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INSPECTION NOTICE
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rer.-O-Phone): 639-4175 Business Phone: 639-4171
Inspection•`---- —
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam !tech. Rain Drain Insulation -plumb.
Plbg. Underfloor Water Lina Gyp. Bd. -Hoch.
Date Requested: ( Time
—AM PH
Address:
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Builder:
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TFOLLOWING `OdRRE�CTIUN3
BE ARE REUUIREDs
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Inspector:
1 APPROVED i DISAPPROVED APPROVED SUBJF. T TO ABOVE
Call For Reinsp.
Cir(OF TIGARD
CtiYOF 11GARD r
COMMUNrl Y DEVELOPMENT DEPARTMENT osfmooN
13126 SW Hdl Oki. P.O.klcoa x3307,Tlpiud,Oregon 07223(603)630.4176 PL..I.11YID I NG PE.RM I T
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6.39-4171 DATE_ ISSUED: 09/17/92
SITE ADDREHES. . . : 14807 SW KENTON DR PARCEL- 2 S 1 12CB--1;3900
SUBDIVISION. . . . : 0SHFORD OAKS i ZONING: R-'7
BLOCK. . . . . . . . . . . LOT.. . . . . . . . . . . . . : 146
CLASS OF WORK. . :ADD GARBAGE_ D I SPOSAL.S. . : MOBILE HOMES SPACES.
TYPE= OF USE. . . . 4 S WASHING MACH. . . . . . . : BACKFLOW PREVNTRSi. . : 1 + �
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . . 'TRAPS. . . . . . . . . . . . . . . I
STORIES. . . . . . . . :2 WAFER HE_ATE:RS. . . . . . . CATCH BAS1145. . . . . . . .
FIXTURE - _-----_ - LAUNDRY TRAYS. . . . . . : S;F• RAIN DRA 7:AS. . . . . :
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . . .
LAVATORIES. . . . . : OTHER FIXTURES. . . . . :
TUB/SHOWERS. . . . : SEWER LINE (ft ) . .
WATER CLOSETS. . : WATER LINE: (ft ) . . . .
DISHWASHERS. . . . : RAiN DRAIN (ft ) . . . . :
Remarks: SPRINKLE=R PERMIT l
Owner; -- -_- -----_._.___._.._......._.._..___.___________._ ______._._.__.________ FEES
DOUGLAS JONES III type amor_tnt by date recpt
14807 SW KENTON DR PRINT $ 15. 00 J14 09/17/92 -
5PCT $ 0. 75 JH 09/17/92 -
T I GARD OR 0724:'4
Ffhone #: '
Contractor:
OWNER
Phone ##: 15. 75 TOTAL
Req #. . : 0 +000
RE EUI RFD .. NSPEC'TIONS
This permit is issued subject to the regulations contained in the To: )---oLlt Insp
Tigard Municipal Code, State of Ore. Specialty Codes and al l other Final Inspection
applicable laws. All work will be dune in accordance with
approved plans. This permit wili expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 160 days.
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P'e r m i t t e e Si' 1 a't r_r r•e :y "jJZ•, ��,,����J ___..�__._.___._.._..�____.____ �.__.___._...__..___.___..�-~ ,
Issr_ted By : .r
44 Lal .l tor inspect i on - 639 _it1 75 1
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Permit No:
�^ Address:
1 Date:
Issued by: yl.�_
—FOR OFFICE USE ONLY__
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit ■
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 313:
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1 . I own, reside in, or will reside in the completed structure.
2. I I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.F ___--I My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the strtlr-
ture must be registered with the Construction Contractors Board.
OR
3. B. 'J O I will be my own general contractor. i
If I hire Subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the construction Contractors Board
and I will immediately notify the office issuing this ouilding permit of the came of
the contractor
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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
reversa side of this form.
a
Ignat ,;re of Permit Applicqnt We
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
y
INFORMATION NOTICE TO PROPERTY OWNERS ■
ABOUT CONSTRUCTION RESPONSIBILITIES I
Y'I NOTE: This Information Notice to Property Owners About Construction R isponsibilities
„ was developed by the Construction Contractors Board in accordance with ORS 701.055(5), ! ■
*' passed by the 1989 Oregon Legislature.
If y.,,, acting as your own contractor to construct a new home or make a substantial improvement to an
5
owisting structure, you can prevent many problems by being aware of the following responsibilities and areas
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of concern.
EMPLOYER RESPONSIBILITIES:
■
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 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 withheld the
tax from your employees: For more information, call the Oregon Department of Revenue at 378-3390.
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Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance r
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3 purposes on the wages of all employe-4s. For more information, call the Oregon Employment Division DHR
at 378-3224. p
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers'
compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your �
employees is injured on the job. For more informatic i, call the Workers' Compensation Division DIF at 373-7134.
U.S. In ernal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.
You vAl be liable for the tax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 221-3960,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
code requirements that may by brought to your attention through inspections.
Liabilit and PropertDaInsurance: Contact r
J ____`_yp yma�a c you i nsurance agent to see if you have adequate insurance
coverage for accidents and omissions such as faring tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done.
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have 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 to: Construction Contractors Board
700 Sumrnei St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/74/89
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C I.T r OFT I GARII REC. E:I PT Cid' PAYMENT RE C:E I��T NO. %9 p E'.31 186
CHECK AMOUNY x 15. 75
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NAME JONES, SAC��Ut.;.l_INl CASH AMCIUN'r s 0. 00 ►
0�3l17l9
ADDRESS a 14807 93W KE:NTON I)P SUBDIVISION NT DATE UE�nIVISICIN a
T IGARD, OR
PURPOSES OF PAYMENT AMOUNT PA I U PURPOSE OF PAYMENT PMOUN'r t-,A I U
PI..UMA I NO PERM �15. 00 BUILD PER 0. 75
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INSPECTION NOTICE y„
City of Tigard Building Department
13125 SN Ball Blvd. Tigar'i Oregon 97223
6 9-417 Busineaa Phone: 639-4171
Inspection Line (Rec-O-Pho ): 3
---'_-
Inspection: �'---:---
Footln YLbg.�laderal.ab Mech. Rough-in Appr/Sdwlk j
9
Pound. Plbq. Top Out
Gas Line FINAL:
Pciet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain
Insulation -Plumb.
Plba. Underfloor Water Line/ Gyp. Bd.
-Mech.
y L-- Time: AM PM
Date Requee': �—
eds_ - 1-1 �.-
Address• J �L L _ Permit
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Builder.:-
THE FOiLOWINO CORAE ONS ARE REQUIRED:
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Inspector:. l!�)' Z"'-'4 " Date-_ 7� 2L_' `r Z
— APPROVED DISAP�VED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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