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is\records\microflm\targete\bui ding.doc
City of Tigard Building Department
13125 M Hall Blvd. Tigard, 0"" 97223
inspection Line (PAM-0-PhonlIe)e 639-4175 Business
BusinessLLP,h''onelI: 639-4171
Inupect ions
Footing Plbg. 7nderslab Hoch. Rough-in Appr/Sdwik
Pound. Plbg. Top Out Gas Line FINALt
Pont/Beam strict.. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. _Her d
Date Requestadt- !���� L/ Tine: PM
r i\IG[�
Addrosat1 L'�L� .. �� P,iatmLt 1 t�r C 137?Z.
Builders.--- - L{,(1 Y ?-00- _r6-7 /
THE FOLLOWING OORRRCTIONS ARE REQUIRED:
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Inspectort_ '" _= ^_ Date: r — 3 _C7
VXPPROVRD DISAPPROVED APPROVBD SOB MCT TO ABOVE
` , � Call For Relnsp.
MECHANICAL
CITE' OF T I CARD PERMIT
FE=RMIT 1�. . . . . . , a MEC93--0:a6,'
COMMUNITY DEVELOPMENT DEPA►RTM-NT DATE ISSUED: 12/28/93
13125 SW Hall Blvd,Tigard,Oregon 07223o81g9 (503)63g-4171
PARC:E.L: 2S 104AA-01300
SITE 'ADDRESS. . . : '2300 SW HELL CT 1
SUBDIVISION. . „ . 1 BELLWOOD ZONING: R-4. 5
BLOCK. . . . . . . . . . s LOT. . . . . . . . . . . . . :61 '.
CLASS OF WORK. . :ADD FLOOR TURN. . . . s E:VAP COOLERS:
TYPE OF USE.. . . . a SF UNIT HEATERS. . : VENT FANS— :
OCCUPANCY GRP. . :R3 VENTS W/O ADPL: VENT SYSTEMS:
STORIES. . . . . . . . 11 BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL_ 'HYPES-•_----•------- 0-3 HP. . . . : DOMES. I NC I N:
: /WGI)/ 3•-•15 HP. . . . : COMML. INCIN:
MAX INPUTS BTU 15-•30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS?. . : 30-50 HP. . . . : WOODSTOVES. . : 1
GAS PRESSURE. . . 1 50+ HP. . . . : CLO DRYERS. . :
NO. OF UNITS----------- AIR HANDL I NC UNITS OTHER UNITS.
FURN < 100K BTU: <- 1.0000 c f n : GAS OUTLETS. :
FURN )-100K BTU: ) 10000 cf•m :
Remarks , WOODSTOVE JNSERT
Owner --------------------------------------------------------- FEES
PAUL J(4COBE.LLIS type amorant by date recpt
•^_:sAe SW BELL CT PRMT ! E5. 00 JH 12/28/93 -
9PCT $ 1. 25 JH 12/28/93 -
TIGARD OR 97223
Phone #: 390-1737
(..ontractor: ----- -__-___________.---__-__-----
OWNER
_ - ----------------------------------
Phone
-•-------------------,.._Phone #: ! 26. 25 TOTAL
-------
REWIRED INSPECTIONS
----•---
This perait is issued subject to the regulAtions contained in the Woodstove Insp
Tigard Municipal Code, State of Qre. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This perait will eupire if work is not stirted
within 181 days of issuance, or if work is suspended for wore
than 180 days.
Per mittee Sign..,t;m.e :
Issi-iPid By:
Ca111 for inspection - 639-4175
Permit No: h1 e4- -*1'3 -43 2-
Address:
Address: 'Z-
x issued by: Gate: /:
_ OR OFFICE USE ONLY____T_�1
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, OAS 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 bL'ilding, electrical, moulianical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under ORS 701.010(7), need not submit this statement. This s',tement will be
filed with the permit.
Fill in the applicable blanks, and initial boxes t and 2, and either box 3A or 38:
1 . f 1 1 own, reside in, or will reside in the completed structure.
2. I 1 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.f I My gene,it contractc,- is
Contractor registration number-_--
1 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. CY -I I will be my own general contractor.
0 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
the Information Notice to Property Owners about Construction Responsibilities on the
reverse erode of this form.
S gnature f Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244.1 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I
INFOR"MATION Nr'TiCE TO PROPERTY OWNERS
A80UT CONSTNUC, 'ON RESPONSIBILITIES
NOTI=. Tr is InformaL,on Notice to Propf.-'-y Owners About Construction Responsibilities
wa- .9evelop,rcl by the Uon, ruction Contractors Board in accordance with (JRS 701.055(5),
passed tiv he 1989 Orego•, Legislature.
If you ar(, 30i,g P^ ;ou. &-wn rontrActor to constru ,t a new home or make a substantial improvement to an
existing r <) y,. an pre% -ant many problem- by being aware of the following responsibilities and areas
of concer
EMPLOYER RES1471% : ;TIES:
It 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 Withhokfing 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 it you don't actually withhold the
tax fro►n your employees, For more information, call the Oregon Department of Revenue at 378-3390.
Unempioryment insurance T_a.c: As an emplcyer, you are required to pay a MA for unemployment insurance
purposes on the wF.ges of all employees. For more information, call the Oregon Employmeni'Division DI-IR
at 378-32.2.4.
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 by brought to your attention through inspections.
Liability and Fropert ry C%, imigp Insurance: Contact your insurance agent to see if you have adequate isurance
Coverage for accidents and omissions such as falling tools, paint overspray, water damage `mm 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 tyre ex rtise to act,,as your own general cont r, to Coordinate the work
of rough-in and finish Vades, 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 Hoard
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89
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MCUBELLIS, PAUL. CHSH "111JUNI a 0. 00
SW BEA L C T PAYMEN1 DWE a I P
11GARD, OR 97,223— �AJ RD IV I S I ON
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