11495 SW VENUS COURT-2 � Nv,S CoLkkT
ADDRESS:
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is\rFcords\i nicroflm\targets\building.doc
INSpF SON NOTICE
City of Tigard Building Oepartllent
13125 AW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Fhone): 639-4175 Businee ones 639-4171
Inspection:_ //`---
rooting plbg. Unklgralab Mach. Rough-in APPr/SdWlk
Pound.
Plbg. Top Out G,+s Line FINALt
.
Piet/Beam 3trvct. San. Sewer Framing -9149.
Poet/Beam Mach. Rain Drain
Insulation -plumb.
Plhg. Underfloor Water Line1 /Gyp. Bd.
-Meeh.
Time:
Date Requested. )= --
/� ����'.� L� Permit
-"'—
Builder: — - - --
THE FOLLOWING OORAHCTIONS ARE REQUIRED:
Inspector:!v Vv Date,
t- "pROVEn _ _ t•IS"PROVED APPROVSD 808JRM TO Al1M
f Call For Reinep. Y'
TE CITY OF TIGARD SITE
IT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
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13125 SW Half Blvd.Tigard,Oregon 97223.8109 (503)14;19'--4}171 DDATEIS U - : OB/01/94
PARCEL: Z'S103DB-0190171
SITE ADDRESS. . . : 11495 SW VENUS CT
SUBDIVISION. . . . GENESIS ZONING: R--4. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . : 13
'TYPE 017 WORE:ADD PPV I N G'). . . . . . . . . ..N RESO. NO. :
EXCV VOLUME. : Cy GRADING?. . . . . . . . :Y VALUE. . . $ , Q)
FILL VOLUME. : 150 Cy I-ANDSCOPING". . . . :Y
ENG FILL` . . . . . . .N SITE PREP?. . . . . . :N
SOILS RPT READ?.N STORM DRP I NS?. - - -N
IMPERV SURFACE. . : 5f
Hemar-ks : 150 cu yds of 1` 111
owner," I'LES
ROBERT GARRETT type amount by date V,e c:p
11495 SW VENUS CT PIRMT $ 33. 00 JG 08/01 /94
P L C K $ 22. 50 JG 08/01/94
TIGCIRD OR 97P23 5PCT $ 1. 65 JG 08/01/94
I hone #I
Lont v-act or,
UWW-_R
-____...___.-_____—___--_.___--_—___.
C`hone $ 57. 13 TOTAL
Peg #. . : REWIRED INSPECTIONS
This permit is issued subiect to the regulations contained in the Erosion Cuntv,ol
Tigard Municipal Code, State of Ore. Specialty Lodes and all other Fill Inspection
applicable laws. All work will be done in accordance with Gir-ading I n s p
approved plans. This permit will expire if work is not started Final Inspectionwithin 180 days of issuance, or if work is suspended for more
than 180 days.
S)i g n at u t-e
-7
Issued By :
Call for-, inspection 639-4175
Residential Building Permit_A�Iication
City of Tigard
13125 SW Nall Blvd.
Tigard, OR 97223
503) 639-4171
Jobsite Address:) 1LIIj�
once Use Only
Subdivision: _ Lot N
Valuation: �A,�.
Permit #
Corner Lot? Y N
Reissue of
Mag Lot? Y N
Map & TL #
owner: K C) 4Qrovals BAquired
�( Address: „1 Iy* -KU- Planning _�....r--
`�/ ZZ2 3 Engineering
Phone: "'�� �C' Other
Contractor: _ L ' - Items Regulre4
Address .. Subcontractors
Truss Details
Phone _-_--- Other
Co,,'ractor's License #
(attach copy of current Oregon license)
Contac Name & Phone:
Subcontractors: Architect/Engineer:
Plumbing: — Address _-.___—_----------------
Mechanical:
(attach copy or current OR Contractor's License)
Phone. ---------------
Ilio
JOB DESCRIPTION /� 1 l f �/ �� ��
Applicant Signature & Phone nL.nber z.
tv
Received by:
Date Received:
--
N WORMCOMMA01APP
Permit# Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Pp�mit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg: _
Plumb:
Mech
Plan Check (PLANCK)
Bldg:
Plumb:
Mech
Sewer Cor nection (SWUSA)
Sew�r Inspection (SWINSP)
Parks Dev Charge (PKSDC) — — --
Storm Drainage Chg (SDSDC) _ — _—
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) ^_ _
Office TIF (TIF-0)
Water Quality (WOUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
Erosion Cntrl Permit (ERPRMT) _.
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
= Permit No: '�5 17_
Address:
u�i '. - � t � 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 not registered with the Construction Contractors Boatd 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 . L i own, res;de in, or will reside in the completed structure.
2. U 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.F____.J 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. _I I will be my o�vn general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change :ny 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 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.
_81gnature of Per It Applicant gate
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Noti,_e to Property owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ()RS 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 substantial improvement to an
existing structure, you can prevent rnany problems by being aware of the following responsibilities and areas
of concern.
EMPLOYER RESPONSIBILITIES:
It you hire persons riot registered with the Construction Contractors Eoard to do ;abor in c_-r,nstructing or assisting
in the construction o. improvement of a residential structure, you will, in most instances, be ruled to be an
"employer'' and the people you hire will be "empigyees As the emp.oyer, you must comply with the following
Oregon's Withholding Tax Law_. As an emp iou must withhold income taxes from employee viages at
the time employees are paid. You will be lit r the lax payments even if you don't actually withhold the
tax from your r_rmploypos. dor more information, call the Oregon Department of Revenue at 378-3390
Une,nploymenl Insurance Tax As an ernployer, you arcs required to pay a tax for unemployment insurance
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 Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees If you fail to obtain workers'
compensatio, insurance, you may be subject to penalties and will be Kahle for all claim costs if one of your
employecas is injured on the job For more , 'ormation, call the Workers' Compensation Division DIF at 373-7434.
U.S Inte_rnal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.
o.r wi{I he liable for thf.� tax payment even if you didn't actually withhold the tax, For more information, call
the Internal Revenue Servir.:e at 221-3960
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
ir'c,dr� Compliance: P.; the perrom holder for this pr,�fc. .l, you are responsible for resolving any failure to meet
code requirements that rriny bQ brought to your attention through inspections. i
{
Liability and Property Darn age Insurance Contact yo,jr insurance agent to see if you have adequate insurance
cc��er,_ryr foo ACc Onnts and omissions such as falling lools, paint overspray, water damage from pipe punt•
to-s. fire, or work that must be redone.
Time to Supervise Employees Make sure you have sufficient time to supervise your employraes.
Expertise. Make sure you have the expertise to act as your own general contractor, to coordinate the work
cit rough-in and finish trades, and to notify building officials at the appropriate times so they can perform
the required inspections.
If you have a Aditional questions. write to. Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-278-4621
0244J
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