction contractor if the structure is sold
• or offered for sale before or upon completion.
3. A . I I My general contractor is ,
Contractor registration number .
I will instruct my general. contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
a
3. B. C i I will be my own general contractor.
If I hire subcontractors, Iwill hire only subcontractors registered with the Construc- •
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I 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 understand
the Information Notice to Property Owners about Construction Responsibilities on the •
reverse side of this form.
4 1,4.E - .�!� ..--17 ' . ; %'.:" c� '93
ignature of Pe mit Applicant ,. Date
• CONSTRUCTION CONTRACTORS BOARD • .
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I
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), .
passed by the 1989 Oregon Legislature.
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 Department of Revenue at 378 -3390.
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 DHR
at 378 -3224. •
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 DIF at 373 -7434.
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 221 -3960.
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 punc-
tures, 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 to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310 -0151
Phone 503 - 378 -4621
0244J 10/24/89 " .
CITY OF TIGARD BUILDING INSPECTION NOTICE "' - L.-/
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing . Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fire. - e
Post /Beam Struct. Plbg. Top Out Elec. Rough -in 40
Post /Beam Mech. San. Sewer Gas Line -Bid•.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
Date Requested: 6 . -.F Time: AM PM
Address: // 7 3 54 wt rl -e Cre.51 Pr;
Builder: Permit #: it/5 g.� - a y‘,51
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: . 420/ f
Date: 072
Y DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
optq -
CITY C TIrARD BUILDING INSPECTION DIVISION Ms 5'3 _0(
24 -Hour Inspection Line: 639 -4175 Business Line: 6 9-41
1t - ffJwDate Requested -, A `► AM LD
Location . (jc vvvi_f C-/Q S Suite MEC M
1
Contact Person Ph PLM
I
Contractor Ph SWR
enant/Owner ELC
Retaining Wall ELR
Footing Access: z `
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear �_
Framing ,L A. /�� ..i _ `L
Insulation
Drywall Nailing • `�
Fire Sp , _ n
Fire Sprinkler CLA
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Fin
PART FAIL
• UMBING
Post & Beam P
Under Slab C I� �
Top Out I O
Water Service
Sanitary Sewer
Rain Drains
DVdrinal
PASS T FAIL
Post & Beam
Rough In
Gas Line
Smo - Dampers
PART FAIL
• CTRICAL
Service
Rough In
UG /Slab , ► `
Low Voltage W
Fire Alarm
V Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 4/2 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY O TIGARD BUILDING INSPECTION DIVISION �'3 _ 0
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
V.Q.514-(01/■—Date BUP
Requested c l ` c�� � AM PM 5 ; BLD
Location / / SS 51 Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
CBUI� Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: / � 43'_
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear �, D
Framing ) �i Z' v '-� ' 3 5
Insulation `
Drywall Nailing ( S
Fire wall \A 6
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof srE
PAS PART FAIL kA sY ��
`\ ` �,
PLUMBING 6\f v1
Post & Beam
Under Slab f
Top Out d l
Water Service
Sanitary Sewer
Rain Drains ✓■- .l` Qr
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk
Other
Date � EXt `I Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site
•