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i:\recordslmicroNm\targets\bufiding.doc
CITY OF TIGARD i/z
COMMUNITY nF"FLOPMENT DEPARTMENT
73125 SW Nell Blvd.Tigard,Oregon 97223.8199 (503)839-4171
C rti4�r,ii it:J�t ., I L,L:
DUILDING
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t 1-I-I I RD. . , . . 0 _:f r«.a'l. HE:Aj_._......._.
LOOR LOAD. . . . .40 p:i f VALUE--. 8610b PARKING SP(10ES'. .
i.i_ l"N DRA , .
F= VI -_(.1"i tn'E4..r.L"R k."E A -0 f PrIPS. . . . . . . . . . . .
Fa ':iF:WLFR LINE (ft ) . VA TF'1F-)r'S. . . . . . . ..0
14F) C."R LI!`•IC: ( ft " , :0 . . . . . ..
ORDAGE: DISP. . . :17..1 RMN DRAIN ( ft ) . :0
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F Permit No:
Address:
v► ' / Issued by:----`_._.— Date:
_FOR OFFICE USE
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 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_z_l I own, reside in, or will reside in the completed structure.
2. CSI 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.( _ 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.E- J I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registereJ with the Construc-
tion Contractors Board If I change my mind and do hire a general contractor, I will
contract with a contractor why is registered with the Construction Contractors Board
and I will immediatelk, 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.
lgnature of Per Applicant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
IIMSPZCTION hC. (7,
CiL•y of Tigard Bui)dinr, Depart►aent
13125 SR Ball Blvd. Tigard, oregoa 97223
Inspection Line (Rec-O-Phone): 63J-4175 Bueineoe Phon7639-41;,7
Insp-ction: cm*a J"- �-_
Footing Plbg. Underslab Hoch. Rough-in h Appy/Sdwlk.
Found. Plbg. Top Out Gas Line FINALf
Poet/Beam Struct. San. Sewer Framing K-1 Ldg. —
Pont/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: , 2 - �'!::uei Z1•QV AH PH
Addreee:_ .. Permit !:
Builder:
THE FOLLOWING CORRECTIONS ARE ABQ+ IRED:
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Inapectors V v Dates N
VAPPROVED DISAPPROVED D,PPROVED SUBJECT TO ABOVE
\�_- call For Reinap.
INSPECTION NOTICE �
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)a 6394175 Business Phone: 639-4171
Ingpecticn: �,301Lf i�Q_(2— —
Footing Plbg. Onderelah Neth. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line _FINAL)
Poet/Berm Sti-uct. San. Sewer Framing (_-Bldg.
Post/Beam Mech. Rain Lrsin Insulation -Plumb.
Plbg. Onderfioor nnWater( Lin* Gyp. Bd. -Mach.
Date Requested: 'v `1 L J Time:
Address
1 ( _�C{ Permit #sc(3_ v
: 7p`
Builder: `-------� ' �
THS FOLLOWING CORRECTIONS ARE REQUIRED:
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ON
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Inapeotorf ---"-^�._ Dates
APPROVED DIDAPPt�CvED APPIIOVIb 8DDJi T TO 11t`ON!
✓-cCall For Reinep.
Y�►
jNS"ECTION NOTICE
City of Tigard Building Depsrtarent
1312> 99 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rx-O-Phone): 639-4175 Business Phone: 639-4171
Inspections —, -�
Footing Plhg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbq. Top out Gas Line PINALs
Post/Beam Struct. San. Sewer
Framing
Post/Beam Hoch. Rain Ora+.n Insulation -Plumb.
Plbq. Underfloor 1 W.tter Line Gyp. Bd. f -M.ect,.
Dat" Request.eds l& �� - Times / AN _ PK
Address: Permit fs o
Builder:
IBE ►OI.LOWING CORRECTIONS ARE REQUIRED:
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Inspectors^ Dates 16 1
APPWWRD DISAPPROVED APPrA)M BVBJWM TO AOM
—^_Call For Reinap.
INSPECTION PECTION NOTICE
City of Tigard Buildimj Department
13125 SN 3x11 Blvd. Tiyard, I..•egon 97223
Inspection Line (Rec-(-Phone)t 639-4175 Business Phones 639-4171
Inspection: _ -------
looting :ltog. Underrtlab liech. Rough-s_n t._+pr/Sdwlk
=fturA. tibg. Top ..:.t Gas Line FINAL:
Post/seam Struct. Nan. Sewer framing -Bldg.
Post./Beam Fisch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water(/Line Gyp. Rd. -Koch.
c:l _ 2 l7 7 Timet _�Pll
Aate Regrestedt _ AM
Permit #t
Builder.:
TNA IOLLOWING CORRECTIONS ARE REQUTRRDt
Tnspectort ---- --� Datet -�O 223 —
i
"FROM DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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CITY OF TIGARD — RECEIPT OF PAYMENT RECEIPT NO. :93—,244136
CHECK AMOUNT 49. 43
AME : PROWN, JACK C. CA IA AMOUNT 0. 00
DDRESS : 10445 SW 90TH r.,AYMt.--.NT F-ATE' a 09/13/93
T I GA 11 D, CSR SUBDIVISION
v,URPOSE' OF PAYMENT MOUNT PA I D PURPOSE' OF PlAYMFNT AMOUNT PAID
r-.,L-nN ('l'HECV.,FF— 9-2414 4R. 43
TOTAL AMOUNT PAID 48. 43
CIIY OF TZGORD --- RECEIPT OF r.lAyf!F.7-NT RECEIPT NO. 03-E,44260
CHECK AMOUNT 78. 23
NAME BROWN, JACK CASH AMOUNT 0. 00
ADDRESS PAYMENT DATE S 09/17/93
SUPDIVISTON
1-:,URP0SE OF PfAYMFN-U AMOUNT PA t D PURPOSE OF PAYMENT Al'l(IIJNT PAID
BUILDING PERM 74. 50 ST. BUILD PER 3. 73
4
cm
U.1
10445 SW 90TIA
TOTAL.. AMOUNT PAID 78. 23
13WSVIHillD&& PLNCK/RECT #
CITY OF TI_GA D 9 n23 PERMIT N
COPAMUNI'i'Y DEVELOPMENT DEPARTMENT �; 1
(503)3�0"'"71" DATE ISSUED
JOB ADDRESS: --//) TAX W,,.P/LOTn /.-S/ 35A6 037-0
SUB: f.S�j ,j lC {"G� M LOT: _f D LAND USE:
VALUATION:
OWNER SPECIAL NOTES
NAME: -�.�� �rv�; �.� REISSUE OF:
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
PHO E: _�`�� _ /_5 �i '_� — SENSITIVE LAND:
CONTRACTORAPPROVALS RE UQ IREO
NAME: _ ��� Q�-- PLANNING:
P2,2;ESS: ENGINEERING: — —
FIRE DEPT:
PHONE: --.__ OTHER: _
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS:. PLUMB: LIST/SUBCONTRACTORS:
M CH: _. BUS TAX: _—-- ----- -
A,RCH/ENGINEER CALCULATIONS: _---
NAME: _ TRUSS DETAILS: _
ADDRESS: _. _e-- — _ _ OTHER: _.
r
N PHONE: - —
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PROPOSED BLDG. USE:
'1 COMMENTS: '5,f
A :ANT SIGNAT RE
� c
RV- ved By: -- Date Received:
PEPMIT 9 ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
5f13 -0ZI10-432 00 Building Permit fees
10-431 00 Plumbing Permit fees
_ 10-431 01 Mechanical Permit Fees
10-2310 01 State Building Tax (5%) —
r
Building
Plumbing
Mechanical _
10-433 nO Plans Check Fee 3
Building 4 3
Plumbing
Mechanical
10-230 06 Fire ^-
30-202 00 Sewer Connection _
30-444 00 Sewer Inspection _-
25-448-92 Commercial TIF Fees
25-448-04 Industrial TIF Fees —
25-448-06 Institutional TIF Fees
2.5-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees _
25-448-05 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) _
TOTAI0
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