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CITY OF TI.:ARD BUILDING INSPECTION NOTICE `•{
Inspection Line (R(c-O-Phone) 639-4175 Business Phone: 639-4171
Inspection:_ �Z,�.�d_._C-t _J4� .'�.
Footin Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
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Foundation F'ib,t. U^darslab Mech. Rough-in Fireplace
Post/Boam Struct. Plbg. Top Out Gloc. Rough-in FINAL:
Post'E!oam Mech. San. Sewer
Gas Line
Plbg, Underfloor Rain Drai, Framing Plumb.
Alarm Water Line Insulation
Underflr. Insul. Shear Wall Gyp. Bd. -Eloct.
Requested: i - —Time: AM PM
Date Requ ,
Address:--L";— SSS L4 5
Builder:
i HE FOLLOWING CORRECTIONS ARE REOU'AED:
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Ins ctor: ='-Me:
APPROVED _DISAPPROVED APPROVED SI'BJECT TO ABOVE
_Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O Phone): 639-4175 Business Phone: 639-4171 �
Inspection: —_----.•-- ___ _-
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Footin Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
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Foundation PIbg. Underslab Mach. Rough-in Fireplace
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Post/Beam Slruc;t, Plbg. Top Out Elec. Rou y""in FINAL:
awlPost/Beam Mech. c_ao, Sewer Gas Line Bldg.
Plbg. Underfloor Rain Drain
Framing -Plumb.
a Water Line Insulation Mech.
Alarm
Underflr. Insul, Shear Wall Gyp. Bd.
•-lect �
�. C� tj Time: AM --PM
Date Requested: � -----
Address: ���'�_ - ■
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Builder. Permi'. �:_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:_
XAPPRC)VED _DISAPPROVED APPROVED SUBJECT TO PC:'vE
' Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 IAI
Inspection:
Fooling Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Pibg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elsc. Rough-in FINAL.-
Post/Beam
INAL:Post/Beam 'Mech. San. Sewer ras Line Id ✓
Plbg. Unde floor Rain Drain Framing Muinb. y
Alarm Water Line Inst la}iancli�>
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
)ate Requested: � — 1 Time: AM PM
Address: f. L �� I�`�`
Builder: C, —
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Per6 mit #: C� _ 36
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: `_/�
Date:( !'
_APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
��� JL all For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NCTICE�a%`
Inspection Line (Rec-O-Phone): 639-4175 Business PI-ane: 639-4171
Inspection: Z_,-
Footing Susp. Ceiling Sprink. ough-in Appr/Sdwlk
Fcundation Plbg. Underslab Mech. Raug -in Fireplace
Post/Beam Struct. Plbg. Top Cut Elec. Rough-in FINAL:
Post/Beam ,!-ch. San. Sewer Gey L'.ne ��C.i y •
Plbg. Underfloor Rain Drain Framing IilrPibJ
Alarm Water Line Insulation
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:_ q5 Time: AM PM
Address:_ `, s _ c��•►�L�_1.�.Y�-� e L l
Builder: 2 C' ` I Permit #: _9 5-
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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APPROVED _DISAPPRGVEU APPROVED SU J_CT TO ABOVE
,Call F Dr Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE ,
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 lt)
Inspection: —
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace I
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall yp. Bd;,� -Elect.
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Date Requ=ested: 1 U �/. 3 1�.�Time: AM PM
Address: r4 5G2=� `' `2–�Y4 �� _��
j Builder: G (2 Permit #:_J S
THE FOLLOWING CORRECTIONS ARE PEQUIRED:
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Inspector:_ _ Date:_ "
APPROVED DISAPPROVED APPROVED SUBJECT 10 ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPCCTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 63)-4171
Inspection: !-F`P
Footing Susp. Ceiling Sprink. Rough in /A,ppr/Sdwlk
Foundation Plbg. Underslab �Rough-_In Fireplace p
Post/Beam Struct. Plbg. Top Out I=lec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line1�atio�� -Mech.
Underfir. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: �' Time: AM PM
Address:
Permit a:
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: i _`.'._Date: 16zq o N ?
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`APPROVED _DIr,'APPROVED PPROVED SUBJECT TO ABOVE
_Call For Reinsp. .
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CITY OF TIGARD BUILDING INSPECTION NOTICE
L Inspection Line (Rec-O-Phone): 639-4175 Elusiness Phone: 639-4171
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Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Founda+ion Plbg. Underslab Mech. Rouge-in Fireplace
Post/Be.3m S. ^t. Oifbg. T Q Elec. Rough-in FINAL:
I
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm WatQr Lin Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: 45- 5 Time: AM �PM
lAddress:
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THE FOLLOWING CORRECTIONC ARE REC+UIRED:
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Inspec!or:- Date:
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: L
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
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` a4�r x����
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: h }�
Post/Beam Mech. San. Sewer Gas Line -Bldg. r.• a`� ;��"
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Meeh.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
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Date Requested: � ■
Time: •� AM PM r� �}� �i ,L+ ,'{*•hp k,,
Address: IZ `iS �JL(� IVt2�flVlll a fid, �,, o� ��
Builder:Jll �' 61 WAA Permit #: ILELL .15 6HZ`r
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Data:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
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—Call For Reinsp. ((
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t,"�• d �' r CITY OF TIGARD BUILDING INSPECTION NOTICE '
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
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w Inspection:
rl, s Footing Susp. Ceiling Sprink. Rc ugh-in Appr/Sdwlk
' Foundation Plbg. Underslab -_AAoct�.-Rcugh-inr Fireplace -1(
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Post/Beam Struct. Plbg. Top Out Elec. Rough-in 10 FINAL;
Post/Beam Me,:h. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain `��/ Plumb. ti ,
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. Elect.
Date Requested: 1 V 'y' Time: AM PM
Address. 1 �"�� Ga Ulf 9AJIV I"j
P r �4,ry 114
Builder,, A o 5N vya- Permit#: Mn 4
THE FOLLOWING CORRECTIONS<RE REQUIRED:
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Inspector: --------"`� Ute: 1 d �� {
_APPROVED _DISAPPROVED /Y,,APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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_ Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Pianck/Rec. #
Permiit # .L� !�y Zy
Phone (503) 639-4171 Dal,-, Issued ! -7 -�
FAX (503) 684-7297 ISSUED :1y
CITY OF TIGARD TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: !� 4. Complete Fee Schedule Below:
L Number of Ina ctions r permit allowed —
Name of Develolpment pe �'
rlddreSS I�g`I J W r` f �E I M� Service included: Items Cost(ea) Sum 1
q
City/ ;tate/Zi p �� J 4a. Residential-par unit 4
1000 rut it or less $11000
U t.,\U i,n•` '&&dddhional 500 not it or 1
Name (or name of business) porlion theroof $25 00
Commercial❑ Residential(
Lorded hsd Energy $25�
2
i Each Menu1'd Home or Modular
Dwelling Service or Feeder $68 n0
2a. Contractor Installation only: 4b.services i: seeders
Installation,Alterati +r siccation 2
Electrical Contractor 200 amps or less SIX)00 2
201 amps to 400 a, $110 00 2
Address 401 amps to 600 amps $12000
2
City State Zip 601 amps to 1000 Amps $18000 2
Phone No. Jour 1000 amps or volts $34000 2 ±
'— Recanne:t only
$5000
Contractor's License No. I
Contractor's Board Reg. No. _ 4c.Temporary Services or Feeders E
Installation,alteration,or relocation 2
Signature of Supr. Elec'n 200 amps or leas $50 oo 2 !
License No. Phone No. 201 vmps to 400 amps 100 0$7510
401 amps to 600 amps E100 00
Over 600 amps to 1000 volts
2b. For owner installations: sea Above
c� I 4d. Branch Circuits
Print Owner's Name -' (V S t New,alteration or"onsron per panel
Address 0Cb,4 .r7 �_�` _�H"� -INE- �,r a)The tae or branch circuits W tit
2
T7 / purchare of serrke or Aeeder W.
cityY( 1 _ State �� Zip. ZZ Fach bfii r_h circuit $500 _
Phone No. 5- - 4 _ hl rhe lee for branch circuits wflhouf
The installation is being made on properly I own whic" is purchase of service or Aeecier fes. z
not intended for sal , lease r rent Fist additional
nalcirbranch
t„$6 n0
R Each addhionrd branch arcuh -�_ $5 09
Owner's Signature �1 )W 4e. Miscellaneous
(Service or feeder not included) 2
3Each pump or irrigation taros $40 00 _ 2
. Plan Review section (if required):
Each sign or outline fighting $40 VO
Signal cucuit(s)or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel,alteration or w1ons,on $4000 _
_4 or more residential Unilr,in one strVcture Minor Labels(10) $10000
Service and feeder 225 amps or more
System over 600 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Pnr hourinermon $35 00
Par hour $55 00 M
I Plant $5500 _
Submit 2 eels of plans with application where any of tire above
apply. Not required for temporary construction services. 5. Fees: �Ac�
5a. Enter total of ahcve fees 8 V
NOTICE 5%Surcharge(05 X total fees) $
PERMITS BECOME'VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 15b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) 4
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. LJ Trust A i,ount N $
Balance Due $
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 638-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink, Ruugh-in Appr/Sdwlk
Foundation Plbg. Unr' ,slab Mech. Rough-in Fireplace
"s
Post/Beam Struct, Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Uncerfloor Rain Drainr ming -Plumb.
Alain Water Line Insulation
-Mech.
Underfir. Insul. Shear Will Gyp. Bd. -Elect.
Date Requested: "
Time: AM PM �
Address: L —
�-•—''�`--��'t�c car �:_'�'�- ._
Builder. 'S — U Permit #: ! c
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:—
Inspector: � �� ��—�_^
Dater `
__APPROVED I�WAPPROVED APPROVED SUBJECT TO ABOVE
vll For Reinsp.
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Cf.Y OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639 4171 I Y,
E �rdk3 i}Ir.
Inspection:
Footing Susp. CeilingSprink. Rough-in Appr/Sdwlk y�
Foundation Plbg. Underslab Mech. Rough-in Fireplace ;NPc, a� F.. •
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Moch. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain40
Framing -Plumb. + f� '..
Al;,rm Waler Lina
-Mach.
7rbi i
( Underflr. Insult Shear Wall. Gyp. Bd. -Elect.
Date Requested:_—_ cD Time: AM PM s
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Address: 4
Builder:_ / ?—( Permit #: > 0
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
, Date:
PROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
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—Call For Reinsp. 1
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j CITY OF TIGARD BUILDING INSPECTION NOTICE I
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_ i
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk I
Foundation Plbg. Underslal- Mech. Rough-in Fireplace
Post/Beam Struct. Plbg, Top Out Eloc. Rough-in j`FINAL:
Post/Beam Mech. San Sewer Gas Line ( 'V -Bldg.
Nlbg. Underfloor Rain bra;n raming -Plumb.
at0� r ,u, Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: __Time: AM PM ■
Address:__
Builder: Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED: --��
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Inspector. Date:— % —�J
_APPROVED _DISAPPROVED XAPPROVED SUBJECT TO ABOVE
Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: I
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Upderslab Mech. Rough-in Fireplace
Post/Beam Struct. C',IV Out ' Elec. Rough-in FINAL: I
Po Beam Mech. San. Sewer Gas Line -Bldg.
Plb . Unde loor +' Rain Drain Framing -Piumb.
a Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: f�y�l`l Time: ' AM —_PM
Address:
Builder: 7 c: _ r` Permit #:a',
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Ins ecmr - i Date:
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PROVED DISAPPROVED __WPPROVED SUBJE T TLS ABOVE "k
_Call For Reinsp. ��
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CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : M5T95-0306
13125 SW Hall Blvd,Tigard,Oregon o7223•mfsa3' 54:1x3%14171 DATE ISSUED: 041/28/95
y PARCEL: 2S104AA-09400 t_
SITE ADDRESS. . . : 12845 SW KATHERINE ST
SUBDIV13ION. . . . : KELLWOOD 3 ZONING: R-4. 5
BLOCK.
_______
LOT. 115
_---
REISSUE: DWEI ' I 111G UN I 1-S: 1 DAC:)=_ML I IT. . . . . . . . :0 s f ■
CLASS OF WORK. :ALT BEDRMS:2 BATHS:2 GARAGE. . . . . . . . . . 10 sf
TYPE OF USE
. . . vSF FLOOR AREAS---------- REQUIRED SETBACKS------____
TYPE OF CONST. :5N FIRST. . . . o393 of LEFT. . sO ft RIGHT. :O ft
OCCUPANCY GRP. :R3 SECOND. . . .O sf FRONT. :O ft REAR. . :O ft •
STORIES. . . . . . . : 1 FINBSMENT:O sf REQUIRED--------------------
HE IGHT. . . . . . . . : 0 ft TOTAL--------:393 s f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . E : 10000 PARKING SPACES— :0
:0 �
Remarks: (;qRRAGE CONVERTED IN TO (2) BED ROOMS AND (2) BATH Rn"MS
----------------------------------- PLUMBING ------------------------------------
SINKS. . . . . . . . . . :0 FLOOR DRAINS. . . . 10 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :2 WATER HEATERS. . . sO TRAPS. . . . . . . . . . . . . . 30
TUB/SHOWERS. . . . : 1 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :2 SEWER L,' c (ft) - :121GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :0 WATER LINE (ft ) . sO OTHER FIXTURES. . . - :0
GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :0 i
WASHING MACH. . .
:0 SF RAIN DRAINS
•4i
–__- FEES ----------------
---------------
MECHANICAL ------- -•------ -r-------------
FUELTYPES----------- l
UNIT HTRS. . :O type amount by date recpt l
/GAS/ / / VENTS . . . . . :4 SPRT $ 80. 50 B 08/28/95 95--269834
MAX INPUT:O BTU VENT FANS. . :2 BPLC t 52. 33 JD 08/04/95 95-268929
FURN ( 100K . . :0 HOODS. . . . . . :0 B5PC f 4. 03 b 08/28/95 95-269834
FURN ) =100K . . :0 WOODSTOVES. :O MPRT $ 34. 00 B 08/28/95 S5--269834
FLOOR FURN. . . . :0 CLO URYE"'r. : 0 MPLC 8. 50 B 08/28/95 95-269834
BUIL/CMP ( 31AP:O OTHER UNITS:O M5PC f 1. 70 B 08/28/95 95-269834
GAS OUTLETSsO PF'RT f 43. 00 B 08/28/95 95-269834
Owners –•----------------_-----•---- --P5PC $ 2. 25 B 08/28/95 93-269834
JULIUS SIMS
12845 SW KATHERINE ST
TIGARD OR 97223
Phone #1 579--0121
Contractor: -------------------------'---_
OWNER
Phone #:
Rc g #. . : 000000
: 228. 31 TOTAL
This permit is issued subject to the regulations contained in the ------- REwUIRED INSPECTIONS -- ----
Tigard Municipal Code, State of Ore. Specialty Codes and all other Post/Beam Strutt Mechanical Final
applicable laws. All work will be done in accordance with approved Post/Beam Meehan P1umb Final
plans. Thi, )ermit w, 1 expire if work is not started within 186 PLM/Underfloor Building Final
days of issuance, or if work is suspended for more then IN days. Mechanical I n s p _
--� Q Plumb TFraminop Out Ins Permittee Si�nature : d"" �� - - InsulatinYnsp _
I s s�_t a ci i1 y : ��_._�uu_1L y�`�" ---- - — — Gyp Board I n s p
Call for inspection — 639-4175
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Permit#: r.�� �y - D���(Q d
Address: 2-� ��e l) 1`Yk I &ay Iy1p
F: Issued by: 6 Date:
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Statement: Information 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 statemen'before a Building permit can be issued. This statement is required
for residential buit:ling, elect,ical, 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 3B:
1. I own, reside in, or will reside in the completed structure.
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2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
betore or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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OR
3B. I will be my ow►r general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
'doard. If I 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
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners ab ut Construction Responsibilities on the inverse 5ibulz of this form.
(Signature of permit applicant) (Date)
(While cope to issuing agenc.l'permit file,
pink copy to applicant)
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1 Information Notice to Property Owners
Abo,.jt Construction Responsibilities
i Note: This Inortnation Notice to Property Owners about Construction Responsibilities
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#� was developed by the Construction Contr(,rtors Board in accordance with ORS 701.0.55(5).
I$ If you 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 aw,re of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES: �
1 If 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 roust 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 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 Dept.of Revenue at 94.5-8091. ►'
Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information,call the Oregon Employment Division at the Department of Human Resources Y,
at 378-3524.
Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compensation Law,and must
obtain v.,orkers'compensation insurance for your employees. If you fail to obtain workers'c,(�mpensation in airan��, })►, m;►y a
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 at the Department of Consumer and Business Services at 945-7888,
.:' 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 1-800-829.1040.
OTHER RESPONSIBILiTIES AND AREAS OF CONCERN:
't
Code compliance: As the permit holder for this project,you are responsible for resolving any failure to mt et code requirements M�
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 coverage for
' accidents and omissions such as failing tools,paint overspray,water damage from pipe punctures, fire,or work that must be
re-done.
Time to suptrvise employees: Make sure you have suft0ent 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
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
if you have additional questions,write or call the Construction Contractors Board(PO Box 14140,Salem,OR 97309-5052,
503/378-4621). The. Board is located at 700 Summer St. NE Suite 3(X), in Svlem.
prop-own.pm4
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Residential Building Permit Application
City of Tigard r S
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: j I�. 45 S\3UK t2_1 N
Subdivision: 1�3r. (�wvcx� `3 Lot# 1 OAieer Use On!y
Valuation: ((-Q CI<_)(1P Contact Date / / initials
Result
New Construction Only: (Square Footage) Planck/Rec
Permit# /7`1 S f-- O .� D
House: Garage: Reissue of
Corner Lot? Y Flag Lot? Y DN Zan& TL#_L_ ,
Owner: u L k u�_�, S► ►'1 �1
Plat#� ry
4`J 5� 4- of C-2,( (y 6- N9'n Approvals Required -�
Address:
X14!f"Q D 2 `9l 72.2 Planning Setbacks _Solar N 4'4
Engineering
Phone: ( 5-0_,�) 6 7 Other
Contractor:
Items Required
� ������
i Address: f�) Subcontractors
Truss Details
— Other
Phone: ( ) `��} ( i E Notes %C f !"�r�'l �f 'Lti•
Contractor's License #_ D N E 2
(attach copy of current Oregon license)
Contact Name: cD W N G 2
Contact Phone: ( ) Pt 11 E
Subcontractors: Architect/Engineer:
Plumbing: ( N f ��� ( / %"/�/��l Address:
Mechanical: 1q e 2
(attach copy of current OR Contractor's L;cense)
Phone: ( )
JOB DESCRIPTION:
rl A-i ria 0o ryfs ( ) • -NI
Applicant Signature Applicant Phone number
Received by: n ice" Date Received:
Permit 0 Account Description Amount Amt. Pd. Bal. Gus I
m stys=y3o 6 Bldg. Permit (BUILD) _,
r , �
Plumb. Permit (PLUMB) J• `"O
Msch. Permit (MECN) 3
Stats Tax (TAX ) 71
Bldg: 3
Plumb: L, 2 ) g
Mech: •7 � i �
Plan Check (PLANCK)
Bldg: S 2. -3 3
Plumb:
Mech: X'• ��
,
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSOC) _
Residential TIF (TIF-R)
Mass Transit TIF (T?F-MT) �.
Commercial TIF (TIF-C)
Industrial TIF (TIF-1) _
Institutional TIF (TIF-IS) _
I
Office TIF (T1F-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
i
Fire Life Safety (FLS) _
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) _
Erosion Planck/COT (EROSN) _
TOTALS:
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Cr.ty Or 753rd409
13125 SW Hall Blvd.
Tigard, CR 97233
(503) 639-4171 - - ---
MINIMUM $25.00 PERMIT FEE +ST. SURCHAF ,
Now Slrmle Fa ilh Reoldencee Ott d
Table 3A Medkmtiui Code OTY PRICE MAT
D 1 BATH HOUSE 3140.00 (3 2 BATH HOUSE 5195. ' I
1) Permit Fee -0- -0- 10.00 I ❑ 3 BATH HOUSE 5228.00
Feil nrJtrdee aY pitftmg tbtt m in tM dlwel" and the Ibv 100 t
of wator service. sari and storm sewer. See FIN" below.
r I C) Supptemenral Permit 3.010 I � �'/ sewer
rumace aI W.CouS i' FIXTURES QTY PRICE ANT
1) incl..outs s vents I I ii.CO I Sims 9.00 I
rumaw 100.0w diULavaro '
21 incl ducts S tents I I '.SJ Tub or TulyShower Coma / 9.00 ( �� C
Hoar rumance 1I
I ii.CO I I Shower Onto � � 9.00
31 incl, vent �
u neater.ww neater Water C:oset
sneZ 9.00
r
1) oe 1cor mounted heater I 6.00 I Olahwrasner 9.6r, } ■
vent not dxL in Garbage (Disposal 9.00 I
5) am""permit I I 3.010 I Wasnrg Machine 9.00 � E
AANW at nesting,rerun.
d) cocgng,absorption unit I I 8.010 I Hoer Oran j 9.00
Sorer or,:amp. pump^ air,:onc. Water Heater 9.00 I
j i !a 3 HP:absorb urrt to 100K 3TU 3.00 I I L2unory Room Tray 9.CO
�-' oor roar a tomo, nam pump, air cone Unntai I 3.00
9) 3-15 HP:absorb until ao SOCK BTU I I 11.00 I Other Fmnyvis (Soec:y) 9.00 f
I Ioder or camp, new pump, air cora. 9.00 1
9) 15.M HP:absap unit.5-1 mil 3 iU 15.00 i
I SToiier or comp, neat pump. air cone. 9.CO
10) 10.50 HP:absom unit 1.1.'5 mil BTU j I 21 90 I 9,00
Sonar or temp. teat;ump,air coriaSateen 1st 100' 30.00 '
t t) >50 HP:absorp unit !.75 mil BTU I 37.50
r ran unit a Sewer-e& Add& 1Ca 25.00
12) 10,000 CFM I 1.550 I i Water Service 1st 1010' 30.00
Air naricirg unit I I Water Service sa. Addit. 20(r I 25.00
13) 10,000 CTM . '.:0
' Stern 3 Rain Otain 1st 100' I I 30.010
Non permse
11) evaporate cooler I I 1..0
i stem, a Rain Ona;n Addy. too• :.R.00 �
vent ran conrecaid
1
5) :o a single duct I I 3.010 I i, Mobile Herne Space I 25.010
enouaon system not Sack Flaw Prevention
161 included:n appliance pannit L� I s.SO I i' '� Cavies or And-P^Ihiden Ceviea I I 9.00
ncoC sarvec Jy any Tao ar'Naste Nct
11 mecaanical axna w I s.SJ I Cannec:ed :a a =xwre 9.010
..o^mmsr�ar-ncustnai Ca= Basin 9.00 �
191 we;ncn' emmir I 30.010 Inso. Jf Extst. Plumbing I AC.CCRtr
� er L.S.,wkacSMve.water
191 heater, scia-, doom driers,atc Scersiy Recueattsd InsoeCans 10.COR1r
I 1.x7
Rain Crain. sings `amtly -weiling I I 30.00
2.1 Gas aiaing Jna z bur cudets =^00 _ Res4entmi .ac%!cw -revent:an
levities I
21) 1Acre hon 1-0er.^,odor i
I
';Except rasidenda/ bacldfow
privet-don devices)
Niriimum ;4s 52.5.J0 SUBTOTAL L� �-
J i i -'dlnimum Fse S:3.00 SUBTOTALi-
5%SURCHARGE
5'i SURCle I )
;LAN REVIEN Z5%CF SUBTOTAL i I �' I )Z' � I �
TOTAL O1-AN Z/1 :.5°' 3U9TC AL
EN . C F I
5c:c:i :arctcrs TOTAL
301! esti:!4 ,^r
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r) PILN( Pit.L_F,1�'I
(.,1`FI^1.14 t 11 l IIy F• D 1
NAMP '101-101; 1 a��;1 d 1 •.:y, ., I` �: .
N1,►�1i1 's`� a 1��'N4�► SitW 14N1'ft 1lw:I INi. c 7. 1'1 a't i�1 I I 1 f a 0A/r:t;4✓ :,
F X C:if EZE), 1`l1? y1161) 1 V i I
111YY1 Ir fiMt:)I, NT 1-411!) I-111 I 'I ! ,► tIV 1-1-►rME.NI (Wit J01d1'
1�•I I. ; i � ,1 (1(n. `'`iffy► Ly 1,Ihll: 1 !Jl i'F 1;11 j
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11 z I r 11 C1MCJtIN 1 P011) t
4:
G1 ?'! Clr' '1`1GAR1) Ett:'i..r'ZPF 0F- PAYMENJ REC:F::Cr'T Pl. . :()1,.70—j 4.,N1+c''C3
CHFI'K nMOUNT 5;R. 31-:1
NAMC s t MA$ JIJ1_.X UR D C fl�,H AMOUNT t 0. ocn
' E'AYMF:NT DATE; OA/04/45 ADDRESS : Ea1MAI L..JGr1n Cl
12845 SW RP'TMERINF ".i1 l3llE i;►IIJItiC(trl s
F�UI�F�Cl F l'1E r'AY Mf.NT AMOUNT 'Fa I r1 G-I..1pr''f�gF (IF PAYME.NT 011C)�1N7 PAID
1r.'_' J/45 SW KATHF RING: Sl
4
PUN CK 8-44-IR
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