Case File i 1.recordslmicroflmltargetslbuilding doc
INBP%CTIJN NOTICU
City of Tigard Helldinq Department
13125 BA Ball BIR]. Tigard, Oregon 97223
Inspection Line. (Rec-O-Phone): 639-4175 Buaineon Phone: 639-4171
Inspection: ')
Footing P1 Underslab Mech. Rough-in Appy/Bdwlk
Found. Plbg. Top Out Gas Line CINALt
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plhg. Underfloor NaterL e Gyp. Bd. - D s
Date Requested: � Time. —_—� _PM
- 032 Address: V _LQesartt �:
Builder:
TBS FOLLOWING CORRECTIONS ARE PEQUIRF.D:
Inspectors.
1 r APPROVED —_ DISAPPROVED T APPROVED SUBJECT To MBOVS
(J•�- __Call For Reini3p.
L@PECTION Nt`'rIGB City of
ng Tigard Bulldiml Department
13125 B# gall Blvd. Tigard, Oregon 91223
Inspeection Line IRec-O-phone): 639-4175 Buoiness Phone: 639-4171
Inspection:_
Footing P !eb �M.ch.U ereRough-in �Apprj!�d.lk
Pound.
Plbg. Top Out Gas Line FINAL:
Post./Beam Struct. San. Sower
Framing -Bldg.
Poet/Beom Mech. Rain D-ain
Insulation -Plumb.
Pl.bq. Underfloor Water Line
GYP. Bd. -Koch.
Date Requeetedr_� �12 ^��
Timet, sAM PM
Address:— armmL ♦= C
Builder:
TRS FOLLOWING CORRBCTIONS ARE REQUIREDs
Inspector:
--------.-,-- Dates
_APPROVED DISAPPROVED
APPROVED SUBJECT TO ABOVE
_____Call For Reinep.
MECHANICAL
C11YOFT'FACRYRD , IM00 PERIVI I T
COMMUNITY DEVELOPMENT DEPAWMENT PERMIT #. . . . . . . a AEC92-0320
13126 SW HWI OW. P.O.Brno 23397,111gaid,0M90n 97223(603)&19417r)
DAIE
SITE ADDRESS. . . : 12120 SW ANN Pl-. FARCE LP 2SI03BB--11900
SUBDIVISION. . . . : YE OLDE WINDMILL ZONING: R--4. 5
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . 138
CLASS OF WORK. . :ADD FLOOR FURN. . . . a EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT* HEATERS. . : VENT FANG"— :
OCCUPANCY GRP. . :R3 VENTS W/O APDL: VENT SYSTEMS:
STORIES. . . . . . . . a BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL TYPE=S------------ 0-3 HID— . : DOMES. INCIN:
a /GAS/ 3-15 HP. . . . a COMML. INClN:
MAX INPUT- BTU 15-30 HP. . . . REPAIR UNITS:
FIRE DAMPERS?. . a 30--50 HP. . . . WOODSTOVES. . : 1
GAS PRESSURE. . . : 50-4- HP. . . . CLO DRYERS. . :
NO. OF' UNITS----------- AIR HANDLING LIN I TS OTHER UNITS. :
FURN ( 100K BTU- 10000 cfm: GAS OUTLETS. : l
FURN ) =100K BTU- > 10000 cfm :
Remarks : GAS INSERT
Owners FEES ---------------
ROBERT LAVELLE type amount by date recpt
12120 SW ANN PLACE PRMT $ 25. 00 JH
12/01 /92 —
5PCT $ 1. 25 JH 12/01/92
TIGARD OR 97223
Phone #:
Contractor: -----------------------------
OWNER
----------------------------------------
Phone #: $ 26. 25 TOTAL
Reg #. . : Q10000
REUUIRED INSPECTIONS
This permit is issued subject to the regulatijns contained in the Final Inspection
Tigard Municipal Code, State of [Ire. Specialty Codes and all ether
applicable laws. 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 :s suspended for more
than 186 days.
Dermittre Signature :
Issued By:
Call for inspection 639-4175
Permit No: �J:/.,� v
Address: �o�/� �,C� C /"-
�� z Issued by.• Date:
•''� / _______ —__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 we 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 applicant, exempt from registration
under ORS 701.010(7), reed 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 . S 1 1 own, reside in, or will reside in the completed structure
2. L____--I 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.C 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
3. B.[ 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 Inforrr +tion is correct and that 1 have read and understand
the Information Notice to Property Uwners about Construction Responsibilities on the
reverse side of this form.
,Lz
Signature of Permit Applicant Date'
CONSTRUCTION CONTRACTORS BOARD
0244J 6/91
VVHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK ,OPY TO APPLICANT
IN(- .-1 &'ATi0N NOTICE TO PROPERTY OWNER.-j
490UT CONP i R!XJICN', RESPONSIBILITIES •
N )TF i m3 Ir f!,•rnat;on Notice to Pr);)erty Owners About Construction Responsibilities
(,;evq ,1ped oy t e Constructio- Cr. tractors Board 0 accordance with ORS 701.055(5),
l asset ''ie 19PJ )r,,:un Leg.-;at ire.
If you are acting as wn coiii act.)r to constt act a new home or make a substantial improvement to an
existing structure, yot ..n pravent ma- y problems by being aware of the following responsibilities and areas,
of concern.
EMPLOYER RESNONSIBILI-(IES:
If you hire persons not iogistered with the Construction Contractors Board to do labor in constructing or assisting
in the constru °:on 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 Wit;. ;o1ding Tax Law: As an employer, you must withhold income taxes from mployee 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 378-33fi0.
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 DF1R
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.
Yu `olWe fiabte for thc tax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service 6t 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code_ Compliance: As the permit holder for this project, you are responsible for r )solvinc, ..ny failure to meet
code requirements that may be brought to your attention through inspr,^,ions.
Liability and Property Damage Insurance: Contact your insurance, agent to see V ,you have a.7equate ins,prance
coverage for accidents ,sions such as falling tools, paint overspr-.,, . ter 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.
�ertise: Make sure you have the expel lise to act as your own general contractor, to coordinate the work
of rough-in and finish trades, and to notify builditig 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
02144J 10/24/89
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CITY OF T I OARD — RECEIPT OF PAYMENT RECE I rrr NO. :.41 54
(.WFrK AMOUNT 6. "
NAME : LAVELLE, ROBERT CASH AMOUNT 0. 00
�aI!DRE6�3 a I0Ii7,0 SW AN14 PLACE. PAYMENT DATE s 12/01 /92
SURD I V 191 ON a
` T 16ARD, OR 97223—
I PUPOOSP OF PAYMENT AMOUNT PA I D PURP0,3E OF P'AYMF.NT AMOUNT PAID
MEk- .i1NICAL F''E i"•.S. m0 57. BUILA) PER
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CCAS STOVE 111SERT
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TOTAL_ AMOUNT PAID — _ __> 26. ;?5
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