9780 SW TIGARD STREET ADDRESS:
1
i:\records\microfIm\targets\building.doc
CITY OF TIGARD
OREGON
-June 1, ' j 9 5
RE: BUILDING PERMIT #
Inspection(s) have been conducted on this project . However, we
have no record of any subsequent or final inspections within the
past 180 days .
Please note that permits become void if there has not been an
inspection performed for over 180 days . In that case, the Building
Division may require a new application and fees to continue work. r
A notice of non-compliance against the property may also be
recorded by the City.
Please advise the Building Division, IN WRITING, within 15 days of
this letter, the status of this project . You may request
additional time to complete the project .
Respond. IN WRITING to: Building Division, 13125 SW Hall Blvd.
Tigard OR 97223 . Be sure to include the following information:
1 . Building Permit # .
2 . Address of property.
3 . Your name.
4 . Your phone number 8 : 00 a.m. - 4 : 00 p.m.
If you are .ready to schedule your next inspection, please call our
24-hour inspection Recorder at 639-4175 .
login\odd_inspections
13125 SW Hall Blvd., Tigard, OR 97223 (.503) 639-4171 IDD (503) 684-2772 --�
CITY OF TIGARD '
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.9199 1503)639-4171
L�
`PLNCK ,�y I
CITY OF TI GA RD "��SW"�°°� �RECT #
_
COMMUNITY DEVELOPMENT DEPARTMENT
rpra,orc�,9;v� PERMIT #
(503)09-4171DATE ISSUED
r JOB ADDRESS: f �o �,�.'i �r'� G/c: _ TAX MAP/LOT X 14 L B - yu yG U
SUB:N�� , 7 G, ,l, ��d. d� ,. LOT: — LAND USE:
VALUATION: ? 3�0
OWNER ` SPECIAL NOTES
NAME: -J 4✓ t. �J �, f��bt /'r qLJ REISSUE OF:
ADDRESS-. 11/F D a �A LAST REISSUE:
FLOOD PLAIN/
PHONE: .r iT _ ��� SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: J tl� �� ' Br��'75�� PLANNING:
ADDRESS: _ 2 V '<> �.r ) ,'t ENGINEERING:
FIRE DEPT: _
PHONE:
OTHER:
CONTR. BOARD #: EXP DATE: � 2
ITEMS REQUIRED VVVV
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH ENGINEER CALCULATIONS:
NAME: — TRUSS DETAILS:
ADDRESS: __ OTHER:
PHONE:
PROPOSED BLDG. USE: _��4-
COMMENTS:COMMENTS: --
E
APPLICANT SIGNATURE
Received By: ___� — _ Date Received:
q NJ
PERMIT k ACC1 # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
M5 _OSLy 10-43?_ 00 [3uilding Permit fees �U' �y �. , - ��':q
10-431 00 Plumbing Permit fees
10-431 01 Mechanical Permit Fees
�! 10-230 01 State Building tax (5%) 3 - 0
IluiIdiFig _ •v3 /
Plumbing —
Mechanical
10-433 00 Plans Check Fee -
Building
Plumbing
Mechanical
10-230 06 Fire -- ------ ---30-?0? 00 00 Sewer Connection -- -
30- 444 00 Sewer Inspection —
25-448-02 Commercial TIF Fees -
25-448-04 Industrial TIF Fees _
2.5-448-06 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 Oev Charge (POC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSD(:) ------
21-445-01 Water Quality (fee in lieu of)
24-445-02. Water Quantity (Fee in lieu of)
TOTAL_
nm/35871).Will
■
Permit No:
ti Address:
' Issued by: Date:
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 riot 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 URS 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:
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 upon completion.
3. AJ I 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.
f1R
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, ' 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 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 pl canter Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PEPMIT FILE
PINY. COPY TO APPLICANT
I
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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 Oregon Legislature.
^
It 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 const ucting or assisting
in the construction Jr improvement of a residential structure, you will, in ,Host 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 1�x Law. As an employer, you must withhold intorne taxes from employee wages at
the gime employees are paid.TYou wily be liable for the tax payment6 even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390.
Unomployment Insu - -
purposes on the wages of all employees. For more information, call the Oregon Employment Division DHR
at 378-3224.
Workers' Compensation Insurance. As an employer, you are subject to the Oregon Workars' C,)mpensation
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 ona of your
employees is ;niured on the lob. For more information, call the Workers' Compensation Division DIF at 373-7434.
U.S. Internal Revenue Service. As an employer, you must withhold federal ine:orT e tax from employees' wages.
You will he liable for the tax payment even it you didn't actually withhold the tax. For more information, cal
the Internal Revenue Service at 221 3960,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this prrajec:t, you are responsible for resolving any failure to meet
code requirements that may be brought to your attention through inspections.
liability and Property Damage Insurance. Contact your insurance agent to spa if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint oversprny, water damage from pipe pcinc
tures, fire, or work that must he re-done.
Time to Supervise Employees: Make sure you have soffirient 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 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503.378-4621
0244J 10124/89
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INSPIM !ION NdPICE
City of Tigazd Building Department
13125 611 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-0-Phone)t 639-4175 Business Phone: 639-4171
Inspections--- ------ -------- - — --
Footing Plug. t'nderal.ab Mech. Rough-in Appr/Sdwlk
round. Plt.g. ^,op Out Gas Line FINAL:
Post!Beam Struct. San. sewer Framing Bldq
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Meeh.
Date Requeatedt -` Time: -AN _PN
Address:
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIREDt
Inspector: Dataf Y2
APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Relnsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 87 Ball Blued. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone: 66339-'4175 Business sone: 639-4171
Inspection:_ --_ �Nv_ 4
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out paw Line FINAL:
/?CPost/Beam Btruct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Rd. -Mach.
Date Requen(t�.eedd:__( `J.Z-_ /Time:/s AM _—CPN
Address-
Builder:
ddress: �/, /lfrloit i / C/LyT
Builder: 4 Z zl - A 2/
i
TAE FOLLOWING CORRECTIONS REQUIRED:
C ✓
T
Inspector: -. -- Date:.
APPROVED DISAPPROVED f APPR[NED SUBJECT TO ABOVE
_Call For Reinsp.
Page No. 1 CASE H'3TOPY FOR CASE NO SUP92 0244
MICHAEL MONTY
09780 SW TIGARD ST
09/09/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
SUPA007 Application received / / / / 08/12/92 PASS JLH 08/38/92 BLT
BIJPA020 Plan check by 08/18/92 / / 08/18/92 PASS RT 08/18/92 DLT
BUPA030 Check for prcl. restrict. / / 08/18/92 08/12/92 PASS RT 08/1B/92 BLT
SUPA090 (F) Issue building permit / / / / 08/18/92 PASS BR 08/18/92 JH
BUPA725 Framing Insp / / / / 08/27/92 PART GS 08/27/92 GES
13UPA799 Final Inspection / / / / 03/18/93 DIS GS 03/19/93 GES
BIIPA970 Case Finaled / / / / 11/08/93 11/08/93 GES
BUILDING PERMIT
CITYOFT=FARD4RD ER 1`4 1 T #. . . . . . . .
COMMUNITY DEVELOPMENT DEPARTMENT cmio"ON
13125 SW Hall Blvd. P.O.Box 23397,TOM,Orem 97223(603)$394176 OATF ISSUED:
']PTTE ADDRi 09760 SW TIGARD
'AJBD I V T S I(IN. N( ' t..L iiL101 1 1 ON AMEND. ZOIq1NGc I—P
BI-OCK. . . . . . . . . . . . . . . . . . . . . . . . :60
RE I 5:UE: FLOOR EXTERIOR W01-1- CONSTRUCTION
OSS OF WORK. :AL.T FIRST. . . . S f N i E31 E I W
TYPE OF USE. . 5F 5ECOND. . . sf PROIELl'
IYFIE OF CONST. s5N THIRD. . . . St No So ES W:
[:OCCUPANCY GRP. : R3 TOT CIL-- - ----,-- --- 0 s f F-(C')(.IF CONST.- FIRE RET'?:
I.ICC:UPANCY I-OAD: BASEMENT. - Sf ARE(.) SEP. RATED
FIT. 16 Ft GFIRAGE. f OCCU SEP. RATED:
BSM1" MEZV RPUD REQU I
I-LOOR 1-001). . . 40 1'.E r"I f I- R371 IT r ft FIR !ft]K DF, I .
DWELLING) LIN I TG: I FRNTi ft REAR: ft FIR ALRM: HNDICF' ACE
H(--DRM5- BATHS: IMF,') 5(JPF'ACF-. P,R 0 r'O R R VIA RV,I NG:
VALUE. $ - L1'500
H im m Ar-k 5 a CHO NGY I NC.3 ROOF LINE' OF HOUSE
Owner., FEES
type amount I.7V (A ate V'Pupi
A001) LP PRIVIT $ 38. 50 1114 08/I L'1/9.:' 2
PLCK $ 25. 03 JH 08/18/'30 2
T IGARD OR 9 7 1-.1';713 5PCT $ 1. 93 11111 0811A/13P 2
Phone #: 684-1911
Lontractors
OWNER
Tione
HEOUIRLD JNBPEUIJON'-;
his permit is issued subject to the requlatior.F contained in the F t,a m i r)q I n%t,-)
�ioard Municipal Code, State of Dre. Specialty Codes and all other I n, u.at i on I nsp
applicable laws. All work will be done in accordance with Gyp Hoard Insp
approved plans. [his permit will expire if work is not tarteo r"l-in Orain Insp
within 180 days of issuance, or if work is suspended for more Final Inspection
than 180 days.
5±I-M i t t;I?P at q n a t Lt t~e
,Sued BV :
Call for inspection 639-4175
� 1i3iuswIiallBt-d. PLNCK/RECTA#CITY OF 1 IGARD PO 13,x 23391 PERMIT # [J � —
tir �Z-v
CO11MUNI Y DEVE1LU1'1 ENT DEI'ARTNIENT liga�d,Orego�97M
(503)639-4171DAI E ISSUF" _J
JOB ADDRESS: •SCC) ',,,4_1� FAX MAP/LOT -g. LQ
SUB: �Jv'1)e c4Pl LOT: LAND USE: _--
VALUATION: —
OWNER SPECIAL NOTES
NAME: _ ��� /11U��� ! _J-- REISSUE OF:
ADDRESS: .- ZLO //y <r`� -S1 — LAST REISSUE:
FLOOD PLAIN/
PHONE: _ _�,� ,i7 �!� __ SENSITIVE LAND:
CONTRACTOR APPROVALS REN RED
NAME: ? k _ PLANNING:
ADDRESS: ENGINEERING: — __—
FIRE DEPT: - —_.--___--
PHONE: OTHER:
CONTR. BOARD #: ---___-- EXP DATE: _---
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: __.._ _—____-._ LIST/SUECONTRACTORS: _
MECH: _ ---- --- BUS -FAX: — -- -
ARCH&N G IN E ES. CALCULATIONS:
NAME: __ . , 1RUSS DETAILS:
ADDRESS: __YT_---- _ OTHER: ---__ --_-
PHONE: _—.-- -- — ------
PROPOSED BLDG. USE: ---
COMMENTS: --------- ---_ ---- --.
APPLICANT SIGNATURE
Received By: _.___-- Date Received:
PERMIT n ACCT # DESCRIPTION AMOUN-� AMOUNT PD. BAL. DUE
fSu2-o:I c� 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 0.1 Mechanical Permit Fees —_
10-230 01 State Building Tax (5%) % — �'4E3_
Building
Plumbing —
Mechanical
10-433 00 Plans Check Fee
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
25-448-05 Mass Transit III 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
nm/3587P.WPf
Permit No:
Address:
Issued by: Date:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, URS 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 3B:
1 . 1— 1 own, reside in, or will reside in the completed structure.
2 . f- I Understand that I must register as a construction contractor if the structure is sold
or offered 'or sale before or upon completion.
3. A.I My general contractor is -_
Conti actor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture mus' be registered with the Construction Contractors Board.
OR ��,!
3. d. l*M—1 will be my can 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 cont-actor who is registered with the Construction Contractors Board
and I will immediate'y 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 have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Si nature of mit pplicant
CONSTRUCTION CONTRACTORS BOARD
02,14J 8/91
WHITE COPY 10 ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction Responsibilities
was developed by the Constructi,m Contractors Board in accordance with ORS 701.055(5),
ppssed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new tiorne 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 RESP;NSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assis,ing
in the construction or improvement M a residential str':cture, 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 withhold the
tax from your employees. For more infnrrTration, call the Oregon Department of Revenue at 378-3390.
Unemployment Insurance Tax' As an employer, you are required to pay a tax for unemployment insurance
purposes on t,re wages of all employees. For more information, call the Oregon Employment Division DI-IR
at 378-3224.
'Vorkers' 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 insuranct,, you may be subject to penalties and will be liable for all claim costs if one of your
employees is injured on the lob. For more information, call the Wor'.ers' Compensation Division DIF at 373-7-134.
U.S. Internal Revenue Service: As an employer, you must withheld federal income tax from employees' wages.
You will be lieble 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: �, r
-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.
Liability and Property Damage !nsurance: 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 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 owh general contractor, ,o 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 Summer St. NE. Suite 300
Salem, OR 97310.0151
Phone 503-378-4621
0244J 10/24/89
PLAN CHECK APPLICATION
C11YOFTIOARD QJYOFi1GARD PLAN CHECK /
COMMUNITY DEVELOPMENT DEPARTMENT SOON PERMIT
»>tsswN 8W,P-O.BON 2X n.TjgfAo+a_1�(SM)MG-4176 —_ DATE ISSUED
' TAX MAP//AT.,1.S I D�
JOB AD1'eFSS:_.� _ --
SUB: `Ltd` ' 1 1 LOT: LAND USE:
VALWX-11 1 Uv SETBACKS: FRONT:: REAR: LEFT: RIGHT:AT
WORK CLASS: HEIGHT: TOTAL (►RFA:
USE TYPE: FLOOR LOAD: 1ST:
CONSTR TYPE: HEAT TYPE: 2ND:
OCcIP GROUP: DWELL/UNITS: _- 3RD:
OCCUP LOAD: NO BEDROOMS: BASEMENT:
NO STORIES: NO BATHS: GARAGE:
INP ST,
APPROVALS REQ'D SPECIAL NOTES ITEMS REWIRED
PLANNING:^" REISSUE OF: LIST SUBr•ONTRACTORS: -
MINEERING: LAST REISSUE: BUS TAX:
FIRE DEPT,: - FLOOD PLAIN/ CALCULATIONS: `
OTHBR: - SEN IND.: TRUSS DETAILS: _
PARKING PIAN:
LANDSCAPE PIAN:
PIAN CHECK BY: OTHFP: _
COMMENTS:
-NUCT y DESCRIPTION Fti'lli'vi+[ M'9Ol:N? PD. BA.L. DUE
PERM, IT •F
10-432 00 Building Permit Fees ----
_,� 10-431 00 Plumbing Permit Fees -
- _ - 10 -431 01 N.,chanical Permit Fees
10--230 01 State Building Tax (5X) -
Buildingy .,
Plumbing
Mech _ v3
10-433 0q Plans Check. Fee �'U� -
B u i l d i ng
Plumbing "
Me.ch f
30-2.02 00 Sewer Connection - --- -
-- 30-444 00 Sewer- Inspection -- --- - -
51-440 00 SLreet System Uev Charge (S()C) --- ---- -
52-449 00 Parks System Dev Charge (POC) - --- - --
31-450 00 Storm Drainage Syst Dev Chrg -
10-230 09 TRFO - --
10 230 06 Washington County Fire N1 (95X) _-�
10-220 00 smart./Wod9ewuod
101(11
APPI.-ICANT SIGNn1URE
kereived By
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CITY OF TIGARD
Srroill WORD ORDER
BUILDING DIVISION
13125 SW IIALL 111M) , TIGAR1), Olt 97223
639-4171
JOB ADDRFSS: - .--- ___�.� _ - PERMIT
I
OWNER:_ . __ CONTRACTOR:
YOU ARE IN VIOLATION OI'7'IIE FOLLOWING:
Lr,
Y j;JT
AND HEREBY NOTIFIED THIS ff DAY OF 19 .1 ATM'
THAT NO MORE WORK SHALL BE DONE ON THESE PREMI ES UNTIL. THE ABOVE VIOLATION HAS
BEEN CORRECTED AND VERIFIED BY THE CITY. CORRECTIONS SHALL BE MADE WITHIN - �4-j_-
DAYS OF THE ABOVE DATE, FAILURE TO COMPLY WITH THIS NOTICE WILI_ RESULT IN TF-IE
ISSUANCE OF A CIVIL INFRACTIONS SUMMONS.
-DO NOT REMOVE THIS NOTICE-
BUILDING INSPECTOR
INSPECTION NOTICE
C:
City of Tigard Building I)*, -taent
13125 SN Ball Blued. Tigard, Oregon 97223
l 1.;&'spoction Line (Rec-o-Phone): 639•.4175 BunLneen Phone: 639-4171
Inspections.__
Footing Plbg. Underslab Mech. Rough-in Appr/Odw1k
Found. Plbg. Top Out Gas Line FINAL:
Pont/Beam Struct. San. Sewer Framing -Bldg.
Post/edam Mech. Rain Drain Insulation Plumb. 1
plbg. Underfloor
WaateerLine r
-
MechAM.
Date Reqested: � v TLWs
Address• CEit I2
Builder:„ l
CFOLLOWING CORRF.CTIONSt E REQ
NE UIRED:
/Az
Inspector:
C_.-APPROVED DISAPPROVED APPROVEn SUBJECT TO ABOVE
Call For Rninnp.
� t ■
INSPECTION NOTICE
City of Tigard Building Department /
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inapecttons` 1
Footing Plbg. Underalab Hoch. Rough-in Appr/Sdwlk
froun1. Plbg. Top Out. Cam Line FINAL-
Post/Ream Struct. San. Sewer taming -Bldg.
Post/Beam Mach. Rain Drain ulation -Plumb.
Plug. Underfloor water Line O
yp. Bd. -Meth.
Data Regveetads
Addreeai Times AM ! P
�t�- ` Permit
Builders -
/THEE FO�LIAWINe, copRzCTIC14 RXQUIRBD:
G Z
Inspector= - - nate.
APPROVED DISAPPROVED y- APPROVP.n [rn,1RCT TO ABOV3
_Call For Reinsp.
All FlUILDING PERMY1
CITYOFTIIFARD
CJ1YC. .AALINRID F,FR PI I T B 1.1 F-,'4w -0'
63
COMkUNrrY DEVELOPMENT DEPARTMENT onem
13125 SW Hod,Blvd. '?-0.Box 23397,TOW,Orepn 9(603)O3 41.76 "1 ISIA-1): 12/12/90
8 0 f:.)W ( i.Ul-lkl) - J, F,ORCEL: 2(21, 2Pw- 4(oi
3 Air
4DIVIS10m. . . " : ZONING.
r.`41ACK. . . . . . . . . « M LOT... . . . . . . . . . . . .
I�E I SSUE F1 OOR EXI*ERIOF,, W01-1- C0NS'TRIJC'YJ0N--
CLASS (:)F W0RK,. :(-)L.1' FIRST. . . . : Sf N: Sa E W
T'YPE 0F f F'ROT'ECT
f'Yf*,E Dr- C0IqST. :',';N THIRD. . . Sf Na E: WC
0CLUI!:1AIsIC,'Y (3RI-1. -R,3 1'0 T'A L.---------- 0 s,f R 0 0 F C()Iq ST F: I RF:. RF.. F I?v
LOAD: BASE M EN T. Sf AREA SEI-*,. FATED:
H1'. : 3.G f-L GFIRAGF , . . Sf 0CCA1 SE:i::,. RWED-
ME ZZ'? REED .......
11.00R UJAD. . . . -40 f i r::F*r -ft RGHT. ft F 1:R 1:1(%.L. SVICIK DE T . . i
()WE-LIANG Lllql'T'S-. FRNT ft K'EAr4'- f t FIR HNDICP OCC!:
14 A I'I-I E-)-
P R 0 C 0 R F,^ 171 0 R K 1.N(:;
61
to c)-F h c-)t.t it,P..
FEES
ITUCHOEL MINTY t.v T)e ;AMOUVIt by ti Ate -r e(7 11
1, 13G5 (SW r.R0NW001) 1-1- PRMT $ 62. 50
I IL CK 4. 40.6:j
T .11(3()R1) (:11"i 972 2;3 5 P CT $ 3. 3.13
;1hmvip 0.-, -1'x'7:1.
P,A Y 11 $ 106. 26 JI-H I2./12/90
N J.C 1-4 A EL M 0 N'T'Y
1-1,365 SW IRONWOOD I-P
I 1C.70RD 06< 972213
llficme #.-, 684-1.971. 4 1 06. 2(-.. i'o,rAL
1t4-q 04', X
REAMIRED INSPECIJONS
'his pewit is issupd subject to the regulations ntmed in the Pcmt/Dr?Aln 11-1sr)
148T-d Municipal Code, State of Ore. Specialty Codes and all ether F-r.-Am.ivir.1 Trisp
,o,lic,lle laws. III work will le lone in accordance with 111 S Ll I ,..I t i a)-I 11-1 S P
inuroyed plans. This persit will expire if vo4 it not started G*vp 14c)a-rd Inst
i,ithir, 180 da'Ys of issuanep. or if vnO is susoendel for more RAJ.1-1 CI-r,A:[n 1,1fiF)
}hen 180 days.
...._....+._.r_...............
.......... _.__._.___... .._.W.__.
Cat]. for ii.i-ispec.,tiaii 639-41.75
i=b- Permit No:
Add
'IO
Issued by: . - Date: --__-__
lg� FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. Lk;ensed 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 box t and either box 2A or 113:
1. [M I own, reside in, or will reside in the completed structure.
l.. A. C-7 My general contractor is - - - - -- - ___ _ _- - -
Contractor registration number
I will instruct my general contactor that all subcontractors who work on
the structure must be registered with the ,onstruction Contractors Board.
OR
B. [TWI, I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and do hire a gereral
contractor, I will contract with a centractor who is registered with the
Construction Contractors Board -nd I will immediately notify the office
issuing this building permit of the name of the contractor.
I hersby certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners abut Construction Responsibilitie, on the
reverse side of this form.
f A) � �, . - qv
Signature ofP4rmIt Appllcan� Date
CONSTRUCTION CONTRACTORS ROARC
0244J 1190
WHII E COPY TO ISSUINU AGENCY PERMIT FILE
PINK COPY TO APPLICANT
r
INFORMATION N0710E TO PROPERTY OWNERS
ABOUT GONSTNUCT;ON RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About ConstructI011
Responsibilities was developed by the Construction Contractors Board In
accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a subst;ntial 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 riot 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 &n "amployer" and the people you hire will be "employees". As the employer, you must
comply with 1:116 following:
Oregon's Withholdin Tax w: As an employer, you must withhold income taxes from employee wages
at theTme emp oyees are pald. You will be liable for the tax payments even if you don't actually withhold
the tax from your employees. For more information, ca.!! the Oregon 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 oi—aTremployees. For more information, call the Oregon Employment Division DHR
at 3783224
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compen.,,a-
fion Law, and mi o'ja1n worTcers' compensation insurance for your employees. If you fall to obtain workers'
compensation insurance, you may be subject to penalties and will be liable for all clairrr costs it one of
your employees is injured on the job. For more information, call the Workers' Compensation Division DIF
at 373.7434,
tJ.S__Internal Revenue Service: As an employer, you must wfto, yid federal income tax from employees'
wages. ou w a e or the tax payment even if you didn't actually withhold the tax. For more Informa
tion, call the Internal Revenue Service at 221.3990.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Com ilance: As the permit holder for this project, you are responsible for resolving any failure
f^ meet code requirements that may be brought to your attention through inspections.
Liability 81Rd Prop_ert�Damage Insurance: Contact your insurance agent to see if you have adequate
insurance coverage or'accldentsanHaFMISSIons such as falling tools, oint over
from pipe punctures, fire, or work that must be redone, p spray, water damage
Time to SVr ervise Employees: Makrr 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
t e wor of rough-in and finish trades, and to notify building officials at the appropriate times so
they can perform the required inspectiolib.
If you have additional questions, write to:
Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
0244J 10124189 Phone 503.378-4621
23 SW I fall Blv
ITS O F T I�GARD �'I"fiox 23397 d -
PLNCK REC T f< 12 7 -
)nl?1I1N1'1'Y Uf1'ELO1'M111;N'I'UI',1'AIYI'MI;N'!
1gard,Oregon 97M /
(503)639-4171 PERMIT N � C. "
DATE ISSUED
' JOB ADDRESS: of-L. TAX MAP/LOT
SUB: _ --_ LOT: _ LAND USE: ---.-.
Y VALUAT ION: 1�,,�4�y
OWNER SPECIAL NOTES
NAME: Mtic.\InPE M0K'A REISSUE OF:ADDRESS: -U,7 LAST REISSUE: _
__�►�„a�w orL� `t��t�
FLOOD PLAIN/
PHONE: SENSITIVE LAND: _
CONTRACTOR APPROVALS RE UIRED
NAME: M1L1rA�, rAnn-1-Y — PLANNING: _
ADDRESS: L ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: EXP DATE: __— —_
-- ITEMS RCQU-IRFD
SUBCONTRACTORS: PLUMB: �_ —_ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH_ENGINEER — CALCULATIONS:
NAME: _ ___ — TRUSS DETAILS:
ADDRESS: — _ — OTHER: —
PROPOSED BLDG. USE: —
COMMENTS:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAI,. DUE
3 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees --
10-431 01 Mechanical Permit Fees T _
10-230 01 State Building Tax (5%)
Bl dg3 -3-- Plumb _--.-- -.- Mer_h ----
10-433 00 Plans Check Fee
Bldg dt2. 0j P 1 umb Mec.h
10-230 UG Fire --- - -- - —
30- 202 00 Sewer Connection --
30 -444 00 Sewer Inspection -
25-448-01 Traffic lu,pact (TIF)
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) _ /r
24-445-02 Water Quantity (Fee in lieu of)
TOTAL. 2
h -
APPLICANT SIGNATURE \
Received By: - Date Received: j- _ /U-9,�j —_
i
nm/3587P.WPF
CITY OF TICARG
BUILDING DEPARTMENT
CORRECTION NOTICE
PERMIT :40. 4 ;'�aZ
ADDRESS 2 Ci Q Now
r SAVE r#/s DAY INSPterr0 r#fsNr�r �:�!�AN#
ME& OtEOMr9Es ANO NAW AXWO WAr MWANNO
WOLAreONS OE 0itr A##.#VA' *MVLAWN Orr-
~me $AME, --.,e-L.cx a
i' d ARt Neptror ON,,rlO lfo INA r N0 A oRr WON
OOLL RE 000 !/PON rMISC PREMISES (ON"L
?Wf A&VVV V/0LAr10#S ARE GORREC r!'0.
NI'N CORREarlows NAME' *Are# m4lo t CALL
00-41rr /rop /NEPECr/om. - r
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CITY OM • ) N2 0123 6r
BUILDING PERMIT APPLICATION TIGARD DATE _-- _ 19---- 4
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT' FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICAT'ONS. OWNER PHONE
OWNER asw H'L a i ADDRESS BUILDER PHONE
ENGINEER
BUILDER �i h�� n+�(TLT ARCHITECT _ _� DESIGNER
STRUCTURE _❑_NEW ❑REMODEL — ❑ADDITION Q REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE El S' ❑SLAB ❑FENCE
- ❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW _ ❑COUNCIL. APPROVED ❑SIGNS
OCCUPANCY_ LAND USE ZONE_ BLDG,TYPE FIRE ZONE_— PLAN CHECK BY_-- HEAT_
-- -- - _ 112 - -- - ---- -- -
OCC,LOAD FLOOR LOAD ------HEIGHT _ -_ NO.STORIES _ AREA VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
-- --_ -- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABL.F CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- - RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEAT+NG.
Total
BV AVPLICAN i OR AGENT
Approved Receipt No
ADDRESS PHONE
DATE INSP. TYPE INSPECTION REMARKS r'LUMBING DATE
Contractor---,
Olt— Permit No.
Rough in
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
FINAL Final
Bi7t;G DEPT. TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATF OCCUPANCY
Landscaping
Zoning Final
X
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Po of- 5 kcAPPROVED FOR T�t'1c
CONSTRUCTION
TIGAND
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9780 SW Tigard Street tir c`
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DRAWING NUMIMP
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17 X 22 PAWED ON NO 1000H CLEARPRINT a
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THAN HT NOTATION ,T ON , �.___—_____1_--_ ___._.. - _ ._�_ .__ ' 6' __ -- --.!�3 �
IT IS, DUE TO THE QUALITY OF - -- - _�_ _._ _ `
No.36
THE ORT C INAL DOCUMENT .
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