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9237 SW NORTH DAKOTA STREET 1S VIO)l 1C HMN MS 1£Z6 U) a CL f- M a m 0 W Z U) N Q7 9237 SW NORTH DAKOTA ST PLUMBING CITY OF TIGARD _ PERh-T - DEVELOPMENT SERVICES PERMIT 0: PLM2005-00265 X3125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171 DATE ISSUED: 6/16/2005 PARCEL: 1 S 135DB-12600 SITE ADDRESS: 09237 SW NORTH DAKOTA ST 'ZONING: R-4.5 SUBDIVISION: MLP95-00001 PP1995-084 LOT: 003 JURISDICTION: TIG Project Description: Plumbing for clothes washer. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: 31F WASHING MACH: 1 BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STONIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS URINALS: GREASE TRAPS: LA°iATORIES: OTHER FIX7 URES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES SHANNON, RICHARD O+ DUS i Y D Description Date Amount 9237 SW NORTH DAKOTA ST TIGARD,OR 97223 [PLUMP] Permit Fee 6/16/2005 $72.50 [TAX]8%State Surcha 6/16/2005 $5.80 Phone: Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg#: IL H M This permit Is issued subject to the regulations contained In the Tigard Municipal Code, State of OR. Specialty Codes and all other m applicable laws. All work will be done in accordance with approved plans. This permit will expire If work is not started within 180 days of (� issuance,or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon J Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by catling 503-246-6699 or 1-800-332-2344. Issued By: �, ,�*_ PQrmittee Signature: �-� 4 Call 503-639-4175 by 7:00 a.m.for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each Inspection. Bdilding Fixtures PI�ImbinQ Permit AID Mj iiYE '.) City of Tigard ,JUN I U 2005 � �� /gyp dRj permit Nn.��n 13125 SW I tall Blvd.,Tigard,OR 97223 Rae Phone 503 h19 4171 Fax. 503.398.1960 _ (Aha Permit No.: 24-(lour Inspection Line: 503.639.4173 �,A I Y OF TIGAR -- Internet www.ci,tiprd.or.us BUILDING nlvisI �ArsRiss6m : �gaa►aar2fer _ /� NodAaNMMltod �' ea al4bnowin 17 TM OF WORK ❑New construction -- ❑Demolition _ Firt�tddl ►rlalaMwamcAeoWR t_J Addition/alteration/replacement - ❑Doha _ New I-3-famlly dwelllop(includes 100 ft.for each utility connection) CATU MY OR CONil VCTION _ SFR(I)bath 249.2_0 _ [A I-and 2-family dwelling - ❑Commercial/industrial SFR(2)Math _ 330.00 D Accessory building - ❑Multi-family - - SFR(3)both _-- -� -399.00 ❑Master builder � - -❑Doha. Fach additional bathAitchen 45.00 ire sprinkler(_sq.fl.) Pais 2 __._. JOB QR IIV1d"ATS)s AND LOCATIO& _ Fie.nun - Job site address: 9 Z 3 7 ' S p/ »-- Catch hain or area drain 16.60 City/State/711': p 2 17-t 7.3 _- Drywell,leach line,or trench dein _ 16.60 Suite/bldg./apt.no.: Project name: Footing stain(no.linear ft.:_) Page 2 Cross stmt/directions to job site: �'- Manufactdred home utilities 110.00 --- Manholes 16.60 Rain drain connector 16.60 Sutilwy sewer(no.linear ft.:�� Page 2 Steam sewer(no.linear ft.:�J` --- Paie 2 Subdivision: - -- Water service(no.linear R:_) Page 2 'fax map/parcel no.. - nature or Was Absorption valve 16.60 _ osocko TION OM %VAk f » : Back flow preventer Page 2 Backwater valve 16.60 Clothes washer 16.(0 --� ----�-- -- Dishwasher _ 16.60 Q IaROP�RTY OWNLII y Drinkini Ibrmtain 16.60 '- - Ejectas/sump _ 16.60 Name: --�_ Expansion tank 16.60 Address: " ee,�,..e►�r - Fixture/sewer cap 16.60 City/State/ZIP: Floor draint loor shalcAaub 16.60 ) Fax;( ) Garbaie disposal 16,60 Mine:L Hose bib_❑ 16.60 136WACT_ ACT �(tll>98N - -- la maker 16.60 Business name: Interceptor/grease trap 16.60 Contact name: i -� -_ Medial gas(value_:f ) Page 2 D. Address: Prima 16.60 a -- - - Roof drain(oommercial) 16.60 � City/State/ZIP: -- -� sin/lavatory 16.60 Phone ( ) -_ - --j Fax- ( 1 -- Tub/showa/shown pen 16.64 J E-mail: Urinal 16.60 m CONTIftACTOR Wats closd 16.60 WBusiness name: FW y," ��- Water heats r 16.60 Address: Other: chy/State/ZIP: SublioUl__-- fee__ ------ - Minimum remit : 572.50 Phone:( ) - Fax:( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Li,.no.: Phan review (25%of permit fee) ` State nrrcrarBe(11%of pamit fee) Authorized s4nawn: R,I h___,� TOTAL PERMIT FEF. -30 Print name: C`k,(4-SDate: This permit• atba ea freer M■permit Is M h b� IM do""alter h hot been accepted uaeomplete. *Fee methodology not by Tri-Co naty Ruild)ng Wheitry Service Board. i Msildina\Pe i 0M,Mr•'-PmnilApp dnc 061nS 40.44 6Tt IM07lr'00UWF.a) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential FweSuppression S stems: Site Utilities Q* r"(00 ' tows Savan FtFee: Footing drain-F 100' - - 33.00 0 to 2 000 $115.00 Footing(train•each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 7re __ $220.00 a g — Scwer-I st 10(1' 33.00 7,201 and teats $309.00 -- Sewer-each additional 100' 46.40 Water Service-Ist Ion' 55.00 Medical Gas Systems: Water Service-each additional 100' 46.40UK- AMa Storm A Rain Drain-I sl 100' 5500 V =M_--— 0 F - $100110 S5,90r.(N) Minimum fee$72.50 __ __ Sko .Rain Drain-each additional 100' 4640 55,001.00 to S 10,000.00 $72.50 f(x the first$5,Mu.00 and S 1.52&r►ach Fixture or Item_ Qh• /a(ft) Tavel additional S 100.00 fr20ion thereof,to and including S 10,0(M).0 Commercial -- Back Flow Prevention Device 46.40 $10,001.00 to$2.3,000.00 $148.50 for the firs S1(1,(100.00 and$1.54 fix Residential Backflow Prevention Device each additional S IPO.00 or fraction thereof,to minimum permit fee$36.25) 27.55 and including,$0,000.00. Rain Drain,single Rmily dwelling 65.25 $25,001.00 to$50,000.00 $379- )fort ?rat$25,000.00 and S 1.45 for each additi al$1000 or fraction(hemp(to Inspection of existing plumbing or __ and inclu n $50.000.00. specialty r ested in ions- hour 72.50 $50,001.00 and up _ $742, for the first$50,000.!10 Old! 1.20 for Subtobl: —�- --- -ach dditional$100.00 or&action thereof Fixture Work: N" Are you capping, moving or replacing existing,Pottures7 I A"comp) structttrc"is defined m an installation of a plumbing "yes",please indicate work performed by fixture. Failure to !ystem t meets any ot'the following criteria. accurately report fixtures could result in increased sewer fees*. PI eek all that apply. as ►• tXk ❑ Any neve oommcrcial building Fixture Type: Rayl— Any new exterior plumbing site utilities. _____ New [Mars/ Cnr� A c(xnmercial Molding with installation,alteration or addition Baptistry/Font f nine(9)or more new or relotxtted plumbing fixtures. Bath -rub/Shower ❑ it,al gas and vacuum systems for health care facilities -Jacuvi/Whitt 1 pr icing services in human beings. Car Wash -Each Stall ❑ Plurilyng in,•tallations,alterations or additiun-t t^food service -Drive Thru rheilitiliq where new plumbing fixtures,including interceptors, Cus idor/Watet Aspirator are btyninstalled for the food service area.Dishwasher -Commercial ❑ Any new-sidential building containing three(3)or more Domestic dwelling u t Drinking Wash Fountain ❑ Any NFP -I.-tultiputpose firesprinkler system. Eye Wash _ Floor Thain/sink -2" Submit >,of plan+'With spy of the above. -3., 4.. Car Wash Drain _bondOf' ; Oarbage -Domestic — Isometric or riser gram is required fbr new buildings Disposal -Commerce Industrial three 3 or more st ies in height. Ice Macb.111effig Drains Oil Septuatior vas Station)) Comments regarding tune work: J Rec.Vehicle Dump Station m Shower -Gang - 0il! -Stall _ a Sink -Bar/l.avatory -Bradlev -- - -Commercial -Service Swimming Pool Filter Washer-Clothes "Note: If the fixture work ceder Obis rmit rvsulbt in on Watcr Extractor Iw Water close(-Toild increase of sewer EDUs,a sewer permit will he issued and Urinal fees assestsed for the sewer increase Hoist be paid before the Other Fixtures: plumbing permit can be issued. i\%i1dina\PemIn\P1 W-PermikApp dx 0&009 CITY of TIGARD, ELECTRICAL PERMIT PERMITS: ELC:2.005-00415 DEVELOPMENT SERVICES DATE ISSUED: 6/16/2005 13125 SW Hall Blvd.,TlUard,OR 97223 `S03-639-4171 PARCEL: 1S135DB-12600 SITE ADDRESS: 09237 SW NORTH DAKOTA ST ZONINCs: R4.5 SUBDIVISION: MLP95-00001 PP1995-084 LOT: 003 JURISDICTION: TIG Project Description: 2 branch circuits to washer and dryer. RESIDENTIAL UNIT- TEMP SRVC/FEEDERS v MISCELLANEOUS 1000 SF OR LESS: 0 - 270 amp: — PUMPI IGA'1 : EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LfG: LIMITED=NERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 201 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+amp/volt: _>-4 RES UNITS: >600 VOLT N MINAL: Reconnect only: SVC/FDR>-225 AMPS: CLASS AREA/SP[C OCC: — Owner: Contractor: SHANNON,RICHARD O+DUSTY D OWNER 9237 SW NORTH DAKOTA ST TIGARD,OR 97223 Phone: Phone: FEES Reg#: Description Date Amount [ELPRMT]ELC Permit 6/16/2005 $53.50 [TAX]R%State Surcharge 6/16/2005 $4.28 REQUIRED ITEMS AND REPORTS Total $57.78 This Permit is Issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and all other applicable laws. All work will be done in accoroance with approved plans. This permit will expire if work is not started within 180 days of issuance,or If work is suspended for more than 160 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at 503-246-6699 or 1-600-332-2344. 0. Issued By r Permittee Signature: OWNER INSTALLATION ONLY The installation is oeing made oproperty I own which is not intended for sale,lease,or rent. _ OW'NER'S SIGNATURE: '�� _._ DATE: _ — im (j CONTRACTOR INSTALLATION ONLY J SIGNATURE OF SLIPR. ELEC'N: -__, DATE: — LICENSE NO: _ - --- Cali 503-6394175 by 7:00 a.m.for an Inspection that business day. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each Inspection.. Els ct:ical PerinQh' "fisatim City of Tigard ReesiveFar d 1 11125 SW I lel!Blvd.Tigard,01>l 4'`72) !1 .7 Plan Review Phone 501.619.4171 Fax: 503.598.19611 DNWBY Other Permit Inspection Lme: 501.639,41 � Date Ready/ily r B a e r„Re 1 for - Internet. wwwci.tigard.orlM�-+�+ JJQARD NaeifierUMethod^-� �L- grppkasatalIsfartandon II��• ,e ❑ New e(ntstl wtion (Additi(nr/alteration/rrpl;;,x ,nt Plesse check all that apply: ❑Demolition ❑Other: ❑Sarvicc over 223 amps,comm'I Ctl.atitrdau6leption 0S 'cc over 120 amps-rating ❑Buitdns over 10,000 sq.0., CATi GMV OP CONBMV117tION, _ of I-and 2-5mily dwellings 4 or more new residential Of I-and 24amily dwelling ❑Cornmcrcialfindustrial ❑ Acecss(wy building ❑System over 600 volts nominal units in one structure ❑Multi-family ❑Master builder ❑(nom: []Building over three mot ies ❑Feeders,400 amps or more ` MATfON AND WICATt431ft ❑Occupant I(*d over 99 persons ❑Ma ufactured structures m M14 91T)L _- __ ❑Egress/lightingplan i� Job no.: _ lob site address: ) r ^ ❑Nalth-care facility ❑other: 4d l) -Jill✓ .+✓I/lT�r /{f� Submit_L sets of plans with any of the above. City/State/7.IP: gin 411 T v.`f The above are not applicable to temporary construction soviet. Suite/bld&/apt no.: Project name: "--1 Cross street/directions to job site: New reoltieNtal single-or wtald-faally dwrlllag nit. ` Includes attacked garalle. _ 1,000 sq.fl.or Ips 143,13 4 Subdivision: (pt tip. Ea.add•I 300 sq.fl.or portion 33.40 1 Tax / cel no.: limited energy,residential 73.00 2 P Limited energy,non-residential 73.OU 2 - - - OE8(R�TIDh L Fach manufactured or modular 4t x S J dy dwdlin�service arid/or feeder 96.90 2 -- -- - ---- IL W -- - Services or feeders haetallatbr,sherstba,sodlor relocation _ 200 aim s or less $0.30 2 ❑PROPtaine OWN 13 TMAW 201 amps to 400 amps 106.$3 2 V -- - — 401 amps to 600 amps _ 160.60 2 m Nae: 601 to 1,000 amps T 240.60 �- -2 Address: Over 1`000_amps or volts 434.63 2 -' Reconnect only 66.83 _2 City/State/ZIP: ^_ Temporary services or feeders iastatlation,alteration,and/or Phone:( ( ) Fax:( ) relocadoa 200 amps or leu_ 66_$3 1 Owner Installation:This installation is teeing made ort property that 1 sawn which is not 201 amps to 400 amps 100.30 2 intended for sale,lease,rent,or exchange.amwding to ORS 447,449,670,and 701. 401 amps to 600 am _ 133.73 2 Owner signature: __ (ate: _ smack eirmlb-new,afterstba,or extension, r posell ❑ A"UCAl f CftACT FWMW A.Fee fox lxanch circuits with avior or feeder fee eachBusiness mune: s -� branch circuit 6.65 2 B.Fee for branch circuits Contact tee' without service or feeder fee, Address: each branch circuit 46.$3 2 —�_- Each WWI branch circuit 6.63 � 2 City/State(ZiP: Miscellaneous(service or iteder not laeladed) IL Pump a irrigation circle 33.40 2 Phone:( ) Fax: ( ) _ !_ Sign or outline lighting 33.40 2 F E-mail: Signal circuit(s)or limited-• _ energy panel,alteration,or Business name: extension.describe: Page 2 2 t+,��,vl, a,v, J ID Address: Each addifloaal Inop!tdoa over aliowable in any of the above Per inspection 62.30 � City/StatdZlP: --- - laveatip hour(l ba oda) 62.30 Phora Ixxdnatrial ant hour 71.75 CCB Lic.. Electrical Lic.: Suprv.Lic.: _ __-- Subtotal Suprv.Electrician signature,required: Plan_review(23xofpextnit IEa) surcharge ifee) L Print name: State surha � _. TOTAL PERMITFFE Authorised signature:164X Tib snoop appoeattea ero6es lr a permit Is see alNahned wKin Iso &ars filer It ten been urcapwd as eaapplete Print notne: _�,t.�, ( S{,&h ,.•r. notV 6& v • Fox methndole>(ry sea by Tri-Cautty Building Ir,'.o.ttry Cetviaore Bd ••Number of inspections Per permit allowed. .f i\B.ilding\Pe itt\F7.C-PamitAppdoe 17/01 440461ST(1(V'9W.0M/w-, !� - Electrical Permit Application _ City of Tigard Fuge 2 - Supplemental Information ^ LIMITED ENERGY PERMIT FEES: RESIDENTIAL W02K ONVI: Fee for ag residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: .— – COMMERCIAL WORD ONIaY� Fee for each commercial system............... ..... $75.Ola` (SEF:OAR 918-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication 1 allation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentat' ❑ Intercoand Paging Systems I,andscape Irrigation Control* Medical ❑ Nurse Calls ❑ Outdoor I.andscapt Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: _ *No licenses Are required. Licenses are required for all other installatfions i FAjilAintlTe mitaTLf-Perm Mpp Roc 04101 s CITYOF T I G A R® MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2005-00346 13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171 DATE ISSUED: 6/16/200riPARCEL: 1S135DB-12600 SITE ADDRESS: 09237 SW NORTH DAKOTA ST ZONING: R45 SUBDIVISION: MLP95-00001 PP1995-084 LOT: 003 JURISDICTION: TIG Project Description: Dryer venting. CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE Or USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS: STORIES: ___BOILERS/COMPRESSORS _ HOODS: FUEL TYPES _ 0 - 3 HP: DOMES.INCIN: 3 - 15 HP: COMML. INC IN: MAX INPUT: BTU 15-30 HP: REPAIR UNITS: FIRE DAMPERS?: 30-50 HP: ODST : GAS PRESSURE: 50+ HP: CLO DRYERS: 1 FURN< 100K BTU: AIR HANDLING UNITS OTHER UNITS: FURN>=100K BTU: <=10000 cfm: GAS OUTLETS: > 10000 cfm: Owner: FEES SHANNON, RICHARD O+DUSTY D Description Date �— Amount 9237 SW NORTH DAKOTA ST TIGARD, OR 97223 [MECII]Permit Fee 6116/200f $72.50 [TAX]8%State Surcha 6/16/200f $5.80 Phone: Total $78.30 ---— Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg'": IL 1— This permit is issued suhject to the regulations contained in the Tigard Municipal Code.State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire If work is not started within 180 days of issuance.or If wor' is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility N(Afication Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. Yost may obtain copies of these W I rules or direct questions to OUNC by calling 503-246-6699 or 1-800-332-2344. w Issued By: —,�1 C V Permittee Signature: — Call 503-639.4175 by 7:00 a.m.for Inspections that busln ss day. This permit card shall be kept in a conspicuous place on the Job site until completion of the project. Approved plans are required on the job site nt the time of each Inspection. r ` Mechanical Permit Application ��** P.eoeivod City Tigard twdREC E I V E D Ode/By Prrmit N. (fit= .>;at�5--oy 3 13125 SWW 1141 Blvd.,Ti Plan Review Phone: 303.639.4171 Fax: 501,50 ,1960 Dd�y Other Permit Inspection Line: 503.639.4175 I I �`'I I t Dole Ready/By 1 B See rep M Internet: www.ci.tigard.or.us JUN 1 b It Wetiaed/MetMtd_ 1 R.gpletastallaarutNtw ❑New txxlstructinn ition/alteration/replacement —--- — Mechanical permit lbose are lased on the value of&@ work ❑ El Demolition Other: pwbrmed.Indicate the value(rounded to the neared dollar)of all mechanical materials cpiprnm�bortoverhaodiandproft. �CAUGORY OF CtONl 111110C'1'K11tl --- vahte:f {�I•and 2-family dwelling ❑C'ommercial/induvtrial ❑ st Accesxy t/uilding ---KNIM&M- ALIWIMiWU1 El Multi-family ❑Master builder For sptcla!a(Jblmintlo►1 use checklL - ❑Other: Ikaaiptian Qty. I EE a. I Trial JOE WM INlrDRMMATION AND LOCATION HeaHa cootie _ _—� Jots site address: Air conditioning or hat pump -- qZ3, sw /VO�t -�_ •�T—_-. 1Wreseite olsh'l- acerawl 14.00 City/State/ZIP: 7 t(+ )mace 100,000 BTU(daaa� 14.00 -- - I.urnace 100,000+BTU(ducistvanto) 1`7.90 SuitP/bldg iept_no.: — _ Project name: T- pas hatm 14.00 Cross street/directions to job site: Duct work _- _- _14.00 - llydronic hot water system 14,00 -- Residential boiler(radiator or -- - hydratic) - - Unit haters(Poel-type,not electric), in-wall in-ch!S"-q"ded�etc._ 10.00 Subdivision: 0,: FlueNent for any or above 10.00 I,ot 11 --- - --- ----- Other: _ _ 10.00 Tax mop/parcel no.: Otter bel appliances 00i- ir WINK or *am t: f, Wales hater _ 10.00 - A pas ace _- 10.00 Flue vent for water haler or Ras -- --- fir eLllact 10.00 - -- -- Loj li0hta-FAWL 10.00 Woor a kt stove_- _- 10.00 - Wood 8r nce/irasert 10.00 _ a "HWO" O hll Chimp /titter/6ueJvent other 10.00 --�--- er: _ IO.OG Name -` Euvlreameetal exbo"t and venWedon Range hood/other kitchen Address: C'w „�, "�- equipment 10.00 City/Statc/7.IP: `� ----- Clothes dryer exhaust- - _I - 10.00 -- - ----- -- Single-duct exhaust(hathrooms, -- Phone:(�j ) Fax ( ) toilet 00mm"ents,utiliq rooms) 6.90 Q APPLICANT E3 CO1tf11'ACT VWWW Attic/crawlspace Ikns — 10.00 — ...— 10. Business name: Other: 00-- -- _— Friel F►ft _— Contact name: $5.40 for lint Goer St I.IM for eaek addhlonal _ d. Address: — ------ - —-- Furnas etc. - - - — — ------ — Ups hat pump City/State/ZIP: _ — Well/suyended/unit heats Phone:( ) _ Fax: : Water hats_____ Fireplace _ I?-mail: Rte m — Barbecue Cb►ties dr r-- - --- JBusiness name_-- - �« ter Address: lc City/State/7.IP: _ Sebaota) Minimum permit The($72.50) Phone:( _ ) Fax: Pin review(25%of permit lee) CCB lic.: State surcharge(9%of permit f6e) 6,� TOTAL PERMIT FEE. Authorized signature: "In pttraw appleallw etglrelt if a permit M■ot OWSISvd"mb r90 dyer alloy It hrm how as eewpteft Print name: Q t L Q40- .,.— Date: ` • Far.methodology set by TO Coonry Building InduMv.Service Bond i,Ruildinl{d'ermitAMPr4WmitAppdoc 12M1 410-4617T( IMbCMVW®) r ` i Mechanical Permit Application - City of Tigard , Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuatloa: P- atilt Ftl'es 51.00 to 52,000.00 _Minimum fee$72.50 _ $2,001.00 to$5,000. $72.50 for the first$2,000.00 and$2.30 for each additi I $100.00 or fradion thereof;to and in luding$5,000.00. $5,001.00 to$10,000.00 41.50 for the st$5,000.00 and -- $I. for each a itional$100.00 or fracti thereof, o and including $10,0_00. _ $10,001.00 to$50,000.00 $231.50 for first$10,000.00 and 51.35 for ea Nditional$100.00 or fraction th f,tsland including $50,000. $50,001.00 to$100.000.00 $771.50 the first%in 0.00 and $1.25 each additi100.00 or fracti thereof,to auding $1 ,000.00. $100,000.01 and up $1 46.50 for the first$100, .00 and .10 for each additional$100. or fraction thereof. Note: All new c mercial buildings require 2 sets of platens. 1� 1 IL o� to J W J i\toildinR\Permit-%\MFC-R-rmitApp.doc 12103 2 CITY OF TIGARD BUILDING DIVISION PERMIT#: MEC2005-00346 13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 6/1W005 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6/24/2005 TIME: 7:09AM PAGE: 79 SITE ADDRESS: 09237 SYN NORTH DAKOTA ST CLASS OF WORK: SUBDIVISION: MLP95-00001 PP1995.084 LOT#: 003 TYPE OF USE: PROJECT NAME: SHANNON DESCRIPTION: Dryer venting. OWNER: SHANNON, RICHARD O +DUSTY D, PHONE #: CONTRACTOR: OYNNER PHONE#: Inspection Request Scheduled For: Date: 6/24/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Moi.:hanical final 010057-03 503-624-3926 N orrections/Comments/Instructions: a - - OC m W SS r] PARTIAL APPROVAL. [jCANCEL. ❑ NO ACCESS �'<IPA FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector. .." pate:��' --�-Phone k (503) 718- __ _ CITY OF TIGARD BUILDING DIVISION PERMIT C ELC2005.04415 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6116/200ra Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6124/20M. TIME: 7:09AM MGE: 81 SITE ADDRESS: 09237 SW NORTH DAKOTA ST CLASS OF WORK: SUBDIVISION: MLP95.00W1 PP1995.084 LOT M: 003 TYPE OF USE: PROJECT NAME: SHANNON DESCRIPI ION: 2 branch circuits to washer and dryer. OWNER: SHANNON, RICHARD O +DUSTY D, PHONE #: CONTRACTOR: OWNER PHONE C Inspection Request Scheduled For: Date: 6/24/2005 Pour Time- Code 0 Inspection Description Confirm # Contact # 1 Message 120 Electrical rough-in 010057-01 603-62.4-3926 N ` orrections/Commentsi Instructions: a`c to m W J PASS ❑ PARTIAL APPROVAL ❑ CAN'CEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: If. y — Date: Phone #: (503) 718- f CITY OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 CERTIFICATE OF OCCUPANCY PERMIT 41. . . . . . . a MST97-006F. DATE ISSUEDs 09/11/97 PARCELe IS135DP-12600 SITE ADDRESS. . . 1 09237 SW NORTH DAKOTA 97' SUBDIVISION. . . . a MLP95-0001 ZON I NO a R--4. .) BLOCK. . . . . . . . . . e LOT. . . . . . . . . . . . . 1003 JURISDICTIONsTIO ---------------------------------- CLASS OF WORK. eNEW TYPE OF USE. . . a SF TYPE OF CONSTRs5N OCCUPANCY BRP. eR3 OCCUPANCY L.OAD e 2 POOR QUALITY ORIGINAL BEST RFTRODUCTInN AVAILABLE Reeorks a path 1 Owners ----------------------------- .-- PETERS, KURT' & LORRAINE 5010 NW SALI9HAN PL PORTLAND OR 97229 Phone M: 690-8351 Contractors ------------------------------ OWE R Phone Me Rep #. . : 000000 This Certificate grants oc empancy of the above referenced building or portion thereof ,arid t,onfirms that the building has br±en inspected for compliance with the State of Oregon Specialty Codes for the group, occupancy, and use under which the referenced permit was issued. IL ac �, I�i►tt. IMt3 I .. ECTOR _~- BIJILDIN13 OFFICIAL _J m PW-T IN rONSP I Cl 0US P(..ACE W J CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE NORTH VALLEY ELECTRIC INC PO BOX 444 SWEETHOME OR 97386 Electrical Signature Form Permit # . . . . : %IST97-0062 Date Issued. : 03/14/97 Parcel . . . . . . : 1S135DB-12600 Site Address: 09237 SW NORTH DAKOTA ST Subdivision. : MLP95-0001 Block. . . . . . . . Lot : 003 Zoning. . . . . . . R-4.5 Remarks : Path 1 street opening permit is required before working in public right of way 5FOOT FENCE IS REQUIRE SEE SITE PLAN Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of work. No electrical inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNER: ELECTRICAL CONTRACTOR: PETERS, KURT & LORRAINE NORTH VALLEY ELECTRIC INC 5010 NW SALISHAN PL PO BOX 444 K H ca PORTLAND OR 97229 SWEETHOME OR 97386 Phone # : 690-835? Phone # : J Rpg # . . : 000883 in C7 i XSig ,nreupervisrng ectncien Please return this completed form to the address above. ATTN: Building Dept. If you have any questions, please call 639-4171, ext. #310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE SHOEMAKER'S PLUMBING PO BOX 250 ESTACADA OR 97023 Plumbing Signature Form Permit # . . . . : MST97-0062 Date Issued. : 03/14/97 Parcel . . . . . . : 1S135DB••12600 Site Address : 09237 SW NORTH DAKOTA ST Subdivision. : MLP95-0001 Block. . . . . . . . Lot : 003 Zoning. . . . . . . R-4.5 Remarks : Path 1 street opening pewit is required before working in public right of way 5FOOT FENCE IS REQUIRE SEE SITE PLAN Your company has been indicated as the plumbing contractor for the permit indicated above. in order for the plumbing permit to be valid, please have the ap^i riate individual from your company sign below and return this Plumbing Signature Form prior to- t ,: tart of work. No plumbing inspections will be author ized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNER: PLUMBING CONTRACTOR: PETERS, KURT & LORRAINE SHOEMAKER'S PLUMBING 5010 NW SALISHAN PL PO BOX 250 a. PORTLAND OR 97229 ESTACADA OR 97023 '� Phone # : 690-8351 Ph # : N R20 - W 35 m X Signature of Authorized Plumber Please return this completed form to the address above. AT N: Building Dept. If you have any questions, please call 639-41'71 , ;;xt. #310 r CITYGF TIGARD MASTER PERMIT DEVELOPMENT SERVICES Pr_RMIT . . . MST917-01062 13125 SW HIII Blvd.,TWO,OR 97223 (3103)639 171 DATE ISSUED: 133/14/97 HQiI TI i %64, H v MLP 9E 00181 ZONING: L7-4. Z st eetoperinp pereit is requirtd before working in public right of way SFCOT FELE IS REOUIRES SEE SITE RA __._.------- ------------____-- BUILDING ------------_--.._--------.----_.._.._______.�__-_�._.__.. STORIES....... . 1 FLOOR AREAS---------- tLSE(QIT_..: 0 if MIND SF'SACKS AMTRED------------- ''r "RS7. ... 944 if 'n'n....... 4Se sf LEF'............ a RVEf"rrRSc Y -= r USE...-F FLLIMP LOAD....: a0 "CND.,.: M if FRONT,........: 20 DARKM „'!ICE'S: 1 UNITS: FINSSMENI: 0 sfRISW_ .......... 5 ,.'�A!VCY ORP.;R3 BDRN: 3 BATH: 3 TOTAL_-----: 1770 sf VALUE..s: 126947 MR..,.......: 28 �........,: 1 077 1 OSETS.: 3 WASHING "� L ... 1 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPSa.......�: 0 .._ = 4 C:,vASITRS.... l rLM'r DQC1"T • . r ".VR LINE ft: t Sr RPIM DRAINS: MCU MIMS—: 0 SARBASE MO..: 1 WATC? HFATERS.. 1 NATER LINE ft: 100 9VFLW PREMi I GREASE TRAPS..: 0 OTHER FIXTURES. 6 mEmim _CEL ?YPES----------- FURN ; 1* ..: 1 SOIL/CIDP ( 3HPs 1 VEN' ''ANS.....: 4 IQTHS.S DRYERS: 1 -^ I / ru R" '-1@0M .. C UNIT HEA'ERS.. . Q INP.: 2 BTU FUM FUR AMi 0 VENTS.........: 0 WOW'OVES..... 0 as OUTLETS...s I 7—;L XT--- ---SERVICE/rEDS_R---- -TEM^ S?.'C,'FEMRS- ---BRANCH C.RCJIT9•--- ----NISCELLANEOUS----- -_ADD'L INSPECTIONS— 20C alp..; f W/SVC TF F",7..: 2 PUMP/IRPIGPTION: 2 PER INSTECTION: - 3 20: - 400 pep..: 0 201 - km alp..: 0 lit WX SVC/FDR: 0 SIGN/OUT LIN LTi 0 PER HM s I t :?: r.at aeF..: ¢ 0: - 629 pep..: 2 CA AD!'.. Ir MR; P ST9kMPNEL...: 0 IN P'LiNT....... 0 VN7 ISE' 7c,"7., 0 !21 - tm aar.: 0 601+4eps-1000 v: 0 Y10 LABEL -10: 0 :?28•z aap!calt. : C _...-__. -_..-..-____.__._._-.._ PLPN PEVIEW .C!. Reconnect only.: 0 )24 AES UNITS..: SVC rm.;r-"2. 5 P... ) 600 V NOMINAL: CLS F1AEA/913C am[ ^r RES!DE ' ^ _______.___..-------__ B. I ST'E7E,. . ;'A."IX,T! S S'EP'..: AL'DIC t STEREO. ; ''IRE pLARN.....: IN'ERCO"."almG: OVTD40R LM LT: NRTM AR ILA&M.,; CTH: :: X BOILER.........: HVAC,..........s LANDS E/IRR18s PROTECTIVE STK., ,ARAec p... CLOD;.... .. ... INS"MrATION: NE^TCI#.. . ....: L'TMR: 11, 4VAC.........,,; DATA/TELE COK: M!RSE CALLS....: MAL 1 SYSTEMS: _ --.•--._-.__ _..__.-___ CAL FEES:! 4°4°.52 _ 'SST d LCRRAIN7 R F[ 4ek A..: U) 'his pewit is :Slued subje_t to the regi.:at i,"s contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all otherJ pi%cablt laws. All Nor' Ni''. to done •--c^eance with eprraypd plans. This pereit will expire if w:r!4 is not started ifithin In 'aps of issuance, or if work is suspehded %r pare than tR0 days. RE01RED INSPECTITIS -------------.____. to .'7et•'1E3t Mecha1 Electrical Seri Gas Line Insp Water Line Insp Building Final .. Elect"i�al R:'ly Sas rlreFla^a AppL'!Sdwll ^sp r,acting ins, InSAZOP Insp Electrical rinal Shear Uall Insp Cep Eoa!','. Ins;: 1pc';an:cal r:.,3', ^'i ':, '..aw VoItagP Rain drain Insp Plaob F T .S t.A tic! C,zl '. fal- insj_jectiar, 59 -4173 CITY OF TIGARD SEWER jIPERMITCTION DEVELOPMENT SERVICES PERMIT #. . . . . . . : SWR97- 00C A�mk 131HSWHAHBhd.,TVW,OR9720 (6 )0)4171 npTE ISSUED: 03/14/007 PARCEL: 1S135DB-12600 09237 SWI' NORTH DAKOTA ST ML.r9f• 0007. 7CININC! R 4. 'S _.clew.. , . . . . . . . . LOT. . . . . . . . . . . . . :003 ' 7:NAN*7 NAME. . . . . .PETEr'S, I1.1.JRT R I_QnRATNC '3A N"1. . . . . . . . . . : FIXTURE UNITS. . . t 0 "_ASO Of" WORV. . . :NEW DWELLING UNITS. . "IDE OF USE. . . . . :SF NO. OF BUILDINGSr 1 `!rTfil_L TYPE. . . . :'BUGWR T MPrPk' `)!_1rsFnrF f Zemal-ks : Path 1 FEES rETERS, "..IJPT d LORr1)PTNr +ype by date 1'Pcpt 71010 SW SALTSHAN PL DR PRMT $ 2200. 00 JSD 03/14/97 97-2917!-- 1 N,S r 7-2'317`' `IP.Jr 1 37. Oq, 03, r-'ORTL_ANT_' OR '.37,x.^ Phone #: 690-8351 ".^NTRACTOR NOT ON FILE 2e35. 00 TOTAL_ ----- REQUIRED INSPECTIONS '`I� Applicant agrees to cusply with all the rules and rtgalations Sewer Inspection tye Unified Sem"e Agency. The pereit expires 188 days fret P datE issued. The total aseurt paid will be firftittd if the rsi: expires. Thr Aperc, dens not ;avartee "-a accuracy of tht je sewer laterals. If the sera i[ not locatr.' at the spasuresen' lel, the installer shall prespect ? feet in all dire:!Uir+s frog e distance given. If not so located, the installer shall pur:.lasa "•ap and Sier Sewer" Pei-sit and the All Cy will inst., `, all. CL NCall for insp^ct ion — G11-_4175 w a :ITY OF TIGARC Residential Building Permit Application eedBy 1125 SW HALL BLVD. New Construction Additions or Alterations Date Recd "CARO, QM 97223 Single Family Detached or Attached (Duplex) Date to P1 E " 503-639-4171 Date to DST �+ 503-684-7297 ✓ I�mit» Print or Type caw.d.3- Incomplete o illegible applications will not be acceptedwill , r Name of Protect (� N Job Address site AGMSS Architect M Address 'I LAJ i ndvl,w 2ipPh �yOwner Mating Address,',f0 w �1�A" 1 �� ac Istel Engineer s pvfh General "am. q�19 /t)til� PttiStI ,n —934r Oescnbe work New fi Addition O Al isition O R Contractor Mailing Address to tate done "O Additional Description gf Work: p C�tyrstste Ip Phone /5 !cmc ce w /0��!Cl/f�0 Oregon Const.Cant. Board L:c.K Exp. oats ITer •0- ,arh copy of Current COT Business-1 ax or Metro a Exp.Date PROJECT _ticonsea Name VALUATION $ a L 9,A 17.Q 4 Aechanical NEW CONSTRUCTION 4Nl.Y: Sub- Mailing Address Sq. Ft. House: 1 Sq. Ft. Garage Contractor l k�c, �th `� c tyrs to Zip phi Comer Lot YES NP Flag Lot Np l k -77 (check one) �/ check one) _ Oregon st.cont.aoaro GRestricted Audio/Stereo / 6u lar Xttach copy of C c"-� , :.. � Energy � S stem V � Current COT Business Tax or Metro a Exp.Date Installation Alarm Licenses _ Garage Door HVAC Name _ Opener Systems Plumbing (check an that Other. f S� O�_n � �_r' apply) Sub- Maiiirg Address - Will the electrical subcontractor wire for all YE NO I-ontractor � S(� Zv i t t restricted ener installations? t z, Phone—� Has the ga/79�b dPi t recorded N/ YDS N7 Oregr ��nsc cone. Boa L:c 0 Ex . 0 e Reissue Of MST4: IL Attach copy of Solar Cc pliance FX Current Plumbing Lc 0 r �- (Gak:uletion Attached) Licenses —J P� _36_.Q I hearty ockno ledge that I have read this application,that the CO Busi�s Tax or Metro r Dat information given is correct, that I am the owner or authorized (^ 3 agent of the owner, and that plans submitted are in compliance —t Name with Ore on State law co electrical hVa c S' tura f o NA nt Date G: I t. ut Sub- Mailing Address Contact erson Name Phone g3 I ontractor . 0. �Ox L11 �.��i �a/lw' S Still n Zip Phone_ FOR OFFICE USE ONLY: Plat N: L Map/T : 1S 13 5C5CO- 2b Oregon Const. Cont Board Lc A p. Date �IrT��Fpr; 4�� (jos ach Copy of R' ff. 1 Ss .,,, S b s: l zone Solar: ,irrent E'ec real Lic ! Ex .Dsto S tensa•• ?1_ �L� C1 COT Business Tax or Metro# Engineering -I!G , p TIF: 9-1 --in, I /;—,J/-77J 1 .dw(dot) I it ? Permit_# Accouot Description Amount Amt. Pd. @aj, Quo �,i,jZ.006z- MST. Permit (BUILD) 15M. ' 0> sQ". No Plumb. Permit (PLUMB) �ZS, ZS- ✓ Mech. Permit (MECH) 3. , ELC/ELR Permit (ELPRMT) c °° ✓ State Tax (TAX) 7/_ Bldg: 2S, 03 - Plumb: Mech: �• ` ELC/ELR: �� 2 Plan Check MST: (BUPPLN) 315• Plumb: (PLMPLN) Mech: (MECPLN) aE CDC Review (LANDUS) o. 40� `X TW -ooG Sewer Connection (SWUSA) Od, w w Sewer Inspection (SWIN ) 3S, Parks Dev Charge ( C) APA9 I 1050. ,o Residential TIF F- S 70, W /S e,soy/ Mass Transit TIF (TIF-MT) o. ~ " a Water Quality (WQUAL) w � Water Quantity (WQUANT) . &, p�. ✓ Erosion Control Pe i� (F_RPRMT) FO $ IV W Erosion Planc SA (ERPLAN) d'�+�• �- Erosion Planck/COT (EROSN) _ d Fire Life Safety (FLS) ___ TOTALS: rV 4530. doc root 1. 2152 BY LORAINNF. PETERS N b8.57'30" E CITY OF TIGARD ' S b8.57'30" _ -2,1 j r__-----_- PARCEL 3 1 1 F3� I l aur spa FT) 1 r 1 WETLAND I 1 o i BUFFER K x I �� lam• ��t 1 F o I MAIN FLO "'T"�'I --PRIVATE g 1 1L. 0 - }, wo OWN 1 I / I 1 / cone. oWMAY I QA �faE S. Moo PlAl 35.0• o - o N W02'40" E �.rjJ — ea.or - 29'-3' 13'-0" I 1 �� x ��-}-�: �� I► r3.� �t�T racoo I � ; MLP 95--1 � I Lot f j 7 onln) R ZI X03-X90 -8'3S t ml 1 st. 1 1 �n Ib 00 �j S 81-02-40'. W 14r N To rel< LI CE /-� ( - ►y� U 11/15/96 MRR t *AN WAMM olao AIWMMt W. 1000 not idea pall T I ADM*"of THE J jot lAlrw woM m n•M soil .ar ne to rosy %Am 0 M Nry Ale Irm DotA! (J P AW POVIMMI mo moo"CA" llAn f1AICORD Df f I n AIIOCIATtf In 305 N.W. 16TH AVENUE. PORTLAND. OREGON 97209 18031 228-9161 SCALE : 1 ' = 2 0 ' . O Solar Balance Point Standard Worksheet Address Box A calculations: North-South dimension for the lot. Box A. This dimension is determined by finding the midpoint of the North lot line and drawing an intersecting line perpendicular to that point. First. determine which property line is the North lot line. The North lot line is the line with the smailest angle from a line drawn east-west and intersecting the northern most point of the lot. 4V N ?North-South Dimension for Lot: Measure the dance from the midpoint of the North lot line to the South lot line along the described fine. ,t feet t N � MSN Bot 0 calculations: Shade point height for your residence. Box g- 1. Determine whether measurements will be based on the peak or eave of your Which describes structure- The orientation of the ridge is also important your residence? 1 a: If the roof line runs North-South, measurements will (drde one) be based on the peak of the roof coca .� 1B OC IL N 15: If the roof line runs East-West and the rooi pitch is iess znan 5x'12, measurements %%ill 1e �asea on the ease. 9%.01 ova w t7 W .—II 1 c- If the roof line runs East—vest and the roof pitch is 5/12 or steeper, measurements will be based on the b RSC peak. Box S. continued Box 8: 2. Measure change ,n elevation from front property line to finished Ivor elevation. If the lot slopes up from the front bt line to the foundation, the figure is positive. If the lot slopes down from the front lot line to the foundation, the figure is negative. — —C ft 3. Measure distance from finished floor elevation to the affected peakleave. + 1024.5 It 4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, ft deduct nothing. S. Subtract one foot for each foot of difference in elevation from the front property line to the rear property line, if the lot slopes up from the front to the rear. if the lot has no slope or slopes up from the rear to the front, deduct nothing. 0 ft 6. Total figure for box 8: )-L"s ft Box C Distance to the shade reduction line. Boot Q 1. Measure the distance from the North property line to the foundation near the affected peaWeave. 2. Measure the disunce from the foundation to the affected peak or eave. + ft 3. Total figure for box t~: it is moR uxeU to draw a ve*:W Inc w mpnes[nt dw aapropniam Ayre found in box'A'&W al_. W line to nWwent the appropriate fapx*found in boot"C'.The inter cdon d the vertkal and hoReorKal deeevrrkh "value found in boot ICY.The volar in trot 'O'should be m,pued to the value In bot IS ;if the vah,e in bnx 19'is less than or equal in the valve found in boat'O',then the buifdinq is to c ompGancte with the solar balance node. if rw have any q,euicM plesoe contact us at 639-4171,x304 or at the Community Oevok pment Counter. MA)0 UM PERJMIT O SHADE POINT HEIGHT (In Feet Oiwwxa to Nonh-south Ia dir wkdon an fee0 shade 100+ 95 90 63 80 7S 70 65 60 SS 50 43 40 redtuQfors Ine from northern let rinw(in fp@" 70 40 40 40 41 42 43 44 65 39 33 38 39 40 1 42 43 60 36 36 36 37 38 40 41 42 55 34 34 34 33 .30-- --3d 39 +0 41 3o 32 32 32 33 34 36 37 38 39 40 IL 43 30 30 30 31 32 33 34 3S 36 37 38 39 =0 28 23 23 29 30 31 32 33 34 35 36 37 38 N 35 26 26 26 27 28 219 30 31 32 33 34 35 36 :0 24 24 24 2S 26 2� 28 29 30 31 32 33 34 ra _5 2.2 1-1 22 13 24 26 26 27 23 29 30 31 32 20 20 21 22 M 24 2S 2.6 27 28 29 30 UJ 15 18 18 18 19 20 it 2-0 23 24 2S 26 27 28 J 10 16 16 16 17 18 14 20 21 22 23 24 25 26 5 14 14 14 15 16 IF 18 19 20 21 22 23 24 L91 x D. .Maximurn allowed shade point height. 37 feet h: %so1w.chp itetii�ed Zl-'b96 i _ - Permit#: � `00 W L� Address: issued by: _ Date: _ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon I aw, 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 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 I and 2, and either box 3A or 3B: � n ® 1. 1 own, reside in, or will reside in the completed structure. Q ® 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. l� 3A. My general contractor is LJ (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. OR �P ® 3B. I will be my own general contractor. 40f a If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors R F- Board. If I change my mind and hire a general contractor, I will contract with a contractor who is co registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. m w I hereby certify that the above information is correct and that I have read and do understand the Information -� Notice to Property Owners about Construction Re ponsibilities on the reverse side of this form. � yaft - -- _- -- - j- u- 9 (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Intormation Notice to Property Owners - About Construction Responsibilities Note: This Infor otion Notice to 1'roperty Owners about Construction Responsibilities was developed by lie Construction Contractors Board in accordance with DRS 701.055(5) If you are acting as your own contra or to construct a new home or make a substantial improvement to an existing structute, you can prevent many problen-L5 by ng aware of(L following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with t e. Construction Contractors and to do labi)r in constructing or assisting in the construction or improvement of a residenti I structure,you will, in mo instances,be ruled to be an employer and the people you hire will be employees. As the employ ,you must comply wit e following: Oregon's withholding tax law: As an employ ,you most withh d income taxes from employee wages at the time employees are paid. You will be liable for the tax payment evert if you d ft actually withhold the tax from your employees. For more information,call the Oregon Dept.of Revenue at 45.8091. Unemployment insurance tax: As an employer,yo pre quired to pay a tax for unemployment insurance purposes on the wages of all employees. For more information,call th egon Employment Division at the Department of Human Resources at 378-3524. Workers'compensation insurance: Asan emplo r,yo are subject to the Oregon Workers'Compensation Law,and must obtain workers'compensation insurmce for your • ployee, If you fail to obtain workers'cnmpe isation insurance,you may tv subject to penalties and will lie liable for all cla' costs if n of your employees is injured on the ob, For mbre'informaiion, call the Workers'Compensation Division at the epartment o .onsumer and Business Services at 945-7888. U.S.intental Revenue Service: As an empl yer,you must withh d federal income tax frbrn employees'wages. You will be liable,for the tax payment even if you didn't •tually withhold theta For more information,call the Internal Revenue Service at 1-800-829-1040. OTHER RE PONSIBILITIES AND A AS OF CONCERN: Gale compliance: As the permit holde for this project,you are responsible fo esolving any failure to meet code requirements that may be brought to your attention rough inspections. x IL Liability and property damage ins ranee: Contact your insurance agent to see i ou have adequate insurance coverage for ��-• accidents and omissions such as fal ng tools,paint overspray,water damage from pl�e punctures,fire,or work that must be rn `re-done. =s Time to supervise employees: M sure you have sufficient time to supervise your em oyees. m Expertise: Make sure you have the expertise to act as yourown general contractor,to coordinat he work of rough-in and finish trades,and to notify building officials at the appropriate times so they can perform the require spections. 1 If yorl have additional questions,write or call the Construction clmltaci�rt Aottrd'(PO Bv,x.14140,talem,09 0304-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite '10,in Salem. prop-own.pm4 1/94