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LIABILITY: The city o rigard, Oregon, or it's
employees shah nod be les onsiblQ for
4 r'ij discrepancys whlth may pear hereon.
,► 1 APF'RrvED FOR OI�I: T�'IJu\Tie
1Z- EwL IEU �',., / // �` F- 1-
oft rCITY U�+ i���A D
UU � w l
i
PERMIT N� uP�" �_.1�-�-- — -.f �s
15 5 ,,. .. 1 .r 1{::>uN S�r•I�IEE-( y, -
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IF THIS }:_ _ t, 4
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11111 , 11 li it 11 I
DOCUMENT i S LESS I I I I I I I I I I I l l t T I I i I T T 1 l l r l l t l 1 t I 1 �..♦: - • � , : ' M ""` ,
I I I I r I I II III III t - �5r
I I I I I 'T' . 1
LEGIBLE THAN THIS NOTATION , I 1 ��
IT IS DUE TO THE QUALITY OF 6 L 8 R 11' '►
THE ORIGINAL DOCUMENT . No.3e ,
LZ 9Z Z �Z I EZ Z TZ OZ 6T gT LT 91 � T ' � T £ T ZT IT11101111 E3M L 9
Ilililili Illi IIII Ilii IIII IIII IIII !III ILII IIII ILII IIII IIIIIiIiI IIII IIII IIII IIII i"�' I I ' i , , � z T
I Illlill IIII IIII IIII IIII IIII IIII IIII IIII .III III III � •
IIIII IIIIIIIII IIIII 1 IIII
IIIII Illlll( IIIIII 111111
III 111111111 ►Iillllll II
IIII a (III �IIIIIIII Illllllrll I
iiUILDFR VALUE FEE �l 9 MATE a _cf
LOCATION 6t.' j VML SOA1 OWMER
JOB I MAP LOT # TYPE
r'LUMVER MAKt/ti' /�7L�K Cy fJ PERMITSf•�}- - ,Z/ -F FES e
-OWER PERMIT FEE ME:IIANICAL PERMIT
JNTB _ L4T,E �y
EXCJiVAT1Ur7 FILL AIR COMITIONING `O
FOCYIIrIG� FOIJ,MATIO:l VENTU.ATION Ln�—
=FopSPRINKLER SY.,TEM ----
--'s r MASOMY FLUES _,
[tElrTORCI,% STL'El FIRE DOORS EXIM
JTRUCTURAL :;PEELGRACE FTUOR
FLUMBING ii,l. L A VEWA Y v
ROOF FLA;1iIrJG _ jEWER --
FRAMF — STORM DR,;IN
LATH WALLJOAAD PARKING �---
HEATING _ FENCE SCREEN
's WATER HEATER FINAL
September 29, 1992 CITY OF TIGARD
OREGON
Steven P. Mozinski '
4233 SW Redondo Avenue Ll -% ' � '
Portland, OR 97201
Re: 9945 SW Johnson Street Permit # MEC 91-0092
On June 6, 1991 a permit was issued f-or tht, abov` project . As of
this date, there is no record of ,any ,,;,pection having been
recorded.
Please advise the Building Division of H')v ntatus of this project
as soon as possible so that the file may be kept current .
Please note that any permit without for over 180 days
becomes void. If you need additional time to complete the project,
please contact this department so an er.tc,j,., ,,n can be discussed.
Sincerely,
Robert Thompson
Building Department
Noticeb. rev
13125 SW Hall Blvd., 1lgard, OR 97223 (503) 639-4171 TDD (503) _ ___
INDPECPION NOTICs
City of Tigard Building Department
13125 M Ball Blvd. Tigard, Orecpn 97223
Inspection Line (Rec-O-Phone): 639-4175 Buoinesr Phone: 639-4171
Inspection:
Footing Plbg. Underalab Koch. Rough-in Appr/odwlk
Found. Plbg. Top Out GaR Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Fater Line ( Gyp. Bd.� -Meeh.
Dote Requested: f 7 ! Times AN _ PM
Address:_ i� �Z/J_
C Permit 1: y
Builders / --.--THE FOLLOWING FOLLOWING CORRECTIONS ARE REQUIRED: i
Date:_—_—L�
___A;PRnVRD DISAPPROJRD APPROVED SUBJECT TO ABOVE
Call For Reinsp.
;NSPs oN NOTIGE
City of Tigard Building --pertaent
13125 Bw Ball Blvd. Tigard, Oregon 97223
Insr.,ection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspections_--
Footing Plbg. Underelab Mach. Rough-in Appy/Sdwlk
Pound. Plbg. Top Out Gas Lin& FINALS
Poe_/Beam Struct. San. Sewer Framing -Bldg.
Post/Ream Mach. Rain Drain Innulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
f
Times _—
1, C AN �_PM
Date Requested:
Address: 1 12 `1� (7�/� Permit 1:�
I '
Builder: I n 1 I- 2_01 — ---�-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
r -
Inspector: _ / Date:
"PROM DISA^PROVED N APPROVED SUBJECT TO ABOVE
Call 1-For Reinsp.
•. s .. �ne az � es
Ine 13:SRLtgWoBall�b�ildjnq f�Rrt �nt
Ew-tion Line
rnsPxtion; ( P— ,° 639 4175• Bo�Ros9
7 hones 639-4171
o)tlnq -
1bg- Underslab
Found. Meth. Rough-in
Poet/Beam StPlb9• Top out APpr/Sdwlk
ruct. q pae Line
Sir FINAL;
Post"Beam Mach. `""�""----_.�._ Framing
Rain Drain -Bldg,
Plbg• Underflorr Insuletion
r Lim -Plumb,
Data Requested; QYP• Bd.
-Meeh.
Addreee;
Time..
==P11
a. ----AM
Builder; Permit
49
7WR rolIMINc CORRgcTIORs
----_1 ARE RSQvrRsn;
i
_- _'�-_•tom-.�
Inspector;
.......
Date:
DI3APPRpyRD --__ Z
APPR(A gD
--._._Call Fo SURJRcT TO AnoYE
r Reinsp,
INSPECTION NOTICE ( ��
City of Tigard Buildinq Depwrtnent
13125 BM Ball Blvd. Tigard, Oregon 97223
Inspection Line (ROC-0-Phone): 639-4175 Business Phone: 639-4171
Inspection: —_--- -- --
Footing Plbg. Underalab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. Sen. Sewer Framing -Bldg.
post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: /U '�� Times �_AM -_PH
r
Address: +1_4?-3 Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspect.o Date r• w��_*r
APPROVED _ DISAPPROVED �^ APPROVED FjBJECT TO ABOVE
Call For Reinap.
A[ +A # aal ass # # ew
LNUMMION NOTIC=
City Of Tigard Building Depart M
13125 BA Ball Blvd. Tigard, Oregon 972
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlc
Found. Plbg. Top out Ons Line FINAL:
Poet/Beam Struct. San. Sewer Fr-a-m-ing , -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requeated: / 7 ��. Time:
Address:— Permit 1:
Builder:_
THS FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:
Date:-,,/�
__APPROVED ^` DISAPPROVED e_ APPROVED SUBJECT 110 ABOVE
Call For Reinsp.
1
INSPECTION NOTICE
City of Tigard building Departjeent
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-o-Phone): 639-4175 Buniness Phone: 639•-4171
Inspection:
Footing Plbg. Underelab Mach. Rough-in Appr/adwlk
Found. Plbg. Top Out Cas Line FINALS
Post/Beam Strutt. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. /-Moc: .
Date Requestedt _
_ - ��_ —Timet PH
Addreen: �� ifz�i PBLlait
i
Builders`� i
THE FOLLOWING OORRI{CTIONS ARE REQUIRED:
_�_�-------- _—_ Date:
APPROVED DISAPPROVED APPROVED ^7;;Lijzm TO ABOVE
Call For Reinep.
INSPiCTION NOTIQ�
City of Tigard Building Department
13.125 BA Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-phone): 639-4175 Business Phone: 639-4171
Inspections,—•---
Footing Plbg. Underelab Mach, Rough-in Appr/Sdwlk
Found. Plbg. Top Out Goa Line FINAL:
Posthleam Struct. San. Sewer Framing -Bldg.
POst/Be un Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
Dat, Requested e /'�_ ;2-- _Tim= AM
Address: -1 a:L. / Permit
Builder.:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: /�/ --� Dates
f_APPROVED DISAPPROVED APPPOVISD SUBJECT TO ABOVE
T _Call For Reinsp
INSPECTION NOTICR
City of Tigard Building !1epertnant
13125 SW Ball Blvd. Tigard, Cregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: ----
Footing Plbg. Underel.ab Much. Rough-in Appr/Sdwlk
Found. Plbg. Top rat Can Line FINAL:
Poet/Beam Struct. San. Sewer Framing_- -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Wat
er
Line Gyp. ad. -Hoch.
Date Requ.steedt L ! / 1 I Time: —2�--AMPH
Addrose: 1 L I (� "' ' ___ Permit �:�V 7f)`6 113
Builder:_
THE FOLLOWING CORRECTIONS JkRE REQUIRED:
inepnctors ' � _�— Date:
APPROVED DISAPPROVED APPROVFD SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 s0 Ball Blvd. Tigard, Oregon 9722
Inspection Line (Rec-o-Phone): 639-•4175 Business Phon 39-4171
Inspections
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Mg. Top Out Gas Line FINAL:
Post/Beam Struct. Ban. Sewer Framing ) -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. YY-Hoch.
Date Requested: N
I, (�- Z� C' ( Time: \ AN _P
Address: "r1"I y s C'VlA0'vG0V'4A: Permit Gl 1-190 3
Builder: �� _ Z'[9
THE FOLLOWING CORRECTIONS ARR R*QVIRED:
__--art
�;
Inspector:_- _ - --- Dete: `Z -�^' - it
- -
APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE i
Call For Reinap.
�. tee, •. ...
INSPi9110 MOTICL
City of Tigard suildi g Departret
13125 OW Hall Blvd. Tigard, Oregoe 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Fou,id. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor / Mater Line Gyp. Bd. -Koch.
Date Requested. !� l� Times _.AM PM
Address: �� ,4 p}1—� Pezil"#1
Builder: 4 1 +1
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: � A Date- e I
APPROVED _A__*`DISAPPPROVED APPROVED SUBJECT TO ABOVE
P Call For Reinap.
"w- ! ! ! A♦ ! .!
INSPECTION NQT�j
City of Tigard Building Dep—tnrnt
13175 ow Hall Blvd. Tigard, Oregon 47423
Inspection Line (Rec-o-Phone)s 639-4175 Business Phona: 639-4171
Inspections_ — —
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gan Line FINALS
post/Beam 9truct. Sen. Bower �Fi ramin9 -Bldg.
Post/Beam Mach. Rain Drain InsulAtion -Plumb.
Plbg. Underfloor /Mater Line // Gyp. Bd. -Mach.
Date Requested:
Address.-
Builder!
ddress:Builders f -----
TAE FOLLOWING CORRECTIONS ARE REQUIRED:
In.ipector:__--_------- --------------------- Date:_._,-- ---- —
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
IRS PE IOn OTICE
City of Tigard Building Department {�
13125 BM Ball Blvd. Tigard, Orogoo 97223 1
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-42
Inspect Lon: --
rooting Plbg. Urderalab Mech. Rough--in 1.ppr/Sdwlk
Found. P1Lg. Top Out Gas Lino FINAL:
post/Beam Btruct. San. Sewer Framing -Bldg.
�400st Beam Meth Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater lLina(� Gyp. Bd. -Koch.
4u �(—LIO !
Date Re eeteds _� __Times AM PM
jL/5
Address
�. /4
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
SZAC_4f ��A� G./aC/� .IOiuT. .TF/ G7uCT T/aPc
�S'•,• /j c:»Aa r<.a� r Je�virr "_I �>TG's t. O!� Iry C T-
Tv Agi�l�= 4-'` i•�</��``5 :� U r'YG i��1'f !�!S'uL.�-7�
�/1s►r_- SPllci�ri M>V/ -is
Inspectors. —_--- -. Dat01
APPROM DISAPPROVED L/ APPROVED SUBJECT IT) ABOVE
Cali For Rein..;.
n32 MINA MMM wv
1
SNSPECTIQII NOTICE
City of Tigard Building Departustat
13125 OR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-phone): 639-4175 Business Phones 639-4171
FoolLpQ Plbg. Underelab Mach. Rough-in Appr/Sdwlk
J�ind. Plbq. Top Out Gas Tine FINAL=
C'
Poet/Beam Struct. San. Serer Framing -Bldg.
Mach. Rain Drain Inwilation
-Plumb.
Plbg. underfloor Water Line Gyp. Bd.
-:,ec h.
Date Requested= f-
ZZ _
/ -T�= j? AN �PN
Add ress:_ �fl/
nu'_.ider= 247f
THE FOLLOWING CORRECTIONS ARi RgWjREDt
r ��frPc�TE � rc1/ tr�17
L'G�A�O.uCc' �•X0..,2 ' �t�,f 7 d
C74»...
Inspector= -
- nate= _
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVF
__Ca.l For Reinep.
CITYOFTIGA RD
CfTlf 0MECHANICAL
COMMUNITY DEVELOPMENT DEPARTMENT one" PERMIT
13126 SW HWI WA P.O.BIN 233W,Tbrd,OrvVn Of (5W)6304175 E RM IT #. . . . . . .
639 -41 11 UATF ISSUED: 06/06/91.
ADDRESS. . . : 09945 SW JOHNSON ST PARCEL: 2S 1 Oc pA-•Pty_101
,l_!SDIVISION. . . . : NO. 'TILAR)VILLE ADDITION AMEND. ZONING. R-4. 5
BI OCK. . . . . . . . . . : LUT. . . . . . . . . . . . . s20
i-OES OF WORK. . :ADD FLOOR FURN. . . . s CVAP COOLERS:
YPE OF USE. . . . :LryF UN I T- HEATERS. . : VENT FANS. . . :
)I t.'UPANCY GRP. . :R3 VENTS W/C7 APPL:c' VENT' SYSTEMS:
r?FiIES. . . . . . . . : 1 I:aQILERS/COMPRESSORS FlC1UDS. . . . . . .
0-3 HFA. . . . : DOMES. INCIN:
3--15 HN. . . . : cnMML_. iNrIN:
TNPUT: PTU ;5-•30 HP. . . . : REPAIR UNI-iSs
r. DPMPF_R-�' . . . :,►n--50 HP. . . . . WOODSTC,VES. . .
'PRESSURE. . . s 50+ HP. . . . : CLO DRYERS. . :
;,10. OF UN I. TS-_---_.._..._.__ AIR HANDLING UN I TS OTHER UNIT'3. :
URN ( 100K PTU: <= 10000 cfm : GAS OUTLETS. :
I I ON 7 =I OOK B'T U: > 10000 c fi m`
•.-Imai'kSs addition of two tied rooms
nnr.: -------------- _-----___-____ _______.______---- FEES --__.__-_-.--.-
VLN MOZIPISKI type kmourit by date recrt-
1$1.'33 SW REDONDO AVE PRMT f 16. 00 JL_H 06/06/91 -
F'LCK $ 4. 010 _TI._H 06/06
P rl-AND OR 9721711. 5PCT $ 0. '�Ir TI_ A 0E,/V.+6
orae #:
ii•II'•I�'_R
20. i✓0 TOTAL.
REWIRED INSPECTIONS - -
",i s oereit is issued subject to the -tsulations contained in the F i rte 1 I r1 s pect i on
T:yard Municipal Code, State of Ore, Specialty Codes and all other
aopl icable laws. All work will be done in accordance with
approved plans. This oerait will expire if wcrk is not startec
within 190 days of issuance, or if work is suspended for tore
thanHIP days. ---..—_ _.__.____---.__._.. ___ .__._..-.__..__--___..
F e-m i t t e e S i l n a t u r'e: -•-•--_-•-- __
r<
1. ad By
Call for insvect i on
w r.a
CITY of T:GARDMECHANICAL PERMIT Receipt #
13125 SW LALL BLVD. Permit # :t S
1". O. BOX 23397 Description
T I GARD r OR 7223
Table 3A Mechanical Code_ —_ _-- CITY PRICE AMT
(503)63-9-4175 1) Permit Fee 0 -0- '0.00
Nemo of Development 2) Supp!emental Permit 3.00
Job Address ---- --------- ------ -11 Furnace to 100,000 BTU ----�� 6.00
Address
incl.ducts&vents
_ _ ----- -- ---_---- --- --
Tax Lni Map No2) Furnace 100,000 BTU A 7.50
incl."ucts&vents
Lot Block Subdivision ----— --------
-
Name(or name of busmess) 3) Floor Furnace 6.00
incl.vent
Mailing Address Plane 4) Suspended heater,wall heater 6.OU
Owner - or floor mounted healer
City/Stag -- - zip -- - 5) Vent not incl.in -- 3.00
appliance permit --
Name(or name of business) 61 Repair of heating refr ig., 6.00
cooling,absorption unit
Mailing Address-- _ — — Phone — 7) Boiler or comp to 3 HP 6.00
Occupant absorp-unit to 100,000 BTU
City/State i.n -- 8) Boiler or comp to 3 HP- 15 HP 11.00
absorp,unit to 500,000 BTU
Name -- -— 9) Boiler or Comp 15-30 HP 15.00
absorp.unit 112-1 million -
Mailing Address Phone 1�) Boiler or comp to 30-50 HP__ 22 50 -
absorp.unit 1 -1.75 million _-
Contractor CityistaiP---------------zip — 1 1) Boiler or comp to 50 HP M 31.50
absorp.unit 1,750,000BTU _
State Registration No City Bus Taz.Jo 10) Air:Candling unit to 4.50
0,000 CFM
Air handling unit -
I hereby acknowledge that 1 have read this application that the inhrmation given is 13 10,000 CFM + 7.50
cnrrecl,that I am the owner or authorized agent of the owner,that plans submitted are in — -- --
compliance with State laws,that I am registered with the State Builders'Board,that the 14) Non portable 450
number given is correct.(If exempt from State registration please give reason below), evaporate cooler
-.--- 15) Vent tan c)nnected 3.00
to a single duct
----- -- — - Ventilation swz!cuf riot
16) n.50
inclur+ci in appliance permit
- -- - ---�_---- 1.7) Hood served by 4.50
_mechanical exhaust
Signature(owner or agent) nate 18) Domestic.type _ - 7.50
Describe work [I addition U alter.3tion ❑ repair ❑ incinerator
to be done residentidi U non-residential p - 19) Commercial or industrial 30.00
Existing use of , _type incinerator -
building or properly _ 20) Other i.e.,woodstove,v.iter 4.50
Proposed use of heater,solar,clothes dr vers,etc_ -
building or property - -- 21) Gas piping one to four outlets 2.00
Type of fuel-- oil [I natural gas Ll LPG Ll ehetric [.] --
22) More than 4_pnr outlet ^_ -
NOTICE SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION
ON STRUCTION AUTHORIZED IS NOT COMMENCED WITHIV.. 180 5% SURCHARGE 9 p
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPFNDED OR -PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS A'. ANY TIME AFTER --- --- p --
WORK IS COMMENCED. TOTAL p n
Special Conditions
Date issued s __--by
i
ppb.
� l
a
r?
CITY OF 'T:I GARD — RF E-E I PT OF PAYMENT REC:Er I PT NO. :91—i='.1406 1. �'"•
CHECK AMU INT 0. 01'.
NAME: o EMI-n-i, rHR I ST I NE CASH AMOUNT n 1-10. 80
RL'fl)FtE_SS c PAYMENT 1,ATI- a Ot, 06 9t
SUBDIVISION
�d
PIJIIp(JS1=. OF PAYMF IVT AMOUNT FSA ID F'1.JRP,CISE:: OF PAYMENT AM131JNT V'N I D
Ml~CHAN I
CAL PE I Gl. 00 PLAN C HECK rE- k. 0@
ST. BUILD PER 0. 60
9945 SW JOHNSON IST
10-(Al. AMOUNT PAID
i
C'TYOFTIFARDUILDING PERMIT
COMRD pE--pm1 r #. . . . . . . . 9UP')1 —101 1
Y4WID
C,JMMUNITY DEVELOPMENT DEPIATMENT
1312b SW HWI RIVd P.O.BCx 23397,TOW-Or6gon 91 15M)6*4'75 DATE ISSUED: 05/31/91
PARCEL-
L f:iiJLHEn* 5. . . i V.C;,945 ZONING: R-4. 5
,-JBDTVISIDN. . . . : NO. TIGARDVILLE ADDITION AMEND
(73 r'K. . . . . . . . . . .I LOT. . . . . . . . • . • . :20
----------
I'SSUE g FLOOR ....XIERIOR W14LL LUNb ! HUC11LJN--
:318 S+ N: El W.
OF WORK.
:ADD F'I RST. . . .
-iECOND. . . .* f PROTECT OPENINGS?----
OF USE. . . :5P
PF OF CONST. :5N THIRD. . . . : sf N: G E- W:
GRP. -R3 S f ROOF CONST FIrE PET"' �
BASEMENT. , s AREA SEP. RATED
� ("UFIANCY LOAD.a
-)F4. FIT. :20 ft GARAGE. s f OCCU SEP. RATED
ML z 1! REOD
1)01< LOAD. . . . ..40 Psf LEF T: ft RGHT: 10 ft F IR PKI.. ^ SMOK DET. . -
�wi-'(_1-ING UNITS: FRNT ii ft REAR: 17 ft FIR ALRM: HNDICP ACC:
Til--1)RMS!2 TMP SURFACE: PRO CORR. PARKING:
v(.)I.UE. $ : 14628
Ppmarks : addition of two bed roams
FEES
it VUNI MOZINSKI type amol-int by date r1crit
bw REDONDO AVE I-,RM"f # 110. b@ PLL lAb/31/91 d 1;385'
11. 6,3 JLH 1115/e9/91 :1 .',761
?I- i --PiND OR 97201 5. 53 PL.L 05/31/91 21385 '
FIionv 187, 136 TOTAL
''?tj #. HLUUIREU
nprolt is issued subject to the regulations tcrtained in the FoOt/fOfAt)d ITISP
Municipal Code, State of Ore. Specialty Codes and all other Post/Beam Insp
�Policable laws, All work will be done it accordance with Fram: Tlq 1r15P -------
.,Doroved clans, This permit will expire if work is not started Inci -Ation Insin
,Jthin 189 days of issuance. or if work is suspended for more rlyp Board Inso
150 days, Hain drain 1tiso
1- inai lnspec-'tlon
mi t t e e S i gnat .Are ' ---------
e d B v
Call for inspection
CITY OF' TIGARD RECEIPT OF POYM171-41' RI"C'EjP-r NO.
NAME • smmi, CHRISTINE 1), CHECK AMOUNT116. 03
ADDRESS % MOZtNSKI, STUVEN P CAGH AMOUNT a 0. 00
9945 13W 'JOHNSON 9TREET PAYMUNT DATE 05/31/91
TIGARD, OR 97P83— GUBDIVISION
9945, SW JOHNSON Err
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF' PAYME14T AMOUNT PAi!!
BUILDIN13 PERM SUP91-0113 110. 150 ST. BUILD PER
lrTfAt- AMOUNT PAID — — — —> I16. laa
CITY OF TIGARD RECEIPT OF PAYMENT' RECEIPT NO. :91-213761
CHECK AMOUNT 71 . 63
NAME MOZIANSKI, STEVEN P CASH AMOUNT n 0. 00
ADDRESS a BY SMITH, CHRISTINE D PAYMENT DATE a 05/29/91
9945 SW JOHNSON ST SUBDIVISION
TIGARD, OR 97223— 9945 SW JOHNSON
PURPOSE OF' PAYMENT AMOUNT PATD PURPOSE OF PAYMENT AMOUNT PAID
(.',l-AECK FE 5---4rjR 71. 833
I.
TOTAL AMOUNT PAID
Permit No:
Address: S S o
h� 0
�Z Issued by:------� .•�/ Date: --
=yi L— —------.--FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 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.
F:,I in the applicable blanks, and initial box 1 and either box 2A or 2B:
1. P�S) 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. L4jiI 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 Boars: and I will immediately notify the office
issuing this building oermit 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.
Signature of Permit 4p1
1
i4 't �r ---r
� Date
CO�;STRUCTION CONTRACTORS BOARD
0244J 1/90
VVHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Propert a Owners About
Responsibilities was developed by the Const-uction fontract
accordance with ORS 701.05 Construction
5(5), passed by the 1989 Oregon Legislaturrs e,oard in
If you are acting as your own contractor to construct
to an existing structure, you can prevent man y -`
and areas of structure
c , y problems be being or
of the following iarespon�ement
Pr,r.
EMPLOYER RFSPONSIBILITIES: p slbilities
If you hire peruQns not registered with the Construction Con
or assisting in the construction or improvem,,nt of a residential structure
be ruled to be an "em to er„ tractors Board to do labor 1�7 constructing
comply N Y and the people you hire will be "employees As nost
errnstances,
p Y with the following:
Y , you must
Ore on WlthholdIn Tax
��! t 7e t me em to �- �w As an employer,you must withhold income t
r1�a p gees are paid. You will be liable for the tax payments even if YOU don't
tax from your employees. For more information, colt the Oregon Departmentaxes from employee wages
Unem�;�ment Insurance Tax; actually withhold
of Revenue at 378-3390•
Purposes on t e wages oi-a?i employees oi�moreOUfo a required;°t a
at 378-3224• h Y a tax
for ploytilent Div Insurance
D R
he Oregon Employment Division i7FiR
Workers' Compensation Insurance: As an employer, You are subject tion a n must o twin workers' com
compensation insurance, Pensation Insurance for YOUren,Pl the Oregon Workers' Cpm
you may be subject to penalties and will be I ab you fall to
pg�g iwo ars'
Your employees is injured on the job. For more information, call the Workers'
at 373.7434. a o/
Compensation Division DIF
U S. Internal Revenue Service: As an employer, ,
wa9e�s�u will he liable ort a tax payment even if you didn't'
ractu
tion, call ,,�e Internal Revenue Senrlce at 221-3960. thhold federal income tax from em
ally withhold the tax. For piforma
OTHER RESPONSIBILITIES AND AREAs OF CONCERN; more informa
Code Com Bance: As the permit holder for this,pproject, you are r
to meet co a requirements that may be brow ht r
I� to your attentionthroughionspr ction
LiatYad Pro
npert Dama a Insurance; Contact your in 8 any failure
�y ns.
insurance coverage gfiaccs and omissions such as f
from pipe punctures, fire, or work that must be redone surantO agent to see ,f Youray have adequate
ailing too►s, paint over pray, water damage
Ti Or
u eryl9e Employees: Make sure you have sufficient t
Ex ettlse: Make sura you have the expertise to act as your own general
to supervise your employees.
t e wor of rough in and finish trades
and they can perform the required inspections to notify building offl�alsra� contractor,appropriate times ;c,
If you have additional questions, write to:
Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 973 0.0151
0244) 10/24!89 phone 503.378-4621
City of Tigard
INSPECTION REQUEST
for
r GG�sG�Y' 7
SPECTION TIME: PERMIT NO. :--
DATE: ,,;?
O. :_-
DATE: ,,;? / , L2- DATE ISSUED :
INERS NAME :
ADDRESS. S °�'�� °ter✓
)N rRACTOR
=ST : Air 1], Water[] , Visual [I , Laboratory []
_SULT : Approved ❑ Disapproved ❑ Pending
:ETCH:
SPECTOR DATE
TE : Attach supplemental test data beret
I
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. P
Permit fee /p `''__..
Water Closets�Toi.lets� _��+ Permit Issued—
water
'Tubs et _ —_ _ Approved by
T Lavat.or-�ssh Basin__ �a Building Per __
-
-Shower _ _ Receipt No.
Sinks. Kitchen
Sinks= OrdinarXLocation of Building
__ Sinksi Bar--•---.____-------- ---- -------------------•--_•_•-_--.__---__.__----------
-- -ASinksR Sloes_sE;was ___ --__--_--_----__-_____ _ --------------- --
_u_to_mj_tic_D _ h_er__
Laundry TraysName & Address of Owner
-- --Drains._Floor•__- --
.----- . Drains, area
llrai nsA_RET rerator
_
in Drains
�Au tuma is Washer _ N & A r i lamb r --_ _
_ I ounta1ns��TrinKin _ _ Q�
Fountains, Soda O
Hot Water Tank IP"
-- _ c
Water Service Size _
Urinals — - �-71-
Buildin1 :r New) (Alter, Re Alter r or
4 ��- ---. _ _-__ ai�_._ ._
--7a_Tch_-1Fans-
sI _-t a`ri --_- _ :[nsFall
---_--I,awn Sprinkler Sys-ten;Swimming Pool
Pool__-- -_---_----------.______�._.�_----
_Sprinkler _' y.s_tem _.,—______.-----•--
This permit becomes nLTll and v L work or constr'liction authorized is nut
commenced within 60 days, or i construction or work is suspended or abandoned
for a period of 120 days at any time after work is commenced.
All plumbing firms must be licensed by the City of Tigard and post a $1,000 bond.
I hereby certify that I have read and examined this application and know the same
to be true and correct. All provisions of laws and ordinances governing this typ,
of work will be complied with whether specified herein Gr not, the granting of a
permit does not presume to give authority to violate or cancel the provisions
of any other stage or local law regulating construction or the performance of
construction.
Signature of Applicant -
PERMIT TO CONNECT
Tigard Sanitary District i
PERMIT N° 772 DATE Iii
PERMIT 1S GIVEN TO ^ it Zly��t
TO CONNECT A J t/ ✓`/C•�[A�['. �C. _..__----- -----
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST 6(F POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION 1(AS BEEN COM-
PLETED.
PERMIT FEE PAID .........p1QMlp �'pR�T
By
CONNECTION INSPkCTED AND APPROVED
Date _----- ---------.� ..---Buperintendent ------
r ' No.---
Name
�Iz
Address_ _____ �.�E f�' e/' Permit No._—
Name of Occupant_ Permit charge
Connection fee x��
- Paid by �. C`'• G'LrC'/�
- _ - Date connected
Tvpe of Bu'ldinq_ ��ES,p�,c�c r Inspection fee
Service Rate �` Paid by 4�4' Date
Contractor—f _� � �•��{tom' Assessment__ Paid__..____
Size of connection
- b
.. .. �.. .. .s
01
m A 13125 sw 11au Blvd. PLNCK/RECT #
_.I .1A OF 1 I GARD pro Ore on 7 PERMIT #
..c)MMUNIIY 1)[;VI;Li?['MGNT DEPARTMENT
1 igard,Oregon 97223
(503)639-4171 DATE ISSUED
I
X13 ADDRESS: rf'-�S� �tJ v�rt5c TAX MAP/LOT :2 L54ZI a
LOT: ,.` LAND USE: _
VALUATION:
NER SPECIAL NOTES
REISSUE OF:
WRESS: 4z-:33 LAST REISSUE:
�. 7z.C' l FLOOD PLAIN/
"HONE: j41'S- e_45� SENSITIVE LAND:
)NTRACTOR APPROVALS REQUIRED
'AMEN � � —__ PLANNING:
.DDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: _ EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST/SUBCONTRACTORS: —_
MECH: BUS TAX:
ARCH ENGINEER CALCULATIONS:
NAME: _ _ TRUSS DETAILS:
1DDRESS: OTHER:
'HONE:
PROPOSED BLDG. USE:
COMMENTS:
_...
...
-
APPLICANT SIGNATURE _J
Received By: _ Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees _
IV-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building ;.' a
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
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
52.-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst P-v Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
� nm,'3537P.WPf
i ULW-
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•k .R '"
I
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t yXs)ph �OMXS {,, Ce I j ;�rr�� t 1 N i
1 , =I }
1
I ,
t�Ctt.r,�*ANo 91.0113. �
i
,A�)I J y/
I ypr^w�l{5
Q 1 f
1 I �'(apx v
FLAN -•f VI _ION _
"'rC •�.4�X72 G'� I I.., .11 1
! I
p�rRrrr.Bup . 1OJ
._...._....._ _.._.. _.__.._ .._.._.__... � r, 9L
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