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CITYOF TIFARD CrnCiFT1�4RD
COMMUNITY DEVELOPMENT DEPARTMENT oemom
13126 3W Hrl Blvd. P.O.&u 23347,TOM,Oregon 47223(603)6X4176
PLUMPING PERM I T
PE RMIT #. . . . . . . : PLN,;
f_ 9-41'71 DATE ISSUED: 05/28/9c.
SITU ADDP EGti',. . . : 07593 SW ASHr=ORIi ST PARCEL- 251. 12CA- 1 1
SUBDIVISION. . . . : RENAISSANCE WOODS ZONING: R-4. 1-5
13LOUK. . . . .. . . . . . . LOT. . . . . .,?.5
CLASS OF: WORK. . :ADI? GARBAGE DISPOSALS. : 100PTI- r�HOME�SF'r)CF`c; ____..__
TYPE: OF USE. . . . :SF WASHING MACH. . . „ . . . s i3ACKFLOW PR>~VNTRS. . : 1
OCCUPANCY GRP'. . sR3 r"i._non nRAiN' . . . . . . . . TRAP5. . . . . . . . . . . . . . .
STORIES. . . . . . . . s2 WATER HEATEFS. . . . . . CATCH SAS SNS. . . . . . .
.
FT Y T'1JRFG3-- LAUNDRY TRAYS. . . . . . . SF PAIN DRAING. . „
S1 1\1 K 9. . . . . . . . . . a URINALS. . . . . . . . . . . . . GREASE TRAPC,. . . . . . . .
L.AVATORIES. . . . . : OTHER FIXTURES. . . . . c
1US/SHOWERS. . . . a SEWER 1- INE
WATErP CLOSETS. WATER LINE (ft )
DISHWASHFRS. . . . a RAIN DFAIN (ft) . . . .
r":�m a,,k,- aPPIIVKLER SYSTEM
.. ..._..._...__.�_�__ —_.._.___....._.............._...._.._._ FEES .___...._._.. _........
CARL PEDMAN type -1.kM0Unt by state re
759.E SW ASHFORD ST PRM'r f 15. 1A@ JLH 05/r8/92
r G`CT $ 0. 75 JLH 05/28/99
IGAPD 0P 97224
V-4ione #:
Cont,r&r. t or.
0WNER
e #: 1 5. 75 TnTAI....
Pert #. . 00000
REQUIRE=D INSPE.CTI.ONS
This pertit is issued sub►ert to the regulations crntaiaed in the Tap—nl.tt Tns(.?
Tigard Municieal Code, State of Dre. Specialty Codes and all othe+- Fina]. Ins pert iun
applicable laws, all work rill be dope in accordance with
approved plans. This pereit Kill expire if work is not started
within 180 dans of issuance, or if work is suspended for tore
than 188 days. __...�._.
71 i3rf:•_t tR @'
call for- inspection - 639-4175
-bPermit No:
Address: 7��J--
y� 'lam
Issued by: ��-_ - Date:
t85g FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractcrs 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 applicaole blanks, and initial boxes 1 and 2, and either box 3A or 313:
1 . Y' -.'._ I own, reside in, or will reside in the completed structure.
2 . 1 understand that I must register as a construction contractor if the structure is 3o!d
or offered for sale before or upon completion.
3. A . My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
Wre must be registered with the Construction Contractors Board.
OR
3. B.Chi I will be my own general contractor
If I hire subcontractors, I will 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
:he Information Notice to Property Owners about Construction Responsibilities on the
reverse s�de of this form.
Signature of Per it Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORIVIATION NOTICE TO PRJPE RTY OWNE=RS
A BOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This 'nlormetion Notice to Property Owners About Construction Responsibilities
was developed 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 cern prevent many problems by being aware of the tollowing responsibilities and areas
of concern.
EMPLOYER RE=SPONSIBILITiES:
If you hire persons not registereu:1 krith 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 w'.II be "employees". As the employer, you must comply with the following:
Oregon's-Withholding Tax Lay.: As an employer, you must withhold incorne taxes from employee wages at
the time employees ars; 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 n,ust obtain workers' compensation insurance for your employees. If you fail to obtain workers' j
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 wjjj beliable for the tax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 221-3960
OT14ER RESPONSIBILITIES AND AREAS OF CONCERN: I
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.
sew if you have ade ate insurance and Property Damage Insurance: Contact our insurance agent to I
coverage for accidents and omissions such as falling tools, paint overspray. water damage from pipe punc-
tures, fire, or work that must be re-clone.
Time to Supervise Employees: Make sure you ha,,e 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 977,,10-0151
Phone 503-378-4621
0244,1 10/24/89