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NSPECTION NOTICE
City of Tigard Building Departaenl.
13125 SW Bail Slv Tignrd, Oregon 9',113
Inspection Line (Rec-O--Phone': 639-4175 Bunineas Phones 639-4111
Inspection:
Footing nlbg. Underalab !tech. Rough-+.n Appr/Sdwlk
Found. Plbq. Top out Gas Line FINALt
Post;Beam Struct. San. Sewer Framing -Bldg.
:oat/Boam !Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Pater Line Gy2. Rd. Neth.
Date Reguastedt��" Time: AM PK
Addreaa: iY LfL
Perm
itBuilders 1,,
7
Tom FOLIAMING —"CTTIIf!!1'S ARE RSQUIREDs
Inspectors. Dates
APFRdVSD DTSAPPROVED APPROVED St1BJECT To ABove
_Call For Reinap.
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 8W Hall Blvd.TI91A,Onoon 97223.8199 (503)339.4171
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CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO. e93-243591
CHECK AMOUNT a 26, 25
NAME = ZENGER CASH AMOUNT t 0. 00
ADDRESS a PAYMENT DATE 08/25/91
SUBDIVISION a
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PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
MECHANICAL PE 25. 00 ST. BUILD V PER 1. 25
TOTAL
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TO'T'AL AMOUNT PAID — •- — —> 2Ti. $5
--� Pernvit No: f 1? i 3
Addr,-,ss: �� C
h �r Issued by:yiZDate:
L-_ —FCR OFFICE 11ot ONLY
STA r EM ENT:
INFORMATION NOTICE TO PROPERTY OWNERS
,BOUT 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 issueu.This state-
ment is required for residential building, electrica,, me-,hanical, and plumbirg
permits. Licensed Architert and Engineer applicants, T�xempt from registration
under ORS 701.010(7), need c,,ot 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 38:
1 . I I own, reside in, or will reside in the completed structure.
2. ! J 1 understand that I must register as a construction ccntrzct,, ii the structure is sold
or offered for sale before or upon completion.
3. A.I _- I My genes al contractor is _ _ _ --- -
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the strums
ture must be registered with the Construution Contractors r3oard.
OR
3. B.E� I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Con;truc-
tfon 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
%n the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property Own,:rs about Construction Responsibilities on the
reverse side of this form.
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I SId atu a of Permit A plict Date
CONSTRICTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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