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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Bus cess Phone: 639.4171
Inspection:
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Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foun'ation Plbg. Underslab I'Aech. Rough-in Fireplace "{" `
Post/Beam Struct, °Ibg. Top Out Elec. Rough-in FINAL: +` ^�
Post/Beam Mech. San Sewer Gas LineB�
Plbg. Underfloor Rain Drain Framing -Plumb.
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Ala-;r Water Line Insulation -Mech.
Underflr. Insul. Shear WaI Gyp. Bd. -Elect. i a�
Date Requested: I d- Time: AM �M'
Address: a , _ �. �_Q ■
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THE FOLLOWING CORRECTIONS ARE REQUIRED: WJE 511
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Ir spector: Date: Z 7- 9Z
4'APPROVED DISAPPROVED _APPROVED SUBJECT TO ABOVE S' aki
_Call For Reinsp. ;o
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639 4175 Business Phone: 639-4171
Inspection: ,'°
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
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' Foundation Plbg. Underslab h,.;ch. Rough-in Fireplace
Post/Beam Strut. Plbg. Top Out Elec. Rough-in FINAL: g'�� � �
I'wst/Beam Mech, Sari. Sewer Gas Line Bldg. �� ,c��µ, + 1 �
Pibg. Underfloor Rain Drain Framing -Plumb.
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Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. CElec
Date Requested: ( Time: AM PM
Address:
Permit#:C�'1 e) f o G
� E FOLLOWING CORRECTIONS ARE REOUIHED:
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Date:
APPROVED k` DISAPPROV D _APPROVED SUBJE3T TO ABOVE
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CITY OF TIGARD 3UILDING INSPECTION NOTICE
Inspection
Inspection Line ec-O Phone): 639-417F Business Phone: 6 9-41
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Inspection:_ ZJ. N�
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwll -,_/
Foindaticn Plbg. Underslab Mech. Rough-in Fireplace
lost/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
I'ost/Beam Mech. San. Sewer Gas Line
Plbg. Underfloor Rain Drain Framing -PlOb. -4 -
Alarm Water Line Insulation CM-ecF
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Underflr. Insul, Shear Wall Gyp. Bd.
Date Requested: 7 C� ��3�_Time: AM 'M
Address
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Permit #: 'k
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THE FOLLOWING CORRECTIONS ARE REQUIRED: "
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Inspector:_ Date: �—� 7
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APPROVED ^DISAPPROVED ,L—APPROVED SU13JECT 10 ABOVE
—Call For Reinsp.
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Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
b Inspection:
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Footing Suso. Ceiling Sprink. Rough-in Appr/5dwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplane I
Post/Beam Struct. Plbg. Top Out Elec. Rough in FINAL:
?ost/Beam Mech. San. Sewer Cas Line
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Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation Me /
Undedir. Insul. Shear Wall Gyp. Bd. -Elect./
Date Requested:_ � Time: AM PM
Addre3s: l U I�! ���. �-�� 4�x r��,� i ��d��r� � Nj14 r; ■
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THE FOLLOWING CORRECTIONS ARE REQUIRED: }�•':�� ;�,al`�` ' `9`
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_APPROVED
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Call For Reinsp,
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CITY OF TIGARD BUILDING INSPECTION NOTIUF Jnt
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 /
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: ■
Post/deam Mech. San. Sawer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wal! 4?YP_De -Elect.
Date Requested:` ( ? Time: AM PM
Address:
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Builder: !Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date: �a
APPROVED f DISAPPROVED '—A15PROVED SUBJECT TO ABOVE
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hoc/ 4 .<< Inspection Line (Rec-O-Phonu): 639-4175 Businr ss Phone: 639-417'
Inspection:
Footing Susp. Ceiling Sprink. Rough-inppr/Sdwlk
`t Foundation Plbg. Underslab ech. Rough in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in$hl FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
PIbg. Unddrfloor Rain Drain ramin Plumb. F MN
Alarm Water Line nsu �/ Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: �' TimeL>AM PMS
Address' I �O �i( � f1/L•C��y byµ
Builder: Q Permit#:
THE FOLLOWING CORRECTIONS ARE REQUIRED;
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Inspector: Vw Dater rk"
_APf HovEo DISAPPROVED OVED SUBJECT TO Ab)VE
I� 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:
' IFooting Susp. Ceiling Sprink. Rough in Appr/Sdwlk h '6-
Foundation
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: Fr9k"'
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Post/Beam Mech. San. Sewer Gas Line -Bldg.
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Plbg. Unde1loor Rain Drain Framing -Plumb. t 1i fA, r ;,r ■
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Alarm Water Line Insulation -Mech. y ' '� 5
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Underilr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: � S Time:�AM
PM
Address:_ 1 JUGS mac' - lam c r
'yam_Permit #: 01 S
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THE FOLLOWING CORRECTIONS ARE REQUIRED:,aC
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_APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
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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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Footing Susp. Ceiling Z=��XFireplace
Appr;Sdwlk I
Foundation Plbg. Underslab
Post/Beam StrMt. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
P'bg. Underfloor Rain Drain Framin -Plumb.
Alarm Water Line Insulation -Mach. z.
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Underflr. Insul, Shear Wall Gyp. Ed. -Elect. ±�
Date Requested: Time: AM PM
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Address: / GU
Builder: �' y U
Perrnd #: � --
THE FOLLOWING CCARECTIONS ARE REQUIRED , ` C�
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Inspector:
Date:
I APPROVED X"APPROVED _APPROVED SUBJECT TO ABOVE
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CITY OF TIGARD BUILDING INSPECTION NOTICE e fi
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 I
Inspection: a
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Footing Susp. Ceiling Sprink, Rough-in Appr/Sdwlk f I
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Suuct. 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 -Mech. ,
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t;nderflr. 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:
APPROVED f DISAPPROVED _APPROVED SUBJECT TO ABOVE
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Community Cevelopment ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, CR 97223 Planck/Rec. # �„
Permit # C
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Phone (503) 639-4171 Date Issued �i�5'�
CITY OF TIG RD FAX (503) 684-7297 Issued by /� t
TDD No. (503) 684-2772 - I
Inspection (503) 639-4175
1. Job Address: a. Complete Fee Schedule Below:
Name of Development _ Number of Inspections per permit allowed 1
Address ,U U U �� r lttt S Serviceincluded: Items Cost(ea) Sum
I City/State/Zip �j 6"',et" 4a. Residential-per unit <
1000 aq it or lees $11000
Name (or name of business) Each additional 500 m It or
oortion thereof $25 00 1
Commercial❑ Residential Limiled Energy $2503 A
1 Tach Manurd Home or Modular 2
Dwelling Service or Feeder $6B 00
2a. Contractor Installation only: Ab.Services or Feeders
i Inatallation,alleralion,or relocation 2
Electrical Contractor_ _ 200 amps or lase $6000 _ 2
Address 201 amps to 400 amps $19000 _ 2
City State Zip 401 amps to 600 amps $12000 2
601 amps to 1000 amps $18000 2
Phone No. Over 1000 amps or volts $34000 2
Contractor's License No. Fleconnedonly $5000
Contractor's Board Reg. N0. 4c. Temporary Services or Feeders
Installation,alteration,or relocation 2
Signature of Supr. Elec'n _ 21`10 amps or less $5000 2
License No. Phone No. 201 amps to 400 amps $7500 2
— 401 amps to BOO amps $10000
Over 600 amps to 1000 volts
2b. For owner Installations: see W above
Print Owner's 'V31`11k? .rL _L-(�/3, 4d, Branch Circuits
/.� New,altcraiion or extension per panel
Address /rar'�w� �/ `1•'r•-Y �!/� C� n)The lee for branch clrronls with
-- urcha"of sayke or�r Asa. 2
City �JJ State_ Zip i1-3 5 p
"- --- Each branch entad $500
Phone No. � - '� Mi-
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_�. _ b)The les for branch scowls without
The installation is being made on property i own which is purchsaa of servke or Header fes. 2
not intended for sale, lease Or rent. First branch circuit $35.00 2Each additional branch circuit allf, $5,00
Owner's Signature �y Y [./ '`��' �0 5 •- .r� _ 4e. Miscellaneous
(Service or feeder not included) 2
i 3. Plan Review section (if required): Ench pump or irrigation circle $4000 2
' Each sign or oullino lighting $4000
Signal circuil(s)or a horded energy 2
Please check appropriate item and enter fee in section SB panel,aherawn or axlensron $4000
4 or more residential units in one structure Minor Labels(10) $10000
Service and feeder 225 amps or more
_M System over 600 wits nominal 41. Each additional insraction over
Classified area or structure containing special occupancy the allowable in ani of the above
as described in N E.0 Chapter 5 per inspection $35 tie
Par hour E55 00
i Submit 2 sets 3f plans with application where any o'the above In Plant $5500
apply. Not required for temporary construction services. $. Fees:
r�IC
NOTI^,E 5a. Enter total of above fees $ C
5%Surcharge(05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for L
CONSTRUCTION OR WORK IS SUSPENDFD OR ABANDONED FOR Plan Review it required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Suhlotal $
COMMENCED. ❑ TRISt Accowit 0
$ rr
Balance Due $ fir' C
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: a
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace "
Post/Beam Struct. °'bg. Top Out Elec. Rough-in F"IAL: ` •
Post/Beam Mech. San. ")ewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
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Alarm Water Line Insulation Mech. 'J "Wil I
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UndeHlr. Insul. Shear W II yp. B .) -Elect.
Date Requested: ( Time: AM PM >r
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Address:
Builder: U O Z Z--- Pe snit#: k
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NE FOLLOWING COR CTIONS ARE REOU D: "
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Ins ctor l.�l , �✓�.__.__ Date: `� ✓ }
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PPROVED _DISAPPROVED `F-'PROVED SUBJE6T TO ABOVE `
Cal; For Reinsp.
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r{, CITY OF TIGARD BUILDING INSPECTION NOTICE (�\\
In,pection Line (Rec O Phone): 639-4175 Business Phonc: 639 4171
Inspection:
Footing Susp. Coiling Sprink. Rough-in Appr/Sdwlk
Foundation 11Ibg. Underslab Mach. Rough-in F replace
I Post/Beam Struct, Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mach. San. Sewer Gas Line
-Bldg.
Plbg. Underfloor Rain Drain Plumb.
Alarm Water Line Insulation
-Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
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Date Requested:_ #r'
Time: AM PM
Address. / I
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— - ����; permit#:��—c>C;)
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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APPROVED DISAPPROVED
APPROVED 4
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< 1r _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:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
'I Foundation Plbg. Jnderslab Mech. Rough-in Fireplace
4,
Post/Beam Struct. Plh,. Top Out Elec. Rough-in FINAL:
Post/Beam Mec'I. San. Sewer Gas Line -Bldg. I
Plbg. Underflooi Rain Drainraming ) -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
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Date Requested: Time: AM PM
Address:_
F. _ Permit #: C
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: -- _ Date:
APPROVED DISAPPROVED PROVED SUBJECT TO ABOVE
_Call For Reinsp.
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DEPARTMENT OF LAND USE&TRANSPORTATION '
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILL•SBORO,OR 97124 j
COUNTY, INSPECTION REQUESTS: 503/640-3561/693-4415
OREGON
XXXXXXXXX--> 640-347U
Page 1 of 1
1
Date 05/01/y'.,
'1'iine 12 . 27 i
Permit 'Type ttesidential Electrical :permit Permit # 05067058 {
Permit Status A!'NRUVEU Applied 05/01/95
6itus Address 12900 SW KA'FHERINE ST 'TI Issued 05/01/55
Permit 'Title SFR - ONL•; CIRCUIT Completed
Permit Uescr, To Expire 90/28/91,,
Project 'Title SFR - UNh' C'IH(:U.LT Project # P0049565
Project Uescr. * EROSIUN
Parcel Nuitiber 2611,1 - Land Use District ; 4
Valuation U
Legal L+esc:r ,
Uwtier INSPECTION - 'T1VAkO Construction UTH
Applicant Name : 113A, 1'1M Classification 900
Applicant Addz , : 1 Z 9 0U SW KA'I.'HER1NE ST Occupancy
TIGARD UK 9'/l.Z3 Validated by JF
Applicant phone: 590-84ZZ Inspector Area �
Fee description Uri,its F'ee/Unit. Ext fee Data
-___-_----_--------___..__..____..___. ._______.____
let Branch W/out Feeder [Enter #] 1 3b , 00 35 , 00
bubtotxl Electri(_-,i1 Feces : 35 . 00
State Surcharge ai 5%
" 'Total Electrical Fees : 3b . 75
*�* Fees Required *** *** F'eeo Collected & tredits ***
------------------------------------------_---
-W Method Check # Receipt No . Bate Payment
CK x`117 36 . 75
TUTAL 'THIS UA E *,t*** *** 3b . '/5
Fees : 3b ,'/5
AdJustments : UU 'Total Credits : . U0
Total Fees : 3b . '/b 'Total Payments : 36 . 7b
balance Due : 00 t
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NOTICE: This permit becomes null and void If the work or construction for which,t Is Issued Is not commenced within 180 days. Once construction has started,
the permit becomes null and void If construction Is Interrupted for a period of 180 days. I cei My that the Information presented by the applicant and I
his agent or agents In support of this permit Is true and correct ,the best of our knowledge. I acknowledge that the Building Depsrtmr�t's reliance
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be compiled with whether or not specs lee-m the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit doss not grant authority to access private propertt or to use ensements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various times during the process of construction and the building
Inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure oermltted prior to approval by the x
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until all Inspection requirements are satisfied and t
approval Is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structv,n Is provlalonal and revocable until the satisfaction of all Inspection requirements.
APPLICANT'S SIONATUl1 )
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• WASHINGTON COUNTY ELECTRICALion PERMIT
Department of Land Use & Transportat
Electrical Inspection Section APPLICATION
155 North First Avenue,#350.12
Hillsboro, Oregon 97124
Information: 503 840,3470 FAA: 503 693.441? Project/Permit/� - r
^_
' ' S Number L'�0� �d 7 Date
Please cornplete, all secTions, 1 through 5.
i 1. Ltacatlon of jjnstallatlon .L 4. Complete Fee Schedule below I
sAddress �a 9 D o S k KA l )1 c.Y- i ►1 e _�' Number of Inspections per permit allowed I .
Building Service included: Items Cost(ea.) Sum
City I Suite No. I
A. Residential-per unit
Tenant Name
(if commercial) _ 1000 sq.ft.or less $110.00 4 l
Each additional 5sq.ft
Tax Lot �.��� Map No. �� -3 00 or portion thereof $25.00
Limited Energy $25.00 1
Thomas Map Book- Page: Section:_ Each Manuf'd Home or Modular
Directions t ' 'r r aL f'`t Dwelling Service or Feeder $68.00 - 2
LLI� cil �Ii�/rrtrrti /'1 r�� � LE°1� c`yl It"<47Lltr r.tt: J�.
B. Services or Feeders
Commercial ❑ Residentialr-11f Installation,alterations or relocation
2.00 amps or lose $60.00 2
r 201 amps to 400 amps $80.00 2
2a. Contractor Installation only: 401 amps to 6(10 f ripe _- $120.00 2
Electrical Contractor 601 amps to 1000 amp,, - $180.00 2
Address Over 1000 amps or volts $340.00 2
Date Job Number Reconnect only $50.00 2
Property Owner
s - -' C. Temporary Services or Feeders
Contractor's License No. Installation,alteration or relocation
Contractor's Board Reg. No. 200 amps or less $50.00 _ 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n 401 amps to 600 amps _ $100.00 _ 2
I
License No. Phone No. _ Over 600 amps to 1000 volts see W rbove
2b. For owns Installations: D. Branch Circuits
New,alteration or extension per panel
it a� s) The fee for branch circuits with
PrintOwner's a•,le I ikon-No.
k �)C� "510 K pure hese of service or feeder nee. --^
rEach branch circuit $5.00 _ 2
P J b) The fee for branch circuits without
1 tate �� purchase of service or feeder lee. ,f q d
First branch circuit -J-. $35.00 2
The installation is being made on property I own Each add'nl brar,rh circuit $5.00 2
which is not intended for sale, lease or rent. E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
Owner's Signature Each sign or outline lighting $40.00 2
Signal circuit(s)or a limited
3. Plan Review section (if required) energy panel,alteration
Please check appropriate hem and enter fee In section 5B. or extension 040.00 2
_ 1 & 2 family dwellings over 320 amps s/c meter F. Each additional inspection over the alto! 'able
4 or more residential units in one structure In any the above
- Per insppee ction _ $35.00 _
Service over 225 amps, feeder 400 amps or more Per hour $55.00
System over 600 volts nominal In Plant __ $55.00 _
- Building over 3 stories in height
_ Building over 10,000 sq. ft. 5. Fees
_ Occupant load over 99 persons A. Enter total of above fees $ J J- 06,
Manufactured Structures Park or Recreational F% Surcharge (.05 X total fees) s -_
Vehicle Park; new, addition or alteration Subtotal $
Classified area or structure containing special B. Enter 25% of line A for
Plan
occupancy as described in N.E.C. Chapter 5 Subtotal view ;f required (Section 3) $
Submit 2 sets of plans with application where arru 3f the Less Bulk Label Fee $
above apply. Not required for temporary construction
services. Balance Due
For Inspections call ihle permit becomes null and void N the work sulhorited by the permit Is not commenced
within I90 days from dale of issuance of such permit or N the work authorized la
640-3561 or 693-x{415
j L suspended or abandoned at any time after work la commenced for s period of 190 days,
)j -hour recorder,one working day In advance of need MIrlul Permits are non-refundable end nominnefereble
5/93
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j DEPARTMENT OF LAND USE & TRANSPORTATIOI1
LAND DEVELOPMENT SERVICES DIVISION #350-12
WASHINGTON 155 NORTHF � BORO, OR 97124 `` r
COUN'T'Y,
PHONES /640.3470
IZ
OGON INSPECTI Nours): 503/640-3561 or 693-4415
Permit # : 05067096 Fr,3joct # i P0049565 Status P.PPRoVED Paq.a 1 est 1 4i
Applied 05/01/9'a Issued 05/01 /UE Exl-Tres 10/28/95 01/04/95 05 01 �;',•','
I
RE:�FLEG 4,'' ■
PeLmit Title SFR ONE CIRCUIT oTH
Description Begun . 0b/01/95
Job Address 12900 SW KATHERINE ST TI ;t
Owner Nam* INSPECTION - TIGARD Reg.i,)n U
Applicant_ Name IBA, TIM
Phone number 510-13422 Valuation 0 Approved__.___
Inspector Colluluents �
Rei
t
IV11-RF:tUIT' ''
k,
REQUEST ERROR ' �..
� _........... -.—._..�._._ ... _._ _........—.__..__......... __._._...-.—�—.__......... —_. .____...__-..-..--..._._......�._... _..�._......�...�._..._._�._. _- I � tib.
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Plumbing
Mechanical :
Ele:trir.al :
St.ruct.rual
General
Inapected by hate�`;f.r(�-----5//_.. �.
Inspection Requested
rover & S*rv.lrr X1403 fi Al; i.�N JV.K 1
05/04/95 RI 11IlVi4 H523 H /
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DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 0350-12
155 NORTH FIRST, HILLSBORO, OR 97124 0
COUNTY', PHONE: 503/640.3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
Derr( _ U67U )6 Project. # P0049565 Status APPROVED page I oI 1
Applied 05/01 /9—: Issued 05/01/99 Expires 10/2N/95 U5/1i/9 Ua 2
RE:;ELEC
Permit Title SF Il - ONE CIRCUIT OTH
DescriptionBequn : 05/01/95 6
Jot, Addrer.s 12900 SW KATHERI.Nf T TI
Owner Name INEPECTICSN - TIrARD Region is
Anplicant. Name IBA: TIM
Phonv number 590-8422 Vr,luatI'Dn 0 App.caved t
I r,ap e c t o r C,omm e n t.r. Rejected_-_____._
:
_..._.........
...�
lVR-RESULTS
REQUEST ERROR!
Plumbing
Met~h a n i c a l _._ _ ---•- M_r._ _..___ _.._
Electrical
Structrual
Gamer. a1. _
i r.cver-t.e d by
Inspection Requested
CovFr 0403 E AN N : '�ra1
0 / 11 /95 RI 12IIVK H523 N
05/05/95 ISN N, PNIVti LLIT7 I I f�
q 05/04/95 I2I uIIVH H52A H
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec O Phone): 639-4175 Business Phone: 639-41 7T
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk �+
Foundation �Ibg. Underslab Mech. Rough-in Fireplace
-Post/Beam Struct.�Ibg. Top Out Elec. Rough-in FINAL:
(Pamost/BeMeeh. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: /� ( �� _Time: AM PM
I Address: 1 caG'G> ,. c� /L _L ,.
F _ _
Builder: ryt J C� �( ? Z_ Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
I
i
I
I
Inspec tor: L ' �� Date:
'--APf7ROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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I �.
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l_17 1. —� lr MASTER PERMIT
: ITY1:' MIT #. . . . . . . . Mzp.,-005
OF _.. , DA'rE ISSUED: 03/21/95
COMMUNITY DEVELOPMENT DI_PAAiNT
13126 SW Hall Blvd.Tigard,Oregon 9722301911 (603)839-4171
PARCEL: cS104AA--1111300 °
S I I L. w ul,fi{�..,�. . . . t c'j 1�,I�i ;.7W riN T I,l.fry 1 W[. :.�1 ...-• ,� ,,,,,._......, ,
SUBDIVISTt,ra. . . . s BELLWOOD :3 � �- , f.,L ZONING: R-4. 5
BUILDING
RE I SSUE t DWELLING UN I TS: 1 EASEMENT. . I�
LLHSii OF W. 'K. :ADD BUDRMS:O BATHS:O GARAGE. . . . . . . . . . s216 s f +;`;r ■
TYPE OF U51 . . . -SF F=1..iJOR AREAS------------ REQUIRED
1 YPL UF* CUN S'r. :5N FIRST. . . . s75 S LEFT. . s9 ft RIGH'r. :0 ft p
j OCCUPANCY GRP. :R3 SECOND. . . -.5b9 s f F'RONT. :call f t REAR. . :20 f t
6 S I UH I ES. . . . . . . :2 F I NSSME:NT s O s f REUU I RED-----------------------
-JE 1(31-11.. . . . . . . . ..22
-------------_.,.._._,_---_.__-IEI(31•11.. . . . . . . . :22 ft TClTAL-- - -- -:6:54 5f SMOIf.L`= DETECTORS. : Y
FLUOR LOAD. . . . :40 psf VALUE. . . . . zl;: 51615 T='ARKING 6F•'AGE5. . :0
Remarks : ADDING 2ND f L.00R ABOVE GARAGE. AND PDD1NG SHOP AREA
-------------------------------------- PLUMBING
SINK... . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BAC:K1=LQW PREVNTRIS. . ;0
LAVATORIES. . . . . .0 WA7EH HEATERS. . . :0 TRAPS. . . . . . . . . . . . :0
TUB/SHOWERS. . . . :,0 LAUNDRY TRA''t;3. . . t 141 CATCH BASINS. . . . . . . .0
WATER CLOSETS. . :0 SEWER LINE= (ft) . :0 GREASE TRAPS. . . . . . . s 0
DISHWASHERS. . . . WATER LINE: (ft ) . :0 OTHER FIXTURES. . . . . .0
6AHBAbL D 1 SP. . . 110 RAIN DRAIN (ft ) . :0
WASHING MACH. . . :0 GI= RAIN DRAINS. . i k
MECHANICAL .____._______,_. ._._..._..__ _ _.. _._ .. _.___ VLLS
FUE:I. T'Yi-i :i- _- —.__,____. UNIT HTPS. A type amount by date r,ec:pt
VENTS . . . . . :2 BPRT $ 289. 00 JD 02/13/95 95-261659
t.Af,
r1AX INPL11 -0 LTU VENT FANS. . :0 BPLC $ 187. 85 JF In2/01/95 95--2:61 1'19 4,
F'URN . . :0 HOODS. . . . . . .0 B5PC $ 14. 45 JD 02/13/95 95-261659 t r
!'=URN ) -:100K , . :V+ Wf]r.7DS I'OVE S. t 0 MPRT $ 25. 00 JD 0,`/13/`-)5 'd5._ 165').
FLOUR TURN. . . . sO CLO DRYERS. : lit M5PC t 1. 25 JD 02/13/95 95—w61659
MOIL/CME' ( .3'H rlb OTHER UNITS:0 ERGS f 40. 00 JD 02/1 /
GAS OUTLETS:O ERPC 1:3. 00 JD 02/13/95 95-261659
Owners i.;s. 0111 JD ID /13 X35 16 59 "
'T ISA, A CHRIS IBA
1.4900 WG KATHERINE ST
f�
C I GARD OR 97222
I-)hone #: 503--653--365:3
Contractor-:
OWNER
S
Phone #s
$ 5(3;.3. 55 TOTAL.
This pervit :s issued subject to the regulations costa!:reo in the - ------- REQUIRED INSPEC"i I ON`s -- - - -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Footing Insp Gyp l o ar-d Insp
applicable laws. All work will be done in accordance with approved F o t.1nd at i on Insp Rain dr-a i r. Insp
plans. This peren will expire if work is not started within 180 Post/beaten 5trt.tct, Mt'c.,hatr!ical Fina i
lays of issuance, or if work is susprtded fat, more than 188 days, Post/Ream MerWhan Natiloing Final
CrRWI Crain Erosion Cunt -o i.
;Per.mitt:ee Siynrtt 1 ra ; .._.�__ Mec-hat,ic al Ins
FramingFt-aming Insp
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Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 d
(503) 639-4171 I
j Jobsite Address: 7 9 O
Subdivision: � G�'D��c( Lot# Office Use Only
1
Contact Jate / Z/,`Zs_Initials
Valuation: — Re��.t;t —� _ --- ■
Planck/Rec #
New Construction Only: (Square Footage) Permit #
House: _ Garage: _ Reissue of
Map & TL#
Zone
Plat #
Corner Lot? Y N Flag Lot? Y N
Owner:
Approvals Required
_•L I i'� �- � � ✓�� _
Planning Setbacks Solar
Address: — Engineering
Other.
Items Required
Phone: ( ) —
Subcontractors
Contractor: — — Truss Details _
Other _
Address:
Notes L -h r �"5
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Phone:
Contractor's License #
(attach copy of current Oregon license)
Contact Name: _
Contact Phone:
Subcontractors: Arch itect/EngI leer:
Plumbing: Address:
Mechanical: --
(attach copy of current OR Contractor's License)
Phone:
JOEL DESCRIPTION: _ _ —
Applicant Signature Applicant Phone number
Received by: C� . C-L 11,L���t Date Received: 1
NUopnUnvnyq -�'� i_ �/E / �C•'� / �'�0 wi f so vL '
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Permit* Account Description Amount Amt. Pd. Sal. Dub
Bldg. Permit (BUILD) - ti .
Plumb. Permit (PLUMB)
4
Mech. Permit (MECE%
State Tax (TA)V
Bldg:
Plu;nb: '.
Mech: /
�i
52-
Plan Check (PLANCK) i'� w 4
Bldg: :
Plumb:
Mech:
_ Sewer Connectlo,i (SWUSA)
Sewer Inspecti)n (SWINSP) _
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) _
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Office TIF (TIF-0) _
Water Quality (WOUAL)
Water Quantity (WOUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN) _
TOTALS:
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° :MST95-0055 : PROJECT:DELLWOOD STATUS: I UPD: 03/21/95 : :BLT: °
° PERMITTi7,E:TIN & CHRIS IBA PRIM. . :MST95-0055 : °
° SITE ADDRESS: 12900 SW KATHERINE ST °
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Fee Type------------ Fee-Amount Amount--Pd Receipt--- By- Date--Pd o o k �
{aa° (C) BLDG PERMIT FEE $ 289. (.i) $ 260 . 50 95-261659 JD 02/13/95 06(;
0 0 (C) PLN REVW - STRUC $ 187 . 85 $ 169 .33 95-261199 JF 02/01/95 0 0 ,
0 0 (C) 5t STATE SURCHRG $ 14 .45 $ 13 . 03 95-261659 JD 02/13/95 ° ° y;„j.
° ° (C) MECH PERMIT FEE $ 25 . 00 $ 25 . 00 95-261659 JD 02/13/95 ° °
° ° (C) MECH 5$ SURCHARG $ 1.25 $ 1 .25 95-261659 JD 02/13/95 0 0
° ° USA EROSION PERMIT S 40 . 00 $ 26 . 00 95-261659 JD 02/13/95 0 0
° ° EROSION PLANCK - USA $ 13 . 00 $ 8 .45 95-261659 JD 02/13/95 0 0
° ° EROSION PLANCK - COT $ 13 . 00 $ 8 .45 95-261659 JD 02/13/95 0 0
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° :MST95-0055 : PROJECT:BELLWOOD STATUS: I : UPD: 03/21/95 : :BLT: °
° PERMITTEE:TIN & CHRIS IBA PRIM. . :MST95-0055 : °
° SITE ADDRESS: 12900 SW KATHERINE ST °
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° ° * Fee Type------------ Fee-Amount Amoltnt--Pd Receipt--- By- Date--Pd ° °
{la° (C) BLDG PERMIT FEE $ 289 . 00 $ 299 . 00 95--261659 JD 02/13/95 °aq
° ° (C) PLN REVW - STRUC $ 187 . 05 $ 187 . 85 95 .261199 JF 02/01/95 ° °
° ° (C) 5%r STATE SURCHRG $ 1,11 45 fi 1.4 .45 95-261659 JD 02/13/95 ° °
° ° (C) MECH PERMIT FEE $ 25 . 00 $ 21- . 00 95-261659 JD 02/13/95 ° °
° ° (C) MECH 5% SURCHARG $ 1 . 25 $ 1 . 25 95-261659 JD 02/13/95 0 0
° ° USA EROSION PERMIT $ 40 . 00 $ 40 . 00 95-261659 JD 02/13/95 ° °
° ° EROSION PLANCK - USA $ 13 . 00 $ 13 . 00 95-261659 JD C2/13/95 ° °
° ° EROSION PLANCK - COT $ 13 . 00 $ 13 . 00 95-261659 JD 02/13/9 ° 0
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CI'T'Y ;1F T I GARD - RECEIPT OF PAYMENT RECEIPT NO. :95-263216
D4ECK, AMOUNT s 71. 54
IHAME a IMA, TIM AND CHRIS I5 CASH AMOUNT a V+. 00
y� )UC)RESS a liP900 SW KA1'FIERXNE c>1 PAYMENT DATE a 03/22/95
y TIGARD, ORSUBDIVISION i
97P.23—
]PURPOBE: Of' F>A'V'ME-NT AMOUNT PAID PURPOSE'. OF PAYMENT "AMOUNT PAID
DUILIDINQ PERM +ML�T95c'A, ."r{t� 97'. ^E;IIII.L? F,fER..._._ ..._..�. � _ 1. 42+
PLAN CHECK FE t a. 5c1 EROSION ION C:nNTROL. PErM I TFEX 14. 00
lERUfiIC1N CONTROL PLAN !', 4. 55 CR{]"aTON j.'f)
, N"fROE_. 4. 55
p
iDD I T IONAL FEES FOR PERMIT ON MOT95•-0053 t
TOTAL AMOUNT PAID - _ — -. 71.. 54
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 t
Inspection: 1'
I
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk "
A
un atio Plbg. Underslab Mech. R.,ugh-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. Sari. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Flumb.
Alarm Water Line Insulation -Mech. '
lU�derflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Hequested: � LA S Time: AM PM
Address:_ �' e-leG-'
Builder: /G� c�`�z—Z r Permiit #:_..5
l'-
THE FOLLOWING CORRECTIONS A5E REQUIRED'
Z✓ ')T
1
d
I
Inspector:__7:Z7 Date: ,
I �/ ,.
(� APPROVED _DISAPPROVED _ APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
;grarw,iw.awe.....,...........,,...�..._.._.._ _ _ _ _ ._-.._.....,..... (
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.CITY OF TIGARDMASIER �tOt"EPERMIT
COMMUNITY DEVELOPMENT DEPARTMENT F�' RMI'1 #. . . . . . . .. M S T 9`�-
13125 SW Hall Blvd.Tigard,Oregon 07223.9164 (501)'01 17) DATE. ISSUED: 02/13/95 �I
r PARCEL: y51+1114AA-103x«0
12900 SW KATHER I Ne ST
SITE ADDRESS. . . : '
SUBDIVISION. . . . .
BELLWOOD 3 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . : 122
�______-----____.___ BUILDING
REISSUE:
DWELLING I NG UEU I TG: 1 BASEMENT.. . . . . . . . :0 sf
' CLASS UF WURK. .ADD E'cDRM5:0 BATHS:O GARAGE. . . . . . . ,
. . ,�16 sf k.
'`
TYPE OF USE. . . :SF FLUOR AREAS_____,..__._._ REQUIRED SETBACKS___--.___....__._
I'YPEw OF CONST. :5N FIRS"f. . . . :75 sf LEFT. . :9 ft RIGHT'. :0 ft
OCCUPANCY GRP. :R3 SECOND. . . :559 sf FRONT. :20 ft REAR. . :; 0 ft �
STORIES. . . . . . . :2 F I NBSME:NT:O sf
HEIGHT. . . . . . . . :22 ft TOTAL---_-.---:634 sf SMOKE DETE:CTORS. :Y
F LUUR LOAD. . . . :40 ps f VALUE. . . . . $ : 44508 PARKING SPACES. . :@
Remarks : ADDING 2ND FLOOR ABOVE GARAGE AND ADDING SHOP AREA �
_.--------------------------------— PLUMBING __._______.._._______.__._________.-------------
SINKS. . . . . . . . .
.-__--__---_SINKS. . . . . . . . . . :@ FLOOR DRAINS. . . . :0 BACKFLOW PREVNTR5. . :V)
ij
LHVAI'ORIES. . . . . ..0 WATER HEATERS. . . :QI TRAPS. . . . . . . . . . . . . . :0
TUP/,SHOWURG. . . . -0 LAUNDRY TRAYS. . . CATCH BASINS. . . . . . . :0
WgTER CLOSE:TS. . :O SEWER t_INE (ft ) . :0 GRE=ASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :0 , ATER LINE:" (fft ) . :0 vriiER FIXTUFIES. . . . . :0
UARBAGE DISP. . . o0 RAIN DRAIN ( Ft) . :0
WAt�H I NG MACH. . . :0 aF [RAIN DRAINS. . '.0
MECHANICAL .________.__.�---.______ __._..v____..._._- FEES
FUEL TYPEMS-..----.-.--•-- UNIT' HTRS. . :0 type amolint by date recpt:
/GAS/ / / VENTS . . . . . :2 BPRT f 260. 50 JD 02/13/95 95-261659 #
„ -
MAX INPUT-0 BTU VENT F"ANS. . :0 BPLC $ 161. ,•33 JF 02/01 /95 95 ~1199
(=URN ( 100K . . :0 HOODS. . . . . . :0 135PL; E 13. 03 JD 02/1:3/95 95-261659
f"URN D =IOOK . . :0 WOODS'TOVES. :VA MPRT $ 25. 00 ID 1112/13/95 95-2611.59
FLOUR TURN. . . . s 0 CLO DRYERS. t 0 M5PC t 1. 25 JD 02/13/95 95••-2:61659
BOIL/CMP ( 31-iPgO OTHER UNITS,.0 LROS $ 26. 011) .ID 162/13/95 95--261659
GAS OUTLETS:O ERPC $ 9. 45 JD 02/1:3/95 95-•261659
' Owner: $ 8. 45 JD 02/13/95 95--E'61659
TIN & CHRIS IBA
12900 WS KATHERINE ST
k`.
T I GARD OR 97a22
Phone #: 503-653---j653
Contractors
('.)WNER
:f
Phone #:
Reg #. . .
$ `Jic. 01 TOTAL
AL
This permit is issued subject to the regulations contained in the -- - - -- REQUIRED I NSPECf I GINS -- __
{
Tigard Municipal Code, State of Ore, Specialty Codes and all other Footing Insp Gyp Board Inst)
applicable laws. All work will be done in accordance with approved F O undat i on Insp Rain drain Insp
plane. This permit will expire if work is not started within 160 POst/Beam StrLiet Mechanical Final
dayt of issuance, or if work is suspended for more than IN a s. Post/Seam Meehan BUilding Final
_._....._.__ Crawl Drain Erosion Control
rU,ermitee ails " t; a s + _- ..._._.W Me( hanic:al Insp
iwraming Insp
s;5t.1e(i y ^ -- � � �. insi_llat ion Tnsp
Cali for inspect i-on 639-4175
-
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City of Tigard
Residential Building Permit Application
�-�` �
13925 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
I �
Subdivision: ��(`.'� l 00 D d Lot# A)20 C) Office Use Only
Valuation: Planck/Rec# I
�--,
Corner Lot? y No Permit#A Sl�SY-0""5-5
Flag Lot? Y Reissue of a
Map &TL# ZS/U 414/1 — l 0Gc1
Owner: ✓/ l 11 a C'h r I S _L l`�
Approvals Required
Address: l CO .a W K-�A I k L C- jPlanning
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j - Engineering
j Phone: �� -�__ cc �o u!� $ j�•5
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Contractor: o WN Oe" Items Reaulred
Address: _ Subcontractors
Truss Details
w Phone: Other _
Contractor's License #
(attach copy of current Oregon license) i
Contact Name & Phone:
Subcontractors: _
111 Architect/Engtneer:
Plumbing: N Address:
Mechanical
(attach copy of cur,-ent OR Contractor's License)
Phone:
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JOB DESCRIPTION:
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Applicant Signat e & Phone number
Received by; Date Received:
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Permit# Account Description Amount Amt. Pd. Bal. Due
M -00-S Bldg. Permit (BUILD) G
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Plumb. Permit (PLUMB) _
Mech. Permit (MECH) >
State Tax (TAX)
Bldg: 1 4 0
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Plumb:
Mech: /
Plan Check (PLANCK) 3,
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Bldg: 1 6, y
Plumb:
Mec h:
_ Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIr--R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C) _
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Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WOUAL) f
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) 61
Erosion Planck/USA (ERPIAN)
{' Erosion Planck/COT (EROSN) V �
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TOTALS: •5��,1' 1 ' 348 ,S 3
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CITY OF TIGARD
BUILDING DIVISION
RESIDENTIAL PLANS SUBMITTAL
APPLICANT NAME: / P� PLAN CHECK # �� I
U rr� StJI�c-.r �i�rJ
ADCRESS: � � PHONE #
DATE RECEIVED: 1 I `7 S� RECEIVED BY: lez
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CHECKLIST (All items must be in packet before plan will be reviewed)
j YES NO N/A
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1. [ ] [ ] 3 FULL SETS OF BUILDING PLANS (No red line revisions
or tape-ons).
2. 5 SITE PLANS (including tax lot and tax map number,easements,
erosion control provisions, floor elevation of garage and main
floor, set backs, drive-way location, north arrow, scale, location
and termination of rain drains, corner elevations, and contours
if over 15% grade).
3, [ ] [ ] ( BUILDING PLANS SHALL REFLECT TOPOGRAPHY OF LOT
(if house is designed for a flat lot and the lot is not flat, revised
drawings are required. No red lines accepted).
4, [ ] [ ] REVISION TO PLANS MUST BE FOLLOWED THROUGH
FROM ROOF TO FOUNDATION (detailed sections may be
different from the originals as a, result of your changes. These
portions of the structure that are affected by the change need to
be reflected on the plans. Pio red lines will be accepted).
5. }. [ ] [ ] FLOOR PLAN(S)
6. [ ] [ ] FLOOR MING
7. TRUSS JOISTS (engineering, details and layouts)
8. [ ] [ ] ROOF FRAMING PLAN (all hips and valley supports indicated
and detailed).
— OVER —
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YES NO N/A
9. [ ] [ ) ROOF TRUSSES (engineering, details and layouts)
10. [ ] [ ] COMPLETE CROSS SECTION(S)
11. [ ] [ ] ALL 4 ELEVATIONS ARE SHOWN - 3 ELEVATIONS FOR
ADDITIONS AND REMODELS
■
12. [ ] [ j BASEMENT WALL, FOUNDATION AND RETAINING; WALL
SEC-TIONS (will need engineering if walls are S ft. high or
higher)
13. fj�' [ j [ j WALL BRACING (structure must meet tabl,a R-402.10, revised
alternate method 93-7, or a lateral design shall be provided)
14. [ ] [ ] ALL DETAILS REQUIRED BY NO, 13 ABOVE SHALL BE
INCORPORATED INTO THE PLANS. (Attachments must be
clearly legible and fully referenced in the plans).
15. .—� l 1 i BEAM CALCULATIONS (all beams over 10 ft. in length or any
ream that supports a point load).
16. [ ] [ ] ENERGY CODE P TH�IDENTIFIED
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DO NOT MAKE CORRECTION IN RED
RED WILL ONLY CAUSE DELAYS
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Permit#:
/ C Address:
Issued
Issued by: _ __ Date: ,
�G.
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 statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under DRS 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 313:
1. I own, reside in, or will reside in the completed structure.
2 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or u,,-)uu completion.
0 3A. My general contractor is
n
(N, ne) Contractor regis. #
1 will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. 1 will be my own general contractor.
If 1 hire subcontractors, Twill hire only subcontractors registered with the Construction Contractors
Board. If 1 change my mind and hire a general contractor, I will contract with a contractor who is
+, registered with the CCB and will i►rimedively 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 hese real and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Sign4ture of permit applicant) �Y ate
(White cope to issuing agency permit file,
pink copy to applicant)
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Information (Notice to Property Owners
About Construction Responsibilities
Note: This htformation Notice to Property Owners about Construction Responsibilities
wav developed by the Construction Contractors Board in accordance with ORS 707.0.55(5),
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 aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES: �
if you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
,..,y construction or improvement of a residential structure,you will, in most instances,be riled to be an employer and the people
you hire will he employees. As the employer,you must 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 945-8091.
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
at 378.3524.
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 suhiect 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 bd
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 F;ESPONSIBiLITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder f)r this project,you are responsible for resolving any furilLire to meet code 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 coverage for
accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures,tire,or work that must be
re-done.
'Gime to supervise employees: Make sure you have sufficient time to supervise your employees.
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Vxpertise: 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 perforin the required inspections.
If you have additional questions, write or call the Construction Contractors Board PO Box 14140,Salem,OR 97309-5052,
5031378-4621). The Board is located at 7(X)Summer St. NE Suite 300, in Salem.
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c I r Y OF T 1133RD RECEIPT OF PAYMENT RECEIPT N171. :95--P61659
CHECK AW)UNT e ;341;3. 5:33
it NAME: s IBATIM CASH AMOUNT X11. 00
If1C)oii rss s 1;"'�3V�i7a SW KATHERINE T PAYMENT T7F�'
� SUBDIVISION a
T I GARD Ors 9 7282--
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�ol-IRPOSE OF PAYMENT AMOUNT PAm PURPOSE OF PAYMENT AMOUNT PATI)
NUI1_DiNC PERM MST95--005a'i___ _ 260. So MECHANICAL.. PE . 00
�iT. BUILD PER 14. 28 PLAN CHECK 1=E '15• 85 •
EROSION CONTROL, PE:RMITr"EF c6. 00 FRM31ON CONTROL_ PL.AN >r;K 9.. 45
c rtC�;ION C;C1NTr<04_ +). 45
3
12900 8W KAT HE-RINE ST
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11 O IAL. AMOUNT PAID rt _ _> 348. !-,3
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CITY W 1GjARD w RF.C;E~l P,r OF POYMENT RECEIPT NO. 195--EO61 199
CHECK AMOUNT s 16 3. 48
=I I�IAIHF: V I i_l_ANO, T I MOT'H'r CASH AMOUNT s 0. 00
ADDRESS 4 PAYMENT DATE" s 02/01 /95
SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PA I D PURPOSE OF PAYMENT AMOUNT PAID
PE-AN CHECK FE 16-3. 48
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PLV-NCHE=CK #, 1.R
I TpTAL. AMOUNT PAID - ._ _ _.> 163. 48
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