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14SPECTION NOTICE /
City of Tigard Building I>epartaent l
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bunineen Phone: 639-4171
Foocinq Plbg.
inderelab Mech. Rough-in Appr/5dw1Y
To Out Gab Line FINALr
Found. Plbg. P
poet/Beam Struct. San. Sewer
Framing
Pont/Ream 4ech. Rain Drain
Insulation -Plumb-
plbg. Underfloor Water Line Gyp. ed.
-Koch.
G1 _Time! PM
Date Requested: WL-
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() �ACti v Permit #1
7
Builder: -THE FOLLOWING CORRECTION .ARE_R9QU;RSJ4--
17
�! Date:_
Inspector:" — -
PROVED DISAPPROVED APPROVED SUAJRCT TO ABOVE
Call For Relnap.
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INSPECTION NOTICE
city of Tigard Building D0PartJMeat.
13125 SW Ball Blvd. Tigard, on Von 97223
Inspection Line (Rer-O-Phone): 639-4175 Businesw Phone: 639-4171
Inspection: —_ — --
Footing Plbg. Undwrslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Ream Struct. San. Sewer Framing -Bleg.
Post/Beam Hoch. Ruin Drain insulation -Plumb. :
Plbg. Underfloor Nater Lim OYP• Bd. -m wh.
Date Requostedt Time: X PM w
Buildor: _ (f 762'{
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Amin
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Inepecto
APPROVED DISAPPROVED APPROVRD SUBJECT TO ABOVE
rr1i+ Call For Reinsp.
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N� SPF.CTION NOTICE
ity of Tigard Building Depariannt
1'.125 SW Hall Blvd. Tigard, Oregon 977.23
Inspection I,ne (Ree-O-Phone): 639-4175 Business Phone: 639-4171
Inspectiont_
Footir,, Pl`t . Underslab Hach. Rough-in Appr/Sdw1Y
Found. Plbg. Top Out Gas Line FINALt
Post/Beam struck. San. Sewe
r
Framing -Bldg.
Post/Baam Hach. `Rain DraLn Insulation -Plumb.
Plbg. 'Underfloor Water
Line Gyp. Ed. -Meeh. ab
Re
Date questedt_A-� An_ '
� S ( � Y Timet Am _Pm
Address:'' V'1• 4 i t Permit •:P115 `,I 7-a` '
`
Aulldert _0<� �+�,�C� Lr-� 7_
THE MLLCOWING CORRECTIONS ARE REQUIRED:
i
I
Inspect :
Date r
=APPtO�eDDISAPPROVED APPROVED SUBJECT To ABOVE
a l.1 For Rein•p.
INgPECTION NOTICE
City of Tigard BuLIdAjW Departser.t
13125 $W Ball Blvd. Tigard, Oregon 9722.3
Inspection Line (Ree--O-Phone)t 6j9-4175 Business Phone: 6�.9--4171
aspectinns__ _ -- ---- • g
Foots.ng Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg- Underfloor Mater Line /gyBd.
✓ -M�h. w
Date ReQttestedt ./ /1;
Addres,:
Builcert_ !7 2;2u'rL
THE MLLOWING CORRECTIONS ARE REQUIREDs
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Inspectors _ �t- �- Date:
l/APPROVED DISAPPROVED APPROVED SUR.MCT To ABOVE
\ 1 , Call For Reinsp.
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INSPECTION NOTICE
city of igard Bu'lding Department
1312S SSI Hall Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-Pnone): 639-4175 Business Phones 639-4171
Inspections
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Lina FINAL:
Post/Beam Struct. San. Sewer -Bldg.
Post/Beam Hoch. Rain Drain IA/Ylat10� 1umb.
Plbg. Underfloor Nater Lina 0". Bd. -Hoch.
Date Requested: , -� jimes `-AN --..Ll--PM
Address:- / �_/ �Pe�mi��t _01Y2_2_
Bul ldor:
THE FOLLOWING CORRECTIONS I&S rMUTRED:
i
IMprCt:Ote �' /'/V W Dates
APPROVBD DISAPPROVED L•-APPROVED SUBJECT To ABOVE
Call For Rainep. M,
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INSPECTION NOTICE
City of Tigard Building Department w
13125 BA Ball Blvd. Tigard, Dregon 9-223
Inspection Gine (Rec-O-Phone): 639-4175 Busineas Phones 639-4171
Inspection:
Footing Plbg. Underslab NrCh. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Oar Line FINAL:
Post/Ream Struct. San Sower C Framinq) -Bldg.
Post/Beam Hoch. Rain Drain Inaulntion -Plumb.
Plbq. Underfloor Nater Line Gyp. Bd. -Hoch.
Date Requested: 1241. 1ime: AM PM
Address: I(� 11��� lerfit #t AVIV-1-3-C'521
e
Builder: 1�.�kk'c �.t �' -7o 2 '
THE FOLLOWING CORRECTIONS ARS REQUIRED:
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Inspectors Dater
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''APPROVED DISILPPROVED —+ APPROVED SUBJRCT To ABOt,x
_--Call For Reinep.
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IN.91gMI2N NOTICE
City of Tigaod Building Ueparime:tt
13125 tint Hall Blvd. Tigard, Oregon 97223
Inspection Line (RQQec-o-Phone)t 639-4175 Buninese Phonra: 679--4171
Inspections /,� y — --- •
� pAYfYi F4
-rooting UnderaLaL Mech. Rough-in Appr/Sdwlk
t < 4'
b Pound, Plbq. Top Out Gas Iino FII1ALs(/
-
.is +44i'�f xiti a 1r POet/swat. Btrvat. Ban. Sewer Framing -Bldg.
20+aa01 1., Y
2rr + Post�Bean Mach. Rain Drain Insulation -Plumb.
PI-19. Underfloor Nater Line l Gyp. Bal. -Mach.
Date Requestedt -- � �I (l- _Timet 1� AM PN
Addreess L� ►• y-Ya- Permit #s l i� 1 J
Builder:-_^__ (Dr
THE FOI.LoWING WRRECTIO!IS ARE REQUIRED:
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Inspectors !_ _ Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call Vor Reinsp.
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C11Y CF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT s
13125 SW Hall Blvd.Tlgsrd,Oregon 97223.8199 (503)830-4171
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F Permit No:
. e
Address: -------__-----_��—�_
ton 1: ' z ssued by:__— _ Date:
or
—FOR OFF!CE USE ONLY _
STATE..'c,': 1:
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 staterirent before the building permit can be issued. This state- i
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 i
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2. and either box 3A or 3B:
1 . [ 1 own, reside in, or will reside in the completed structure.
2. C - ] 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A. ] My general contractor is
wa
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B.L?)� 1 will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with she 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 building permit of the name of
the contractor.
i
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 Applicant Dat
CONSTRUCTION CONTRACTORS BOARD :.
024AJ 8191
WRITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I.
WIN 11
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,Au�:rrf�fi 41 f ra 1�e Mi.M
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�,�A�`Ve9k+'+%TO'1N ''t+•uk�,,. 'w+d���ir�''I� ?luv,A.q PJLr:wea!"Nt;lsd xq� r ..
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CGNSTRUCTION R'FSPONSIBILITIES
NOTE. This Information Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5), I • •
passed by the 1989 Oregon Legislature. J
- __ ---- -
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 RFSPONSIBIt_ITIES:
If you hire persons not registered with the Construction Contractors Board to do labor irr constructing ur assisting :
+ in the construction or improvement of a residential structure, you will, in most instances, be ruled to be at,
I lernployer'' and the people you hire will be "employees". As the employer, you must comply with the following:
I r
ons Withholding Tax Law: As art employer, you must withhold income taxos from employer wages at
re time employees are paid. You will be liab;e for the tax paytments even if you don't actually withhold the
tax from your employees. For more information call the O,egon Department of Revenue at 378-3390.
Unemployment Insurance Tax_ As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all-employees. Fol more informaticn, call the Oregon Employment Division DHP
a at 378.3224.
l Workers' Compensation Insurance: As an employer, you are subject to the Oreo-)n Workers' Compensation
1 Law, and must obtain workerscomper:sation insurance for your employees. If you fail to obtain workers'
compensation jnsurance, you may be su'aject to p9nalties and will be liable for all claim costs if one of your
employees is injured on the job. For more information, call the W,'rkers' Compensation Civision DIF at 373-7x34.
U.S. Internal Revenue Service Asat, employer, yuji must withhold federal income tax from employees' ,vages.
You will be liable for the tax payrneirt even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 221-3961 .
OTHER RESPONSIBILITIES ANIS AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are respon!Jble for resolving any failure lo meet
code 'requirements that may be brought to Your attention through inspe�aicns.
Llehiriry and Property Damage Insurance: Contact your insurance agent to see it yogi have adequate insurance
coverage for aeeidenty arid omissions such as falling tools, paint overspray, nater damage from pipe punt
tures, fire, or work th.,t must be re-done.
b
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 Cor rtractors Bonrd
700 Summor St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244) 10/24/89
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Residentiital RuIIdln hermApPRP-anon
'ity of Tigard
13125 SW Hall Blvd.
Tigard, OR .97223
(503) 639-4171
-o 2 7 6 Z.
Jobslte Address: 5 sal r'I�'`� 1
? OtfiCh Use Only •
Subdivlslon:7 r r i Oat,ti PLL Lot O Ii -
Planr;C/Rec #Valuailow4i96—N&
% Q go Permit
IC AEL. MoNwIC
vrner. r'Vl F1 Reissue of
1 Address:
O ' r` q 7 Approvals Required
C Plannim) - -
Phone:
Sttgif;'E:ring. ...
Contractor: W Pl
Ac' cess:
Items Required
--- dub;ontractors
Phone: -
Truss Details
Contractor's License #
(attach copy of current Oregon license) Other
Subcontractors:
Plumbing: �!
Mechanical:
(attach copy of current OR Contractor's License)
Architect/Engineer:
Address: —.
t
Phone:
COMMENTS:
�C G'1�1G •�' /��d''�L11 tP (G' ,� �- �G'�.j u, o (0�v2`'� r
Applicant Signature & Phone num`)er
Received by: Date Received:—
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Permit # Account Description Amount Amt. Pd. Bal. Due f
f'nsf�t� 0522 Bldg. Permit (BUILD) S[ 8• S'?) _ •5 '
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
f
7, 53
Bldg: � t:
Plumb:
Mech:
p
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Plan Check (PLANCK) U j 0� �3•a3
l Bldg: lu3 v
Plumb:
Mech:
Sewer Connection (SWUSA) _
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Sewer Inspec ion (SWINSP)
Parks Dev Cha�ge (PKSDC)
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Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
p� n
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
1
Institutional TIF (TIF-IS)
E Office TIF (TIF-0)
Water Quality (WOUAL) _
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Water Quantity (WQUANT) _
Fire District (FIRE)
TOTALS:
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CITY OF -I I[SARI) - RE GE; I P'T OF P'AYME'NT' REC;F 1�'T" NO :93—P7
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CHECK AMOUN r s 166. 43
NOMEa MUhdhl I E: MICHAEL I:A�-►FI AMOUNT a 0. 01 •
+ P'AYWYNT DATE: a to/14/93 I
ODDRL:SS a (SLJSD I V I F110N a !
9715 rtaW f)° Mf�1FtA ST
f IC;AF2I) OR97 i'3 I
!_'I.1RPOc.%F' OF PAYMENT AMOUNT PA 11) F-,'URI"AOSf: OF* PAYMI.NI' AW)UN'I PAID
k�lllt.L;INIyµ PERM ...._ 1.�E1. ``tiM E T'.
BUILD PER PEER _7, y.i �
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MOT 93—f/):=2f."
t•
tOT'AI.. AMOUNT PAID _ ) 166. 43
(:l'1'Y' ()F l' ftU F'�F(:f 1t''1' ('1F" f'AYMI hll' WC;F.IPT N0. :93-41,448515
(.1-IC:f;K (0111)UN 1" 103. 03
NAMEa h1C)NN I<r, M I CHAFF D. (":A��F 1 (lht()(lN T' M• Utt
f.)FA)RESS a 9`x'1.:3 SW UMARA KTREEF�'f F'F1YMk:NI l.)tafF_ x 1P�+' (�/`:�
H)URD I V I -3I ON
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1(y'l I'al.. F)M[]UN T PAID > to 13. 0.-
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INSPECTION NOTI(:E /
city of Tigard Au.,ldinq DePartm:'-+:t 13125 SN Hall Blvd. Tigard, arsgon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-t171
Inspect Lon:�— ---- —_
Footing Plbg. Underalab Mech. Rough-in App-'/Sdwlk
Found.
Plbg. Top OuZ Gas Line FINAL:
-Bldg.
�
post/Beam Struct, San. Sewer Framing g'
Poet/Beam Mech. Rain Dr..in
Insulation -Plumb.
._ r
plbg. Underfloor Water Line (f+YF' Bd_, -Mach. w
Date Requested: Time: —M PM
Address:
1 -7� � ����< Permit 1:
Builder:_ �—
TME FOLLOWING CORRECTIONS ARE REQUIRED:
--- ------ ��- S _
--jog
or:
InspectDate: __
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
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INSPECTION NOTICE C
City of Tigard Building Department (�
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Sur+neas Phone: 639-4171
Inspection.,_-----------
9 �
Footin Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top C..c Gas Line FINAL,
� -Bid
Poet/Beam Struct. San. Sewer Framing g•
Poet/Beam Mach. Rain Drain Insulation)
-Plumb.
Plbg. Underfloor Water Line GYP•
Bd. -Mach. 9
/L� �_ Time: M
Date Aaquaeted:/ j
Address / Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
r
Da71n—
Inspect
-
te: /U C -
_
Inspecto W..._�----
APPROVED DISAPPROV`4D APPROVED SUBJECT TO ABOVE
Call For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-J-Phone): 639-4175 Businegs Phon'-41L i
Inspection:_
Footing Plbg. Ut.derslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Ont Gas Line FINAL:
Poet/Beam Struct. San. Sewrx Framing -Bldg.
r
Poet/Beam Mech. Rain Urain Insula .Lon -Plumb
c Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested:
Tila9s AM PH
Addresa t Porgtit I s �
Bulldert --?z e
_
THE FOLLOWING CORRECTIONS I.RE REQUIRED:
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inspector _`�' - ----- - Date'- -
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APPROVED DTSAPPROVED APPROVED SUBJECT TO ABOVE
1
-_Call For Reinep.
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INSPECTION�OTIrE
City of Tigard Building Department
13125 Sit Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
looting
plbg. Underslab Mach. Rough-in Appr/Sdwlk
� Plt}g. Gay 'Litre FINALS
'ifnand. Top Out
Framing -Bldg.
post/Beam Struct. San. Sewer
Poet/Beam Mach. Rain Drain
Insulation "Plumb'
Gyp. Bd. -Mach.
plbq. Underfloor Water Line �j� z"-
•
-�-2 Time— `�Z PM
Date Requested: _
Permit -=---
Addrees:_��
Builder: v � 1
THS FOI.I.OFIING CORRECTIONS ARE REQUIRED:
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Date: �l ?'-'
Inspect or t y --------
APPROVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE.
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball. Blvd. Tigard, Oregon 9722
Inspection Line (Rec-O-Phoue): 639-4175 Business Phone: 639-4171 I •
Inspection: �—
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top O.:t Gas Line FINAL:
i
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation. -plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: , — _ _2-,—) T ° —PM
ew,
—1�'. 14�i.�f --� _ Permit is
Address: } 7 -�j
Builder:--z /u/� �1�L�_.
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspecto 1- ^_ Date:
_APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_ _Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Hall Blvd. Tigard, Oregon 97227
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 w •
Inspection: _.
Footing Plbq. Onderelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Lin^ FINAL*
Poet/.Ream Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb. a '�
Plbg. Underfloor Water Line Gyp. Bd. -Mach. 1
Bete Requested: Times AM PM
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Address: ,p 1 -;c� I�e-, rte= r,° Permit #: �—
Builder:—
THE FOLLOWING CORRECTIONS ARE REQUIRED*
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Date-
APPROVED �W DISAPPROVED APPROVED SUBJECT TO ABOVE
Fo. Reinsp.
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COMMUNITY
ARD -'►=RMz r #. . . . , . . . M5T9c-r ��E�7
DEVELOPMENT DEPARTMENT
13125SWFWIBlvd p.0.Bat233D7.TOW.Q*W 971M(50d)Q3if4176 ;r�1 rE ISSUED: ��i1c_2/9
P4DDRESS. . . : o9715 SW 01 MARA 5T PARCEL: 2,G1 2.CD-02709
SUBDIVISION. . . . : FREWiNGS ORCHARD TRACTS ZONING: R-4. 5 • •
. . . . . . . . . . . . . :J77
BUILDING
REISSUE:
c _ DWELLING I_Iiv I T S: 1 BASEMENT. . . . . . . . :0 s f
RE I rSSUEw
LLASS OF WORK. :ADD BE:DRMS:0 BATHS: i GARAGE. . . . . . . . . . :0 sf �+
YFIE OF USE. . . :SF Fi...00R AREAS --- __.__.. .-_. REQUIRED RED SET13AC1{a _.-----___ I +;
TYPE OF CONST. :5N FIRST. . . . 80 sf L..EF'r. . :0 ft R I GH7. :`;; ft f
OCCUPANCY GRP. :R3 SECOND. . . c 11-50 s f FRONT. ::='t71 ft RC AR, . :90 ft
�iTUR1Efi. , . . . . , 'IHIRD. . . . :0 sf
HEIGHT :�-'2 ft TU1"AL-.-_.--.--.-- :360 r F SMOKE DETECTORS. CY
FLOOR LOAD. . . . :A-0 p s f VALUE. . . . . 350t1t10 FIA RK I NG SPACES. . :0
Re m ar^k s : BUILT TO RESIDENTIAL THERMAL pE RFORMANCE COLCUr ATI ONS SEE~ F I LE~. :add ; #: .:.
F'L.UMPING
SINKS.. . . . . . . . . . : 1 FLOOR DRAIN!;. I3ACVFLOW F,REVNTR'a. . :0
L-AVATGRIEa. . . . . :2 WATER HEATERS. . . :0 TRAFIS. . . . . . . . . . . . . . :0
TUD/I:iHOWER i. . . . e 1 LAUNDRY TRAYS. . . : 1 CAI'Lli 6ASINS. . . . . . . ...0
WATER CLOSETS. : 1 SEWER LINE (ft ) . -0 GREASE TRAP'S. . . . . . . :0
D I SHWASHl_IiS. . .. , : 1 WATER LINE: (ft ) ,, -.0 OTHER F I X T URES. .
I ARBAGE. IJ15F'. . . s1 RAIN DRAIN (ft ) . :0
WA SFi I NG MACH. . . : 1 SF RAIN DR(4I NS. , , 1
MECHANICAL _ __.____._.____ ___._____.________-• FEES
FUEL TYFIES- ___..._. __...._.... UNIT HTRS. . : I type amor.tn� by date rectot
/GAS/ / / VENTS . . . . . s0 MFIRT S c:8. 50 FILL 05/2W/92 227
MAX INPUT:O 131.0 VENT FANS. . :;= MPLU, ? /. 1c: PILL 165/22/92 t=127
TURN ( 100K . . :0 HOODS. . . . . . : 1 M`PC $ 1. 42 FILL. 05/22/92 2J-7
I URN ) =100K . . WOODSTOVE S. :0 Pr-,J2T $ 1311-,. TO PILL 05/ma2/9E
I'LOOR TURN. . . . :0 L•LU DRYE::RS. : 1 F15FIC $ 4. 13 FILL 05/22/92 227
'�CI11_!CMP ( 3HP;0 OTHER UNITS:0 WI''T?T• $ 370. 50 FILL 0S/4 2/92 21*'7
GAS OUTLET5: 1 BPILC fi 110. 83 FILL 05/22/92 227
B5PIC I, B. 53 FILL 05/;:22 92 x=°27
MILHAEL MONNIE
9715 SW O' MARA ST
110ARD OR 97223
Phone #: 639- /in21
CONTRACTOR NCII ON Fit'-E
-'hone #°
L ct 13. 53 TOTAL_
This nerait is issued subject to the regulations contained in the -- -- REGUIRE'D INSFIECTIONS --- -� _
Tigard Municipal Code, State of Ore. Specialty Lodes and ail other Foot/founcl Insp Gyp Boarci Insp
apnl icable laws. All work will be done in accordance with approved FI l m/c.tnd s l.-a b Insp Rain drain Insp
plans, This oer•it will expire if week is not started within 180 Pl_M/Underfloor Merhanical Final
days of iss-jance, or if work 15 suspect, evl Fel" »pro f— +A^ a" Mec_hanic:al Inst] iumt7 Final
T11 Limb Top Oi-tt BlAi lding F iiia
I-ermitt:ee Sitonatl-[r•pr 'KL61(i(� 7�7fF't,aminrj Tr1st_) Era ion L"' ntrui
Gas Line Insp
I s+.t p r. }�y . - �sL,� 1 r r���.c 1.�t :.o n 1 rr s p
CK�I l for inspect icon - (,39 '417 a
a 4
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Sw Hall lewd. PLNCK/RECT #`?
CITY OF TI(TARD :13397 PERMIT a t�5fsz-oa�7
CONIMUNITV DEVELOPMENT DEPARTMENT gard,Orcgon97223 —
(503)639-4171 DATE ISSUED • •
G
JOB ADDRESS: 9715 S-W aA4ARA ST TAX MAP/LOT �S C) Q— 04?0I
$$
SUB: FAGWInCr OQCMAa.b �Ac7LOT: 2 7 �- 28 LAND USE: -
rA X 1-0 r 2'7 Wq
VALUATION: # 35"0,70. -
i
OWNER SPECIAL NOTES
NAME: /I�,c�R�� & Oeb' ^a hloy)njE _ REISSUE OF:
ADDRESS: a715 SW OM44A --r LAST REISSUE: �
7/C�RR 0 D R -q 7 223 FLOOD PLAIN/
PHONE: co 39 ` 761 Z I — SENSITIVE LAND: —
CONTRACTOR P.PPROVALS REQUIRED
NAME:
/Y)JC'A jeMond! e ; DuJne!^ PLANNING: �.
ADDRESS: `� 7iS SW OMabra Sr ENGINEERING: —
'T�Uarv( Or FIRE DEPT:
PHONE: !y3 9, ?p Z 1 OTHER: 'vo
CONTR. BOARD : Ail A- EXP DATE:
ITEMS_REQUIRED
SUBCONTRACTORS: PLUMB: ._ ^_ LIST/SUBCONTRACTORS:
MECH: _ BUS TAX: --
ARCH/ENGINEER
ARCH ENGINEER CALCULATIONS:
NAME: GRpIG C, HENN ARcNr7�r TRUSS DETAILS:
ADDRESS: /3734 IV6- am ,,oh OTHER:
PHONE:
PROPOSED BLDG. USE: )e5,dlo" _e
,J p
COMMENTS: �ec�tdoe atlootit kifc�te %Ufi{r �C_�/�Gregox oo Glc�c�i_frpti
rr Aw.i -wiz c. �< !Z
Alf
I APP!ICAN'f-nIGNATURf
? Received By: � .__— _ _--_- --_�_ Oato Received:
. '...' f .t'..ntYWS •wnww+v r.n+n.w-rv.....,, .......
i1bW4i34tf'v.Y iwni,.wn....w........:i. ....».�.._.. .........r ..__.
O
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. �ys.3 UE
L12-c.2-Y) 10-432 00 Building Permit Fees 171),57) 74�i
10-431 00 Plumbing Permit Fees g z.5o — _ _ b'2.S o
10-43i 01 Mechanical Permit Fees _
10-230 01 State Building Tax (5%) L��i1� �U'o�
Bu l d i ng �' `" S3
\Y.
Plumbing
Mechanicalg
10-433 00 Plans Check Fee 1/7,� --� Z2� 13
Building
Plumbing _
Mechanical '
10-230 06 Fire
30-202 CIO 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 Dev Chrg
(SSDC) -
24-445-01 Water Quality (Fee in lieu of) --
24-445-02 Water Quantity (Fee in lieu of) -- —.---
TOTAL X13.S 3
nm/3587P.WPF
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•
KDW=•T-Y CONSTRUCTION INC.
Construction consulting.
Labor and Materials Budget Recap.
•
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Remodel Addition 9715 SW OMARA ST. Tigard, Oregon 97223
T
Owner: Mike Monnie
Phase I
Excavation & Foundations 6157
Phase II ,Framing 4184
Phase III Exterior Coverings, Windows & 4193 '
Doors.
Phase IV Pl»mbing, Electrical, Interior, 5,555
Exterior Finish
Phase V Fixtures, Cabinets & Floor 4,100
Coverings
Total $24I Hr
F
* Costs based upon owners current selection of materials
and finishes.
Completion of Phases 1-4 four to f.�_ve weeks
Completion of Phase 5 One to three weeks
Daniel J. Scholten
Kimberly Construction, Inc
F,
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Permit No: r� 2 -GUEs7 a
Address: 5, O��err C• 5 t'
Z Issued by:—P'i'
y:_ t �r.------- Date: '
_FOR OFFICE USE ONLY--
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS r
ABOUT CONSTRUCTION RESPONSIBILITIES
E
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 i and 2, and either box 3A or 3B:
1 . C _ 1 I own, reside in, or will reside in the completed structure.
(
2. I 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
i
1 --
3. Al- __ I My general contr^ctor is _._ --- --------
Contractor registration number
! will instruct my general contractor tha all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B.L_ I will be my own general contractor.
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 building permit of IN,, name of
the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice io Property Owners about Construction Responsibilities on the
reverse side of this form.
Signature of erriit Applicant Dat
i
CONSTRUCTION CONTRACTORS BOATED
0244,1 8/91
I
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICAN f
t
f
INFORMATION NOTICE TO PROPERTY OWNF.'gS r.
ABOUT CONSTRUCTION RESPUNSIBIr_ITIES j
NOTE: This Information Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5), • •
passed by the 1989 Oregot, Legislature.
If you are acting as your own. contractor to construct a new horne or make a substantial improvement to an � y
existing structure, you ran prevent many problems by being aware of the following responsibilities and areas y
of concern.
EMPLOYER RESPONSIBILITIES: Y
• h"
If you hira 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 tho employer, you must comply with the following:
Oregon's Withholding Tax Law: As an emp')yer, you must withhold income taxes from employee wages at f
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 Department of Revenue at 378-3340.
Unemployment Insurance Tax: As an employer, you ars required to pay a tax for unemployment insurance n'
purposes on the wages of all employees. For more information, call the Oregon Employment Divisior. DHR
at 378-3224.
,.1
Vorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation A
Law, and must obtain vvorkers` compensation insurance for your employees. If you fail to obtain worker3'
compensation insurance, you may be subject to penalties and will he liable for all Clair r costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation D vision DIF at 373-7434.
f
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.
You will be IiabTee forThe tax payment even if you didn't actually withhold the tax. For more information, call t
the Intr-rnal Revenue Service at 221-3160,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN: ,. t
j
.,ode Compliance. As the permit holder for this project, you are responsible for resolving any failure to meet
ode requirements that may be brought to your attention through inspections.
t
k
Liability and PropertyDamage Insurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidHnts and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done. r
Time to .supervise Employees: Make sure you have sufficient time to supervise your employees. �
Expertisc- Make sure you have the expertise to act as your own general contractor, to coordinate the work l
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 Summer St. NE. Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 1012,+189
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CITY OF T I GARD PECE:I PT OF PAYME=NT RECO E PT NO.
CHH CK i�MOUNT t 2 7 3. 4Ii
NAME MONN I E, MICHAEL CASH AMOUNT v 0. 0Q' • •
ADDRE=SS n 9715 SW W MARA ST PAYMENT DAT~ ;
SUBDIVISION
TIGARD, OR 97223--
PURPOSE OF PAYMENT AMOUNT PAID PURr.,ot- - OF PAYMENT AMOUNT Pia I D
82. 50
MECHANICAL PE 28. 50 ST. BUILD PER 14. 08 ± r
i
1'U'TAL AMOUNT PAID __ _. ._. _..7 V-,. 45
i
C.I'T`,' rlf' T'IGPl! p f2EC:E"TF'T OF 1'+d':whtE:.rt"I" FtE(:f.1'T'f Plt.l. t+ ' -,'1'"7 1 i
NAMES c HENRY, CRAT(3 C. E AsH AMOUN, 0. 001 i
AT)1)R k Gr:i 137:34 NE: THOMi='SON PAYMENT DATES 05 12/1
SUBDIVISION t ,
OR
�IJf,1'4f:iG;f OF` PlAYME:':N1 ►-IVIO lNT PAID 0if<POSE OF PAYMENT AMOUNT t=n1,
t40. qfA
yr.,:.r�.snornrxan n..r•+us.+wA:�.NP.n„n:emm'e.w.r+w+.s+rwimwk.ww�.'�crnan•;e.a.aSrxar.h '- .. •:��.':.,.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SK Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Busineus Phone: 639-4171
Inspection:_ ---—
• 0 .
Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk II
Found. Plbg. Top Out Gas Line FINAL-
Pont/Seam Struct. San. Sewer Framing 1 -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plump.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
f
Date Requested:
( `� �C Time: AM r PM
Address '% '7 Cl/ /" �LL— Permit f:e/"-2- � f=�
THE FOLLOWING CtRRECTIONS ARE REQUIRED:
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Inspector:. -- �.� N� c}-v ^" Dater
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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