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Lao&.i:\records\microflm\targets\building.doc
i
;NSp>?CTION NOTICE
city of Tiq,ard Building Depart—tet
13125 SM ball Bled. Tigard, Oregon 972 _1
Inspection Cine (Rec-O-P'.ione)s 639-4179 Dueineas P6 539-4171
Inspection: _ — -- --- —
Footing Plbg. Underelab Mach. Rough.-in Apps/Sdwlk
Pound. Plbg. Top Out Cas Line NALt�
Poet/Beam struct. San. Sewer FramLng -Bld
Poet/Ream Mech. Rain Drain Insulation -Plumb./
Plbg. Underfloor Water Line Gyp. Rd. ! MacDs/'
Date Requested: l& O TUMi AM - PH
Address: Permit fs2
Builder:_
THE FOLLOWING OORRECTIONS ARE REQUIRED-
Inspector: —���--- _ Datas
APPROVED DISAPPROVRD APPROVED SUBJECT TO ABOVE
Call For Reinep.
CITYOFTIGACI7Y0Fi16ARDRDPERMI
���+ i:� f r =?
COMMUNITY DEVELOPMENT DEPARTMENT ORIOM ti M
131268W HWI Bbd. P.O.Box M- 97,TlgaM,Oregon 97223(603)639-4175
31'rF- 01)]DRES""I 099-50 5W Rj ;ERWO,,—
SUBDIVISION. . . . : PICKS LANDING
SLOCK. . .. . . . . . . .
RE151,AJE: 1)W E L I-I!') s t-2 I S F Mr, . . . . . . . .
LI-Pi3b Of- WORK. -ADD 1A E,1)R 14 f-.3.Of 130 I HS 0 GARAGE=. . . . `: . . . . . :0 5
TYPE OF USE. . . :SF FLOOR AREC,4` - U I 1?r--1) S U.Trk A C K
TYPE OF CON137'. -5N f IFcSI". . . . : 1,'4�f
f LEFT. 5 ft RIGHT. .
nccuPAi\jcy c-pp.,. FRO!,i ! . ft f"%( F41?. .
STORIL7,. . . . . . . . I THIRD. . . . 0 s f REQU I RF--.D-
HE I GH 1'. . . : lIi rt TOT Al, "4F
FLOUR LOAD. . . . :40 P--J VALUE::. . . . . 50011) SPACE,—
RF%matlks : ft cldd.ltitiri t-)
PLUMBING
SINKS. . . ., . . . I F-1-0f.)R . " . !0 PACVFLOW PREVNTV*�'. :0
L A V -)TO R I E S. . . . . ..0 WATER HEATEH.HS. . . :0 T RAF-",:... . . . . . . . . . . . . . :0
TUD/SHOWERS. . . . :0 LAUNDry 4 TPPY�3. -0 CA"'CH RAS 1:4e 0
WA f E,R CLOGLT S. -0 zr-iEWLR L INE ( f t ) :0 GREASE TRAVIS. . . . . . .
DISHWOSHERS. . . . 1 WP'1F*R LTNV: ( ," ' . :0 0 T HE R F I X 11 J RE S.
GARBAGE DISP. . . : I RAIN DRAIN (f't ) . '141
WASH I NG MACH. :0 SF RAIN EopPir"1:1. . 0
MELHANIC-AL FEES
PUEL I_jj\jj-r 0TR7. Q) typ'? 'Am t� .m t by Hatlp
VENT�', , . . . . O BPR 1 $ 50. 50 JH 07/i="4/9c'
MAX TNPU1-:0 0TU VF-.NT P'AN"'. 0 nPI $ 1-- 83 TL+1 0 7/06/1)P
FURN ( 100K . . :0 HOODS. . . . . . 0 b5c,(- $ 5 3 JH 07/&4i9G,
FURN ) =10011, . . .-0 W(aOY)!"JOE�"
V , it PPR 1 4, -,.10 JFJ 0 4
FLOOR FURN. . . . -0 CLO DRYERS. 0 P5PC 1 JH 0 4
"HP-0 OTHER UN11-5.0
GAS OUTLETStO
Owner:
i()C K M Y E P6
09950 SW Rlt1F-.RWO0D LN
TSGARD OR 97,2:24
'his vervit is isslut-1 subJect to the regulations contained it tf-m RLD 1NbPEL, I ic-IN"i-3
'icard Municipal Code, State of 01-P. Specialty Codes and all nther P0C)t,/ ff1k,mCi Inc c, b,..H- 1dj.nq Pitieil
ipplicabli laws. All work will be done in Accol-or With app-oved plost/BeFlm Stmtct Erostrill cotitt-01
:laic, This verait will er .Vlk Nithir 180 !,LM/(JT)(JPr-f,1f)0v-
of imance, or If 4r,-,
,
I -r fftjflf!l
1.1-1 q"i at i o rl T Ii-,i)
Gyp � rd 7
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I qti,�f�fl Elv I F J.
e`-'1C4,-4 1,7�-j
- [—P-e_rm_i_t No: /2Z5 r C�
Address: _�% f'S'd Zo
uFi zj Issued by:- �-- Date: L
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 sta+ement. This statement will be
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and eithor box 3A or 313:
1 . f 1 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.
3. A.I 1 My general contractor is _-_ _ -,
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.El�___ I will be my own general contractor.
If I Dire 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 C;,nstruction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the 2bove 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.
g ature of Peng' Applic nt D e
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COVY TO APPLICANT
-� IJIISSWHa11131wl. PLNCy '2-/^�RECT # �CITY OF T IGA RD fY)Box Z3397 PERMIT #
Tifird Orcgon 9727 i
COMM[1N1'il' DI;VI�.LcSPMEN'I'DT;I'ARTh1ENT (503)639-4171DATE ISSUED
JOB ADDRESS: 99s a w ,c��yc�.�w o o a �✓' _ TAX MAP/LOT 9—
SUB: LOT: %c' LAND USE:
VALUATION: '� d o o m� —
OWNER
�2 9 A�P 4 7'Oi-'lo ova SPECIAL NOTES
NAME: c /y>y���s REISSUE OF: —�-
ADDRESS: J�9,��0-s w' iCsyr��woaa 4 LAST REISSUE:
FLOOD PLAIN/
PHONE: Za `may`%,`� SENSITIVE LAND:
CONTRAC13R APPROVALS REQU U12
NAME: do c/N�"� 'U14 0 PLANNING:
ADDRESS: ENGINEERING: _ -
FIRE DEPT:
PHONE: - _ OTHER:
CONTR. [SOAR) #: EXP DATE:
ITEMS RE UIRED
SUBCONTRACTORS: PLUMB: _ _____—.___— DIST/SUBCONTRACTORS:
MECH: __—. _ BUS TAX: J-
ARCH ENGINEER CALCULATIONS: _
NAME: TRUSS DETAILS:
ADDRESS: OTHER: ------
PHONE: -
PROPOSED BLDG. USE: 4,yo17/oy 7"6 _5-1,,/EzF XC� ,,e/
COMMENTS:
AI'Pt CA T SIGNATOR
Received By: Date Received: —_�
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees —SO- 50 S o.s d
10-431 00 Plumbing Permit Fees cl�S
10-431 01 Mechanical Permit Fees _
10-230 01 State Building Tax (5%) ?� Y, �
Building S 3
l
Plumbing /. Z
Mechanical
10-433 00 Plans Check Fee 32,Y3 S4. �3
Building
Plumbing —
Mechanical
10-230 06 Fire
30-202 00 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 _
25-4^3-05 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 /12. 11 34. 3
nm/3587P.WPF
1�,
CAIN' OF TIGOPP RECEIVII OF PAYMENT R�-MIPT NO.
ClqEcl-,, AMOUNT : •79.
NnMF MYERIG3, JACK (-;AS14 AlAJUNT t 0. 010
ADDRESS a 99'50 BW RIVE RWOOD LN r:,Aymrh,,i*, tmpz : 07/24,192
TIGAR,D, OP 972,:--4 -
PURPOSE OF PAYMENT AMOUNT POID VILIPPL OF PPYMPN r (.)M('.)L.)N'r
...........
-0 -.4 P E R 1,,l 00
.1 r 50. n V"L.L.IMPINr
ST. 0011 D E'ER r. 78
TOTAL AMM)11t1` POID
ri
CVIY OF TICK)RD PECE' lPT 01-' P(MIRNr RECEIPT N0- 0 9 J,I tl
CNAECK 3,". 33
NAMI- ivra-Rs, jnci-,, M61-4 WOUNT 0. 410
ADDRESS a 9950 SU PIVERWO(A) I tq P,AymEiq,r DATE 0 7/06 1 W
SIM I V 1:3 T ON
TIGARD OR 9 7
Clf' DAYMPNT AMOUNT Pf)I or PAYMENT AM01,111T 1''0 1 J)
P L.'(6 N,- F "i,f.......
ADDITION TO ')l)'30 S.W RIVER1401-1) LONLl'
TO-rAL AMOLINI' 32. 83,
INSPECTION NOTICE
City of Tigard Building Department (f
13125 SM Hall Blvd. Tigard, Oregon 97223 /�,�
Inspection Line ,Aec-O-Phone): 639-4175 Business Phone: 9-4171
Inspection: —
Footing Plbg. Underelab Mech. Rough-in Appr/sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meoh•
Date Requested: 71_Z� `1 Z— Time: '�AH _1'M
Address: / 1Sy y C��T`-__ -_ Permit
Builder: ——
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector bats:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.