11300 SW 97TH COURT K,
ADDRESS:
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639.4175 Business Phone. 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mach.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/5dwlk Reins.
Other.C,� ,l l.� —0. cv�_�_o _`✓\ •
Dater e A.M. —P.M._ Entry:
Address: 5 Ur 0 S 11�1_)
Tenant:�+llC 17,EC?��_ Ste:
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Con Nr L C 1S C (D C1 19C'—
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V,5LV-L� O,rO-1•l„ L C k g ELC:
THE OLLO G'CORRECTION ARE REQUIRED: ELR:
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Inspector: — _ Date: 15 Z
APPROVED ..f DISAPPROVED/CALL FOR REINSP. CF CO
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Orogon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
i
Inspection:
Footing Plbg. Underslab He . Rouah-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Ream Strur_t. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water L ne Gyp. Bd. -Mech.
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Date Requested:_ _Time: AM PM
Address: L� / 1 Permit
Builder: _
THE FOLLOWING CORRECTIONS ARE REQUIREDs
wOy 12
Incpector: nate•
APPROVED DISAPPROVRD APPROM) FUBJECT TO ASOV-,
Call For Roinap.
INSPECTION NOTICE
Clty of Tigard Building Department
13175 SN Hall Blvd. Tigard, Oreqon 97V3
Inspection Line (Rec-O-Phone): 639-4175 Businea Phone: 639-4171
Inepection:_ i'JO _� /� //I✓CT �C
Footing Plbg. Underelab Hoch. R ugh-in Appr/Sdwl.k
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing --Bldg.
Poet/Ream Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. ad. -Hoch.
Date Requested: / %� _Time: ___AH _SPH
Address-_11 360 SG✓ / _ Permit f:__` _
Builds--
THE
uilds-:THE FOLLOWING CORRECTIONS ARE REQUIRED:
f'Dy C�/r.� �C'>c�/S/ �c-?d
P'/C' /,/(40 leipct>-�
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Inspectors! -- - Date:LrJ "Cr --
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
—Call Por Reinap.
C11YOF TIGARD
Cff MIT
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COMMUNITY DEVELOPMENT DEPARTMENT �ooM� PERMIT '#. . . . . . . :ILDING BUP92-0299
9126 SW Fill Blvd. P.O.Boot 23397,'ripad,OreWi 97223(503)83(1.4176
SITE ADDRESS. . . : 11300 SW S7TH CT PARCEL: 1S135CA-01700
SUBDIVISION. . . . : GREENBERG HEIGHTS ZONING: R-12
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :8
--------------------------------------------------------------------------------------
REISSUE: FLOOR AREAS----------- EXTERIOR WALL CONSTRUCTION-
CLASS OF WORK. :REP FIRST— . : sf N: S: E: W:
TYPE OF USE. . . :SF SECOND. . . : S f PROTECT OPENINGS?------------
TYPE
PENINGS?-------------
TYPE OF CONST. :`,N THIRD. . . . sf N: S: E: W:
OCCUPANCY GRP. :R3 TOTAL--------: 0 s f ROOF CONST: FIRE RET?:
OCCUPANCY LOAD: BASEMENT. : sf AREA SEP. RATED:
STOR. :0 HT. : ft GARAGE. . . : sf OCCU SEP. RATED:
3SMT?: MEZ Z?: READ SETBkCKS--------- REQU:RED----- -------------- -
FLOOR LOAD. . . . : psf LEFT: ft RGHT: ft FIR SPKL : SMOK DET. . :
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM: HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE. $: 8000
Remarks: REPLACING OLD SHEET][NG BEFORE ROOFING
Owner: ------------- ---- - - ---- ---------- --------- FEES
DAVID LUCUS type amount by date recpt
11300 SW 97TH CT PRMT $ 74. 50 BLT 10/08/922 232507
5PCT $ 3. 73 BLT 10/08/92 232507
TIGARD OR 97223
Phone #: 684-6967
Contractor: --------------•--------•--------
OWNER
-----------------------------------------
Rhone #: $ 78. 23 TOTAL
Reg #. . : 00000
------- REQUIRED INSPECTIONS --------
This peroit is issued subject to the regulation, contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
apps kable laws. All work will he done in accordance with
approved plans. This pertit will expire if work is not started
within 189 days of issuance, or if work is suspended for more
than 188 days.
- Permittee Signature :
Issued B y=
Call for inspection - 639-4175
Permit No:
--
--_.— _—
Address: ---
Q s
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\�0 ' z 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 Constrriction Contractors Board to
sign the following statement before the building permit can be issued. This s!ate-
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. Thi,; 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 own, reside in. or will reside in the completed structure.
2. [ _] 1 understand that I must register as a construction contractor i;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.0 I 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, 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 ProperSy Owners about Construction Responsibilities on the
revers side of this forrpr— ,
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Signature of Permrt Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE Zv PROPERTY OWNERS
ABOu*r 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)7
passed by the 190 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 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 constructing or assisting
in thL construction or improvement of a residenJal structure, you will, in most instances, be ruled to be an
"employer'' and the p6ople you hire wil! 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 e,,9n if you don't actually withhold the
tax from your employees. For more informatian, call the Oregon Department of Revenue at 378-3390.
Unemployrnent Insurance Tax_ As an employer, you are 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 376-3224.
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'
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 more information, call the Workers' Compensation Division DIF at 373-7434.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.
You will be liable 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:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
code requirements that may be brought to your attention through inspections.
a
ri Liability and Property Damage Insurance: 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 ;)unc-
tures, fire, or work that must be re-done.
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
LL; 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 Summr,: St. NE, Suite 300
Salem, OR '7310-0151
Ph)ne 503-378-4621
0244J 10/24/b9
G.1'TY OF:, TI8ppv — Rp*["C'IF''r or, PAYMENT RECEIPT N . x9e �,2507
CHECK AMOUNI" n '78. 2;3
NAME n LUCAS, DAV ID CASH AMOUNT n 0. 00
00DRESO n 11300 SW 97TH CT PAYMENT DA-rF a ]0/0El/9c
T I GARD, OR SUsc I V I S ION n
r-•I Ifmosr 0c PAYMEN I' (aMUUNT PAIL) PURPWX OF POYMF".N'T 04MOLINT PAID
rs ........
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(� 1?lzsswliau nwe. PLNCK/RECT CITY TIGARD l'OBox 73397 PERMIT #
COMMUNITY DEVELOPMENT DEPARTMENT ^r,6aal,Oregon 977L3 —
(303)639-4171 DATE ISSUED
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JO -ADDRESS: 1 13o c (,, u- I-1 4 k c A TAX MAP/LOT AS 135 611-0!7o v
SUB: LOT: _ LAND USE:
VALUATION:
OWNS �' SPF_CIAL NOTES
NAME: n�,, C� Ls REISSUE OF:
ADDRESS: L1 c)0 S c.,,, 9 4-t, C-4 LAST REISSUE: _
FLOOD PLAIN/
r
PHONE: SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: PLANNING:
ADDRESS: ENGINEERING:
FIRE DEPT: _
PHONE: OTHER:
CONTR. BOARD #: _ _ EXP DATE: _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: �.. LIST/SUBCONTRACTORS:
MECH: _ _ BUS TAX:
ARCH ENGINEER CALCULATIONS:
NAME: _ TRUSS DETAILS: _
ADDRLSS: OTHER:
PRONE:
PROPOSED BLDG. USE: _
COMMENTS:
APPLICANT SIGNATURE
Received By: Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees Lld(i
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee
Buildipg
Plumbing _
Mechanical
10-230 05 fire
30-202 00 Server Connection
30-444 00 Sewer Inspection
25-448-02 CovimLrcial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Iustitutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic fees
25-448-05 Mass Transit ', IF Fees
— — I
52-449 00 Parks System Oev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee ;n lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
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TOTAL —_._— , 2-3
nm/3587P.WPI-