11055 SW COTTONWOOD LANE-1 ADDRESS:
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INSPECTION NOTICE
City of Tigard Building Dapartmano
13125 SM Ball Blvd. Tigard, Orw➢oo 91223
Inspection Lina (Hoc-O-Phona)i 639-4175 Business Phones 639-4171
Inspections
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out One Line i'INALs
Post/Beam Struct. San. Sewer �Traninq _Bl �
Post/Beam Mach. Rain Drain Insulation -plumb.
Plbg. Underfloor Nater Line gyp. ad. -Mech.
Date Requesteds � OFF
Lne s
Address i L
Builders_
THE FOLLOMIM CORRECTIONS ARE REQUIRED i
jint
Inspecto`rls, � '7 r� � Dates
APPROVED DIsAPPROM APPROVED SUBJECT Tri ABOVE
^—Call For Rainsp.
INSPECTION NOTICa 7
CilT of Tigard SmUdi" D.partmmat
13223 M Z01 Pivd. Tigard, Or"ca 97223
Inspection Lin. (Rao-O-P )r 63t
4175 Business Phonar 639-4171
Ins�tionr ,�j/ 1 -
Footing , Plbg. vnderelab leech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out gas Line FINALr
Post/B.aa Struat. Ran. sewer Framing -Bldg.
Poet/Beam Noah. Rain Drain Insulation -Plumb.
Plbg. Ond.rtloor Nater. Lin. gyp. ad. -Noah.
Dat. ReQuestf e/d�t Tim.c /�AM PN
AAdr.se►1t r� � _ t� Persalt f►`1
Builders /��D ��r /,Sh Y)
TIN FOLLOWING CORRECTIONS ARB RBQOIRED►
Inspector►.-
APPROIRD ,--, DIJAPPROVED APPROVED !OBJECT To ABO"
Call For R.Lnsp.
,_
CITY OF T N GARD P� . 1 T
QOMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.119ard,Otogon 97223,4199 (503)839-4171 DATE I CGISUL-Vi:
1;-31.:44�', Ibc
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OILL!44NICAL
FAS
LJL-.1- I f PES-- LIN I T :HT FT s. . :0 type r3 m, C'Ll T t: try diat*''
VEN'rS OPIRT $ OZL. 50, jH ob/ IE/93
X I NP U'l - 0 b I'U DF-NT F014S. V,, E-+i:)L. 4(,'1. i:,3 J -1 04
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3. 13 JH 2 4URN ( 1121(aij, 16 HU00S. :0 B5I
FURN 1)W Es. 349
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CHET RL43 illi
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:' I GARD UR 9782.1
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W I,I IR
AMP #v-
i:i.i porta is issued subject to the refulatiots contained in t1%.F. Reali I RE U I NrPF"L:T I(INS
iiqatl 6picipai Code, 6tite of Urp. SpICIA'sty C,aes 90a a!; Wet i ucit,'faund 111sp
apitL400 ia"s. Ail olori 14111 be akt in actordei�a with 4voyto Frami!ig Inip
plies. This FMrvjt *J�114.kpit%e if work is nit stirter, within IN (jl'ain Ins
iarce. 24' 404 it sw-nteC f7r vire t!ir 18? davc. X., '.i i,,J i rig V. x ri A I
11all for irisp*c:t ic— 639-41 i5
Permit No:
Address:
(sur z Issued by: '^-' Date: J a
o
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPLRTY OWNERS
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 bla0., and initial boxes 1 and 2, and either box 3A or 313:
1 . I own, reside in, or will reside in the cornpieted structure
2. _] 1 understand that I must register as a construction contractor if the structure is sold
or offered for saie before or upon completion.
3. A. My general contractor is,
Contractor
s,Contractor registration numb r__,._
will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Boa +.
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 immed°ately 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.
nature of ermlt licant Date
9 P
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO IS' AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFOR59ATION NOTICE TO PROPP:RTY OWNERS
.ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction Responsibilities
wa4 developed by the Construction Contractors Board in accordance with ORS 701.055(5),
pa:sed by the 1989 Oregon Legislature.
If yuu 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:
It you hire persons riot 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 wlll'be "employees" As the employer, you must comply with the following:
Urejun's Withholding Tax Law: As an employer, you mus+ withhold income taxes from F,:nployee wages at
the time employe-m are paid. Yau 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.
Unernplcyrment Insurance Tax: As an employer, you are requirod to pity a tax for unemployment insurance
-- -
purpoaes on the wages of all employees,. Fer more information, call the Oregon Employment Division DHR
at 378-3224.
Workc;rs' Comrensation 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 it 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 ars 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 t0. 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 responsihle for resolvinq any failure to meet
code requirements that may be brcdght to your attention through inspections.
Liability_and Property Damage Insurance. Contact your insurance agent to see it you have adequate insurance
coverage for accidents and omissinns 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 tradet7, 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 503.3764621
0244) 10/24/89
CITY OF TISARD RECEIPT OF PAYMENT RECEIPT NO. s93-239994
CNE='r< AMOUNT a 65. 63
NAME s ROBINSON, CHESTER CASH AMOUNT a 0. 00
ADDRESS a DAYMENT DATE a 05/12/93
SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PALL
1 Uif DING PERM 62. 50 ST. BUILD PER o' 13
11055 SW COTTONWOOD LANE
TU'(At. AMOUNT PAID 65. 63
�''(J OF
(�! �`� »ins sw N,e DW. PLNCI(/RECT 0L/_ 7 f*iuel 1 1 TIGARlJ PERMIT / Yr sf¢3-b
COMMUNITY DEVELOPMENT DEPARTMENT r�.�aai9ru*
(SO3)6'94"' DATE ISSUED _
. JOB ADDRESS: j .sj--swGeo TAX MAP/LAT 151- 3q 4c - 0.2634
SUB: LOT: (l? f,,-(tAezcd .M LAND USE:
VALUATION:(t
0 D
'{'€ — SPECIAL NOTES
NAME: ��QS.�L ..� � REISSUE OF:
ADDRESS: __ 1 D �•f.r k' C�a ��. u� ,� K LAST RCISSUE:
l` D JIP 7.0 2 3 Z 2/ FLOOD PLAIN/
PHONE: J ;K _ SENSITIVE LAND:
CONTRACTOR 6 W h -P Y ) APPROVALS3EQU—IRED
C
NAME: eltle J 1 r �j d r'k s 4.. PLANNING:
ADDRESS: 11P.s'4- s w C''o t 46K WP.V el 04 s&1 -` ENGINEERING:
l' 72 Z J -- 'Y 2 -2 FIRE DEPT:
PHONE: 071,1"' 7, J-6 y OTHER: itr�
�� F` 1c(7-
_
CONTR. BOARD 0: _ _._ EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS: _
MECH: _ BUS TAX:
ARCHANGINEER CALCULATIONS: _
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE: _ S f Or*i�� f Li* p le C ,a
COMMENTS: 5�CG t'S d ' Al
APPLICANT SIGNATURE
Received By: Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10--432 00 Builaing Pers, t Fees -.5
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanic;J Permit Fees
10-2.30 01 State f;uilding Tax (5%)
Building 3 /�
Plumbing
Mechanical
10-433 00 Plans Check Fee /, �'� le 3 qL____ ^"
Building
Plumbing
Mech,an i ca i
10-230 06 Fire
30-202 00 Seder Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial. TIF Fees
25-448-06 Institutional TI1- 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 Oev Charge (POC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSOC)
24-445--01 Water Quality (Fere in lieu of)
24-443-02 Water Quantity (Fee in lieu of) _
TOTAL _6�,
C
nm/3587P.W111
CITY OF TIGI)RD -- RE-CEIPT OF PAYMENT RECE-.1 PT NO. a 93-239585
CHECK AMOUNT a 40. 63
NAME % ROBIN,,3,ON, CHrSTER CASH AMOUNT o m. el(a
ADOORESS x t 105 SW COTTONWOOD I-N PAYMFNT DATE a 04/30/93
SUBDiVISlON
TIOORD, OR 972iP3—
PURPOSE OF' PAYME'N'T AMOLIN'r PA i t) P,LlRFl0CJ:-' OF PAYME"T AMOUNT PAID
PLAN 40. (,3
ACCESSORY STRUCTI)PE
T01(it AMOLIPIr 0. f.,
I"SPECTIQ"CgICE
City of Tigard Building Department
13125 8w 8al� Bled. Tigard, Oregon 97223
Inspection Line (Roc-O- ne)s 639-4175 Business Phones 639-4171
Inspections_ - �--
Footing Plb�/Undorslabech. Rough-in Appr/8dwlk
Found. P'.ag. Top Out woes-LCne FINALt
Post/Beam Stru,s.. San. 8ewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater Line Gyp. Bd. -Mw--h. 3c)
Date Requestedtt,_1L y�`/Z /—Times AN PM
Address: ///) 5S 14AZZ� it f:q,,)-/ - --Zoe�
Builders
TBE FOLLOWING CORRSCTIONS'ARE
-R_EQ-UIRREDt
n
Inspectors_ -
,...
APPROVED DISAPPROVED APPROVRD SUBJECT Tit ABOVE
—.Call For Reinsp.
C17YOFTIFARD MECHANICAL
RTfes.
�COMMUNRY DEVELOPMENT DEPAMENT PF Irl I T
13126 SW WI sird.P.O."230W.TiiAM,Or"M9T2231sa+la39-41� PERMIT #. . . . . . . hlE_1.92 -0317
�___ -----_ -----f:39- 4171 DATE I SSUED a 11/20/9L
SI"TE. ADDRESS. . . s 11055 LW COTTONWOOD LN PARCEL: IS134AC-026.36
SUBDIVISION. . . . a ENGLEWOOD NO. 3 ?ON I NG: R-4. 5
FLOCK. . . . . . . . . . a L.OT. . . . . . . . . .. . . . # 193
CLASS OF WORK. . SALT FLOOR FURN. . . . s F_.VAP COOLERS:
TYPE OF USE. . . . :SF UN IT HE.ATEr-3. . : VENT FANS. . . :
OCCUPANCY GRP. . -.R3 VENTS W/O APPLs VENT SYSTEMSs
STORIES. . . . . . . . a2 BOILERS/COMPRESSORS HOODS. . . . . . . a
FUEL TYPES------------ 0-3 HP. . . . a DOMES. INCIN:
: /GAS/ ! / 3-15 HP. . . . % COMML. INCIN-
MAX INPUT: BTU 15-30 F'P. . . . a REPAIR UMTS:
FIRE DAMPERS'?. . : 30-50 h P. . . . a WOODSTOVES. . :
GAS PRESSURE. . . % 50+ F",P. . . . i CLO Dr 'ERS. . %
NO. OF UNIT'S---------- AIR HAND INQ UNTTS OTHER UNIiS. a
F=URN ( 1O0K BTU% 1 <= 10000 cfm: GAS OUTLETS. s1
FURN ) =1O0K BTUs > 10000 cfm :
Remarlca% ELECTRIC:. TO CCAS CONVERSION
Owner'. —-------------------------------------------------- FE=ES
CHET ROBINSON type amount by Bete recpt
11055 SW COTTONk jOD LN PRMT $ 25. Piis JH 11/20/92
-
SPCT $ 1 . 25 .TH 1 1/i=•IX1l9 ' —
i
TIGARD OR 91223
Rhone #:
Contractor: -----•-------------------------
JIM HEINTZ
SOUTHWEST SHEET METAL
10415 S14 72ND
PORTLAND OR 97223--0000 -----------___.__..__.______________..__—
Phone #: 503--246--6294 $ 26. 25 TOTAL
Reg #. . ; 450139
—•------ REQUIRED INSPECTIONS ----- -
Ibis permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Lode, State of Ore. Specialty Codea and all nther
applicable laws. ffil Mork will bF done in acenrdance with
Approved plana. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for rare
than 180 days.
1'ermi.tterr Signature :
C
I ;gi_ted 13y%
Call for inspection — 639-4175
CITY OF' TIGARD RECEIPT OF PAYMENT RECEIPT NO. %92-233927
HECK AMOUNT z 0.00
NAME SUUT14WEST SHEET METAL CASH AMOUNT a 6. 25
ADDRESS –,AYMENT DATE >t 11/20/S2
SUBDIVISION
(--l-JRr-,OSE OF PAYMENT AMOUNT PAID PURPOSE' OF PAYMENT AMOUNT PAID
1. 25
ME CH—A WE l 25. 00 ST. BUILD PER
11055 SW COTTONWOOD LN
II
TO TAI. AMOUNT PAID 1-16. 25
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11055 S
W Cottonwood Lane �+
1 of 1
08/20/96
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