Case File �l
F.
N
12340 SW JUT,,X4 OA?
�--- —,nom►
U) V1 U) v) V) V) V) V1 N fn fn V) V4 fn Vl --4
D D A D D D D D D D D D D D D D v v D o <
V J (D J V J J J V V V V V V V
J (p tDCn (p f0 N (O lh d N A N N N N tD
J c (b (O (n (� J V (n o m o 0) 01 O>cr O N N
(p (D 7 7 Q C. 7 3 7 N N n T
m T �' T T O c0 O (D ro (C)
II
o� = c _T y o m ti m m 3
V d N Cl) Z "L 1 cr
3
Z7 U T U 9
v v v v o
D
N N
2
� A
ttp�, p
A
_rt
N cn• i
J
K3 i:3r (O (O (O (D v p —41
d ro
ti pp A A (���1 `' {���1 D o c (o (c (o WN ro O
y] 1 W W W W W W (J W W W W W W W W W t,,�
(p
(V N W
C m
0 m' (D
o
r,' m
a ••
Cl) cn w w Co w w n rn -4 m w w m w m w
CD
nn D '� qp
D tp Z D n D D D rrn T n T W
D
(n cn p fn r N r I G cwn Vii n p r r c O
W
00
r=
i9 0
�+ a
c
N N m W w CO ri co T
cO.
C
d
W WW
W W ( Cn1 W
W O W W W W W (p m
Lo Q
m m o o' o' 'D' z n n v� cn Z
0 7 C v d 00�� n m
T is c o °n rrr�� O O
C c a 3 an � X00 X X
� m o� rn m Z -4
T � -+
_m
� ¢ c} O
LA
c Q"
DAT
i
COMMUNITY DEVELOPMENT DEPARTMENT E ---- 11/;23/1)3
m`uaaw1:8mBlvd,nn*,d.oa*"o wruoo°e1uw �uu mow��vv
| ` PARCEL. : 1S134CB-17200
/
/ IITE ADDRESS. ' ; 12340 SW ANTON DR
SUBDIVISION. . . . : ANTON PARK I } ZONINB:R-7 PD
| 8LUCK. . . . . . . . . . .. LOT. . . . , . . . . . . . . :099
| ---�---------------------- ------------ -------------------- -'---- -
|
!.-,LAS'S WORK.
-NEW
�ORK :NEW
|
| TYPE OF USE. . . oSF
OCCUPANCY GRP. V^���� �» ��
OCCUPAWY LOADx2
| Hema, ps : PATH I
I'-'OUR D CONSTRUCTION�
BEAVE17TON OR 97075
Contractor : -
PO BOX 157*7
BLAVERTON OR 97075
Phone 590-01;.05
Thig Certificate yrants occupancy of the above refPrenced building or portion
thereof and ronfirms that the nuilding has been inspected for compliance with
the State of Oregon Specialty Codes for the group, 91cupanry, and use under
which the referyAced permit was issued. .1 A
POST IN CONSPICUOUS PL.ACE
i
CITE' QEF TIGA►,RD
COMMUNITY DEVELOPMENT DEPARTMENT
1?125 5W Hell Blvd.Tlpmrd,Orrpon 97223.8199 (503)939-4171
i
I
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
1=;125 SW Nall Blvd. Tigard,Oregon 97223.8199 (503)830-4171
i
1 f / �� �!
13125 SWtiaUBhvd. PLNCK/RECT # S/ `
CITY OF TIGARD PERMIT # nlsf /`3 - U
C4MM11N[TV f11:VFIOPMrNrDFPAI?TMFNT Tigard,Oregon 97223
(507)63"171 DATE ISSUED
JOB ADDRESS: TAX MAP/LOT /S/ 3fag /720Q
SUB: LOT: _ —�— LAND USE:
VALUATION: Slimy.
OWNER SPECIAL NOTES
NAME: St12-4,� C'T?C) — REISSUE OF: _
ADDRESS: LAST lX I �?-_� LAST REISSUE: _
��L cfJ V 6p- FLOOD PLAIN/
PHONE: y l -o 3 s SENSITIVE LAND:
CONTRACTOR APPROVALS REQU I REO S c y tF yl ppa Q'
NAME: SigME ICS C; 7 -- PLANNING:
ADDRESS: _ _ _ ENGINEERING:
FIRE DEPT:
PHONE: _ OTHER: Z .�
CONTR. BOARD #: EXP DATE:
() ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: PL h1.016/A-) LIST/SUBCONTRACTORS:
MECH: C BUS TAX:
ARCH ENCTNEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: 1,///Z Jb IJ rU-ri ALV.D OTHER:
C�N1 YIN ^ c E $ -
PHONE:
PROPOSED BLDG. USE:
COMMENTS: t2
APPLICANT] GNATURE /
Received By: r Uate Received: !(_ _
PFRMII k ACCT N DESCRIPTION AMOUNT MOUNT PD. BAL. DUE
Wsfyj-o3ffq 10-432 00 Building Permit Fees
10 131 00 Plumbing Permit FPes
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
111 umb i ng
Mechanical
10-433 00 Plans t;heck Fee s?- �3 -�, � LZ i
Building
PI umbi ng
Mechanical
10-230
10-230 06 Fire
34, 033 30-2.02 00 Sewer Connections
30-444 00 Sewer Inspection 3; 3j
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 /to
52.449 00 Parks System Dev Charge (POC) S 5� �'
31-450 00 Storm Drainage Syst Dev Chrq
(SSDC) -
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
TOTAL -
_51q
nm/3581P.WP1-
1
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Nell Blvd.Tigard,Oragon 97223.9199 (503)639-4171
I
Permit #:
Address: An Imn Dr__
issued by: s�� '�Q�ti _ Date: ���Q,l�
Statement: Intormlation 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. 1 own, reside in,or will reside in the completed structure.
2. 1 understand that 1 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. #
1 will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If 1 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 certif that the above information is correct and that I have read end do understand the Information
Notice to Pr erty wn rsrabWAInIsructio, Responsibilities on the reverse side of this form.
(Signature of p nit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
information Notice to Property Owners
About Construction Responsibilities
Note: "Phis Injort►,,rtion Notice to Property Owners about Construction Responsibilities
iiia developed by the C'onstructro►r C'ontruu tars B,)ard ire accordance with ORS 701.055(5).
If you are acting as your awn contractor to construct a new home or make ,+ substantial improvement to an existing structure,
you can prevent tnatuy problems by being aware of the following responsibilities and areas of concern.
i
EMPLOYER RESPONSIBILITIES:
if you hire p:rsmis nut registered with the COMAIUCUUn Cumene! +I Board to du labor in constructing or assisting in the
const u0ion or improvement of it residential structure,you will. in ulna instam+:es,be ruled to he on cmployer and the people
yon hire will he 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 pitid. Yov voll he liable for the tax payments even if you don't actually withhold the tax from your employees. for more
infornnani m �all the ()regon Dept. of Revenue at 949-9(191.
I'nemployment insurance tax: As an employer, you are rryurred to pay a tax for unemployment insu.ance pr.nrposcs on the
wages of all employees. For more information,call the Oregon l mployrnent Division at the Department of Human Resources
at 379-3524.
Workers'compensation insurance: As an empl(, rr, tori arc subject to the Oregon Workers'Compensation Law,and must
obtain worker.'c ompensation insurance for your enrplo)ces. 11'you fail to obtain workers'compensation insurance,you may
he subject to penalties and will he liable for all claim ensu if one Of.N oureml)loyees i injured on the job. F or more infonnaUon,
call the Workers'Compensation Division at the Department of Consumer-and Btisincs Services at 945-7899.
11'.S. internal Revenue ervice: As an employer,you must withhold federal income tax from employees'wages. You will he
liable for the t,ar payment even it'%i+u didn't actuall\ �,\ithhold the tax I or more information,call the Internal Revenue Sero ice
at 1-80, .,29-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Conde compliance: As the permit holder for this project,you are responsible for ink*,any failure to meet code requirements
that nnav fn 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 ornissauns such as falling tool. paint oversprny, wafter damage from pipe punctures,fire,or work that must be
re-clone..
Time to supervise employees: Make cure you have sufficient time to supervise your employees.
Expertise: N1ake sure you have the expertise to act as your own general contractor,to coordinate the work of tough-in and fin ish
trades, and to notifv building* officials at the appropriate times co they ran perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board(YO Box 14140.Salem,OR 97309-5052,
503/378-46211). The Board is located at 7W Sumrner St. NE: Suite 3M, in Salem.
prop-ou n.pm4
1194
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # ill L)l ri5 Di'l�l
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
MUM New Single Familj, Residences Only
fl
"dw` ❑ 1 BATIK HOUSE$140.00 C1 2 BATH HOUSE$195.00
Job I ❑ 3 BATH HOUSE$225.010
Addres3 wft� nr Fee includes all plumbing fixtures in the dwelling and the flrst 100 feet
A -I aoS of water service, sanitary sewer and storm sewer. See fees below.
w�.x.•.�.« a FIXTURES QTY PRICE AMT
�)C (,1(,�1r it'll 1 Sink 9.00 -�
�+�^�•� Pt- Lavatory 9.00
Owner � 01 Tub or Tub/Shower Comb. 9.00
wft•• Shower Only 9.00
Water Closet 9.00
N-i.-'W b r l Dishwasher 9.00
Garbage Disposal 9.00
Occupant rs.,. Washing Machine 9.00
Floor Drain 9.00
w�•�•
no Water Heater 9.00
Laundry Room Tray _ 9.00
"• Urinal 9.00
l' Other Fixtures (Specify) 9.00
R- 9.00
Contractor
9.00
r' a 9.00
Sewer 1st 100' 3000
�•+• •�*•�"^ rJrf&a.Tm"' Sewer-ea. Addit 100' 25.00
Water Service 1st 100' 30.00
1 hereby acknowledge that I have read this aoplicadon, that the Water Servix ea. Addit 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm 8 Rain Drain 1st 100' 30.00
I am registered with the Constructi-ri Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please Mobile Homo Space 25.00
give reason below.) _
Back Flow Prevention
Device or Anti-Pollution Device f 9.00
SO- w�i - �• Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition L7 alteration Q repair C) Catch Basin -� 9.00
to be done residential Q non-residential U insp. of Exist Plumbirg 40.00.1hr
Specialty Requested Inspections Y 40.00Rv
Existing use of -' -
building or property - Rain Drain, single family dwelling 30.00 -
Residential backflow prevention
devices 15.00 I`!
Droposed use of
building or property ---- *(Except msidentlar backflow --
prevention dev(ces)
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF S7.SURCHARGE r
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PLAN REVIEW 25% OF SUBTOTAL L
TOTAL
Special Conditions -
- ----
by
Date issued �l _