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CITY OF TIGARD
C►REGON
April 6, 1992
David Ause
10241 SW 69th
Tigard, Olt 97223
Re: 10241 SW 69th Permit #BTIP 91-0005
Dear Sir:
The last inspection conducted on the above project was a gypsum
board inspection on August 27, 1991. The next required inspection
will be a final inspection.
Pleasa advise the Building Division of the status of this project
as soon as possible so the file may be kept current.
Please note that any permit without activity for over 180 days
becomes void. If you need additional time to complete the project,
please contact this department so that an extension can be
discussed.
Sincerely,
Brad Roast
Building Official
Notice.A '
I
13125 SW Hall Blvd.PA.Boot 23397,Tigard,Oregon 97223 (503)639-4171 -------'---
INSp1saP—IM-NO-T-1 C-1
city of Tigard Building D'pah2sa't
13125 SN Ball Blued. Tigard, Oregon 97223
s Phan 639-4171
Inspection Line (Roc-O-Phone): 639-4175 Businese:
Inspection:_._—
Footing
Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Plbg. Top Out
Gee Line FINAL:
Found.
-Bldg.
Post/Beam Struct. Ran. z3wer Framing
Poet/Beam Mecb. Rain Drain
Insulation -Plumb.
� )plbg. Underfloor Water Lina �yp• Bd. -Neck.
Time: _AM PM
Date
Permit is
Address: G' ----
Builder:—
TBE pOLLOWINr, coRRECTIONS ARE REQUIRED:ZY -----
=-Z
i v
Y L_ Dates
Inspectors_
// NPPROM 6pW=oT To ASM
APP�D DIBAPPWW _—
Call For leinsp.
^ MW 11111 ! MEW W
�N�Pwc'rION woTic�
City of Tigard Building DePaxtaant
13225 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phones 639-4175 Business Phone: 639-4171
Inspection: - —
Footing Plbg. Underslab Nech. Rough-in Appr/Sdwlk
Top Gas Line FINAL:
Found. Plbq. To Out --
l�Frasyies�
Poet/Ream Struct.. San. Sewer -Bldg.�.
Poet/Beaminsulation -Plumb.Meeh. Rain Drain ./'��.—.`
^lbg. Underfloor Water Line' Gyp. Bd.
-mech.
_Times �_AN PH
ate Requested: _
Ad'dress --
Bu
THE FOLLOWING CORP.ECTIONS ARE REQUIRED:
1A Y
&AC 42
Inspectors ___ Dates - Z 7-
APPROVED DISAPPROVRD a rppROVED StIB39CT To ABOVE
Call For Reinap.
sx��EKE MA 111KI RK
Permit No:
Address:
IH! ' issued b _..- -=, _- - Date:
issu y. —
��z_. •, '' ___FOR OFFICE USE ONLY---
159
-- ----
\� --
STATEMENT:
INFORMATION NOTICE TO PROPERTY OW14ERS
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. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statemert. This statement will be filed with the permit.
Fill in the applicable blank., and initial box 1 and sither box 2A or 2B:
1. = I own, resi,ae in, or will reside in the completed structure.
2. A. = My general contractor is --_ ---------- - ---- --
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
(1P
B. E= ] 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 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 Propert; Owners about Construction Responsibilities on the
reverse side of this form.
c•�
SI ti of Perml plicant ate
CONSTRUCTION CONTRACTORS BOARD
0244J 1190
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
M
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.
If you are acting as your own contractor to construct a nevti home or make a substantial improvement
to an existing structure, you can prevent many problems by being aware of the following responsibilities
and arras of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing
or assisting in the construction or improvement of a residential structure, you will, in most instances,
be ruled to be an "employer" and the people you hire will be "employees". As the employer, you must
comply with the following:
Ore on Iss Withholding Tax Law: As an employer, you must withhold income taxes from employee wages
at ih—e-tTme emp ogees are pard. You will be liable for the tax payments even if you don't actually withhold
the tax from your employees. For more information, call the Oregon Department of Revenue at 378.3390.
Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes en tFe wades o employees. For more information, call the Oregon Employment Division DHR
at 378-3224.
Workers' Comp!! sation_Insurance: As an employer, you are subject to the Oregon Workers' Compensa
tion 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 one of
Your employees is injured on the job. For mare information, call the Workers' Compensation Division DIF
at 373-7434
U.S. Internal Revenue Servica: As an employer, you must withhold federal income taut from employees'
wages. wi�i'hP abhor the tax payment even if you didn't actually withhold the tax. For more informa-
tion, call the Internal Revenue Service at 221.3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERT::
Code Cornpliance As the permit holder foi this project, you aie responsible for resulving any failure
to meet code requirements that may be brought to your attention through inspections.
t_iabilltyarid Property mage Insurance: Contact your insurance agent to see if you have adequate
insurance coverage76r accents anT5rnissions such as failing toots, paint overspray, water damage
from pipe punctures, fire, or work that must be redone.
Time to Supervise Employees. Make sure you have sufficient time to supervise your employees.
Ex ertlse Make sure YOU have the expertise to act as your own general contractor to cogrdinate
the. work-of rough-in and finish trades, and to notify building officials at the appropriate times so
they can perform the required inspec,ions.
If you have additional questions, write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310.0151
Phone 503.379.4621
0244J 10124189
c'TYF T' ABUILDING PERITII'T
RP Wl-,R ITI I I ff
TCn�
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW HWI Blvd. P.O.Box 23397,TIpM,Ovgon 97223(60)§3"17$
I I L. 1-4 1)1)14'1:::S 5. 10P41. SW E." I 1.1 0 PFIRCEL; IS136AA-
ul'!D I V1.S3.0 111. . . 11 :
ZONT.146.-
i'LOCK. . . .. . . L.C)T, . . . .. .
E ISSUE: FL 0 0 R AREAS ExrE..":raoR, wni...L
1.1 ASS OF WORK. -.ADD FIRST., . . . » sf N. S.- E» W
TYPF-* 0F• U 9 E. . . .,5 F S E.C 0 N D. . . c420 sf PROTECT
TYPE Or` CONST. ."5N THIRD. . . . » sf N: Sr E: W:
OCCUP"ANCY GRP. -R3 'T 0*T A L 420 sf ROOF CONSJ.- FIRE RET?-.
CIC:CUPONCY LOf)D: sf AREA SEP. RO'TED:
STOR. :2 HT. n20 f t s f (:1( CUf.)EPI� R(.)'T'El)::
Fj s . IIEZZ")c RE UD REULII
ILOOR I-OAD 40 risk f L..1 F T. ft R G 1.4'T ft FIR S P K I.- SMOK DET. .
DWE.'A.-LING UNJ.'TG,., F'RN'I'- ft REAR: ft FIR 01.-RVI-. HNDICP ACC.
0 1,:*.V R 11 S . 13PTHS- IMP SURFOCE. rRO CORR: P()1-�."I H(31-
'. $ 12600
V,*-,'v.--,nia•r+.s.-., addi.ti.oii to existing tiC)tp%e.
t)oiii.is -rooni above qaraqe
FEf--S
1)(WID f1USE type A M Q Lt V)t by date recpt
0241 SW 69T1-4 AVE_ 1."RlIT $ 98. '' 0
P L CK $ 64. 03
TIG(4RI) OR 97223 15 P C'T 4. 93
0: i.?45-6167 P f.)y M sti 167.. 46 JLH 01/007/91
('111TRACT'GR NOT ON FILE
$ 1.67. 46 TOTAL.
REQUIRED fNSP'EC7JONS
rhis aermit is issued subject to the regulations contained in the Framir,q Insp
Tipard Municipal Code. State of Ore. Specialty Lodes and all other 111s1(letiorl Disp
applicable laws. All work will be done in accordance with Gyp P:)a-f-d 1.11sp
aporoved plans. This permit will expire if work is not started Rain d-raiii Disp
within 186 days of issuance. or if worl, is suspended for more
than IN days.
..............-------
Pe!rniittep Si.qiiatt,lre
...........
Py ............
................... .............
Call fo-r, inspe(,tioii 639-.41.75
MmmmmE-MmLMLn%MLmqMLMw
Of.- TIOARD PECLIPT OF PAYMENT RECEIPT' NO. y
CHEU' AMOUN-r 167. 4,�
NAME AIDE, W)VE CASH AMOUNT 06
ADDRESS 10241 GW 69TH PAYMENT DA'rE (Y) (17!91
SUPY)I V I q I ON
TIGARD, OR 9722,"'N', 1024t SW 68TH
PURPOSE OF PAYMrP` i-'iMOIJN T r"A I D PURPOSE OF PAYMENT AMOUNT PAi 0
6-1YEFTN67FF I IF-, -4, —
Pq. )005. 90. 50 FIAN FE 6 4.0-3
ST. BUILD C'[ 1, 4.9.7
Ii
—101- AMOUN) PAID
' 13125 tuPLNCK/RECT_L�#
IO[u)x23397 PERMIT #
CITY OF TIGARDTprd, .�
—.1----�—",�—o—
s
Orcgon 97223
('OMM11N11Y 1)1;'V1�,1,1)1'ML,N'T Dl;l'AR'i'Mi?NT
(503)639-4171 HATE ISSUED
TAX MAP/LOT
JOB ADDRESS: _ --- — LAND USE: -
LOT:
SUB:
VALUATION: SPEC_IA L_NOTES
OWN[R- REISSUE OF: —
1� 1 p
NlIMC: ��` LAST REISSUE:
AUDRCSS: _ '2 FLOOD PLAIN/
SENSITIVE LAND:
PHONE:
APPROVALS RE UIREQ
CONTR�OR
PLANNING: � ----
NAME: ENGINEERING:
ADDRESS: _ FIRE DEPT: —----
--�— - OTHER: _ ------__,
PHONE: — --'—
CONTR. BOARD #: — -
— EXP DATE: ___------ IT—RE-�RED
LIST/SUBCONTRACTORS: ----
SUBCONT_ RRS: PLUMB: ---- _ BUS TAX: .__----------
MECH: CALCULATIONS:
ARCHLENGINEER. TRUSS DETAILS:NAME: ___------_`_� ----- OTHER, .__--- - -
ADDRESS:
PHONE:
PROPOSED BLDG. USE: -
COMMENTS:
Date Received:--
Received By:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit ;ees �� _ • s`''
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5q) _ 3
Building /
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building u -3
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connectior
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-V3-01 Residential Traffic Fees
25-448-05 Mass Tronsit TIF Fees
52-449 00 Parks S;stem 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