InitiallyGood 1
ADDRESS :
i:\records\rnicroflm\targets\buiIding.doc
CITYOFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT OF TIMRO Z/
13125$W tiWl Blvd. P.O.Bar 23307.Tip",OreqDn 97223(61X1183 -4176
PLUMBING PERMIT
r-"E R M I T #. . . . . . . : PLM922-0078
639-4171 DATE ISSUED: 06/01/92
SITE ADDRESS. . . : 12550 SW BELL CT PARCEL: RG104AP-00800
SUBDIVISION. . . . : BELLWOOD ZONING, R-4. 5
BLOCK. . . . . . . . . . t L01.. . . . . . . . . . . . . :57
CLASS OF WORK. . :ADD GARBAGE DISPOSALS. . : MOB ILE H014E SPACES.
TYPE OF USE. . . . iSF WASHING MACH. . . . . . . : SACKFLOW PREVNTRS. . : l
OCCUPANCY GRP. . :R:3 FLOOR DRAINS. . . . . . . : TRAPS. . . . . . . . . . . .
STORIES. . . . . . . . i WATER HEATERS. . . . . . I CATCH BASINS. . . . . . .
FIXTURES----- L.AIJNDRY TRAYS. . . . . . - !:.)F RAIN DRAINS. . . . . :
STINKS. . . . . . . . . . i URINALS. . . . . . . . . . . . a GRE.ASF-". TRAPS. . . . . . .
LAVATORIES, . . . . : OTHER FIXTURES. . . . .
TUB/SHOWERS. . . . t SEWER LINE (ft) . . . . :
WATER CLOSETS. . I W('TF;'P 1-11\IF- (ft ) . . . .
DISHWASHFRS. . . . I RAIN DRAIN ( ft ) . . . .
Remarks : 11PRINKLrR SYSTEM
Owners ---- ---------------------------------- FEES
LEONARD CURRIER type amol-int by date rocpt
12350 SW BULL CT PIRMT $ 15. 00 JLH 06/01/92
5PICT $ 0. 15 JLH 06/01/9e
TIGARD OR 97223
Phone #:
Contractor
OWNER
--------------------------------------
Phofle 15. 75 TOTAL
Req #. . : 00000
REWIRED INSPECTIONS
This wreit is issued subject to the regulations COrt4in@d in the Top-ot-it Itisp
Tigard Municipal Code. State of Dre. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for sort
thin IBA da".
Permittee B i.qyiat 1-ire
BY :
Call for inspection F,739-4175
i
CITY OF TIGIARD — RECEIPT OF PAYME=NT RE G:F1CST 1,40. a9;P—c.27914
CHECK AMOUNT a lb.00
NOME s CURRIER, LEONARD CASH AAOUNT n 15. 75
AWR1:SS a IR':-!'50 SW BELL CT PAYMENT DATE:. A 06/Ql1 /92
;3ULxD I V I E3 I ON
T IGARD, OR 13722.3—
` PURPOSE OF Pl)YME NY AMOUNT PAID PURPOSE OF PAYMENT HMOLINT PAID
{K.1.IMD I NG PE FdM 15. 00 5T. BUILD PER N. 751
i
srnn I NKLE:R rYF 1'E::M
TOTAL. AMOUN-E G-` )X V)
Permit No: ,
Address:
C
issued by:_ �__ __ Date: L -
/'f -
\„ __—__-_FOR OFFICE USE ONLY_.___._-__
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note:Oregon Law, ONS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be Issued. 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 blanks, and Initial box 1 and elther box 2A or 28:
1. F= I own, reside In, or will reside in the completed structure.
2. A. = My general contractor is -----_---.------- --.__._._-_----_ --- - ,
Contractor registration number ..___�___�._..�.
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. 9EEC-1 I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction 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 havo read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
q 2-
Signature of Permit Applicant _._ Date
CONSTRUCTION GONTR/ � 'ORS BOARD
0244J 1190
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
T
INFOR11'MON NOTICE TO PROPERTY OWNERS
ABOUT CO.''STRUCTION RESPONSIBILITIES
I NO r- Th13 Information Notice to Property Owners About Construction
L
' Resuonsibilit'es was developoJ by the Construction Cc..,tractors Board in
c^ordanct, with (')HS 701.055(5), pas3ed by the 1989 Oregon Legislature.
t' Ddu are io tl s yoar own contractor to construct a new home or make a substantial improvement
t.., -,r til; a aruc' .ro you can prevent many problems by being aware of the following responsihillties
an,1 'AS ,oricerrl
EIVirLOYER
If YOU hire pet, not registered with the Construction Contractors Board to do labor in constructing
or assisting in the constructior 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:
e on's Withholding Tax Law. As an employer, you must withhold income taxes from employee wages
,a t o t m Amp1oyees 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 3783390.
Unemployment Insurance Tax: As an employer you are required to pay a tax for unemployment insurance
purpose ' on the wages 65Femployees. For more information, call the Oregon Employment Division IBNR
a t 378.3224.
Workers' Com unsation Insurance. As an employer, you are subject to the Oregon Workers' Compensa-
fio 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'
vva esYuu w I be Ia lP_Tor the tax payment even If you didn't actually withhold the tax. For more Informa-
tion, 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 co a requirements that may be brought to your attention through inspections.
Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate
Insurance coveta►accidents an7c omissions such as falling tools, paint overspray, water damage
from pipe punctures, fire, or work that must be re-done.
Time to Supervise Employees: Make sure you have sufficient ti,,)e to superv'se your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate
the W&Tof rough-in an(' finish trades, and to notify building off+cv, Is at the appropriate times so
they can perform the requirr , 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
0244J 10124189
City of Tigard Building Departssnt
13125 9M Ball Blvd. Tigard, Oregon 97223
Inspection Lina (Roo-Q-Phone):
� )639-4 745 Buri9ness Phone: 639-4171
Inspection:_- 1 d�G" \ KJw X k /��Y -------- _..-
Footing Plbg. Underelab lMch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/beam Atruct. San. Sewer FraoLng --Bldg.
Poet/8gam Hoch. Rain Drain Insulation -Plumb.
Plbq. Underfloor �nWater Lino Gyp. ad. -Hoch.
Data Requeated: w � 4 L� � Timet � AH PM
G a
Address f 1�7 5� o wu Permit 1 f 1 I O `
Builders
TBE FOLLOWING OORRECTIONS ARE RRQUIREDI
InspectorsOe-
APPROVED DISAPPROVED APPROVP.^ II:1 IPM TO AnOVE
Call For Reinep.