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11210 SW FAIRHAVEN STREET ADDRESS: azweoi- i,',record s\m icrc tl rn\ta rg ets\b u i[di 3�EEa'toN�� Cita of Tigard Building pwpaxta"M 13125 aw Ball Blued. Tigard Inspection Lina (Rr:�Phona = R39_ Oreg., 97223 4175 Business Phone= 639-4171 ,Inspection, "� l /'Doting Plbq. Underslab Nach. Rough-in Appr/8dwlk Found. Plbq. Top out CAN Lina Post/bees 8truot. IINALe Ban. Bomar Framing Post/edam Mach. R -Bldg. Rain Drain Insulation -Plumb. Plbg. Undartloos Mater Lina per' 8d. -Mach.Data Rxquastedt_ I 7� Address: ) r TimePermit M 4 euildar= T" FOLLONINO OORRac-TIONB AM IRED= i 1 ----- / i - ---------------------------- Inspector= �- APPROVRD — --� __.� OIBAPFROVRp /��' APPROITRp 8UfkTECT TO ABpV '� % G''C, �''. For Reinsp. I1.�8PRCTII�1 IIdIICb, �t� City of Tigard building Depe:taeat , 1312S IRI Ball blvd. Tigard, Oregon 97223 Inspection Line (Rec---Phone)s 639-4175 Business Phones 639-4171 Inspections_ Footing Plbq. Underelab Msch. Rough-in Aper/Sdwlk Found. Plbq. Top Out Ou Line lINALs Poet/Boom Strutt. Ban. Bower Framing -Bldg. Poet/Beam Mach. Rain Dratn Insulation -Plumb. Plbg. Underfloor Mater Line Gyp. Bd. --Kwh� Date Requested t C �� '( I Time: ("` AN PN Addrease Permit Builders THE lOLLOMING CORRECTIOIIE ARE REQUIRED: = �K�c1 -%mac ► Y� c--a-A r `L.� VIV Inspectors �__L _]�r�L — Dste: Cl APPRCP4TD DISAPPROVED APPROVED SUEJNCT TO ABOVE --Call For Reinsp. CITY OF T'FARD C"y MECHAN I CAL. ✓ COMMUNITY DEVELOPMENT DEPARTMENT nNo M PERMIT 4WIM 13126 SW Hell Blvd P.O.PAx 23397,Tigsrd,Oregon 97Z?3(". )6X4176 I VIE RM 1 T #. . . . . . . . MEL92—&R55 639-4171 L DATE ISSUEDo 09/30.192 SITE ADDRESS. . . : 11210 SW FAIRHAVEN ST PARCEL-: 2SI03DC--06300 SUBDIVISION. . . . : EXODUS ZONING: R-3. 3 BLOCK. . . . . . . . . . . L_OT. . . . . . . . . . . . . .4 CLASS OF WORK. . :ADD FLOOR FUR14. . . . EVAP COOLERS: TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . : ULCUPANCY ORP. . :R3 VENTS W/O APDL: VENT' SYSTEMS: STORIES. . . . . . . . . BOILERS/COMPRESSORS HOODS. . . . . . . : FUEL 0-3 Hl-*,. . . . DOMES. INCIN: . / 3-15 HP. . . . : /CAS/ COMML. INCIN: MAX INPUT : EA I U 15-30 HP. . . . : REPAIR UNITS: FIRE DAMPERS?. 30--50 HP. . . . : WOODSTOVES. . : GAS PRESSURE.. . . . 5111+ HP. . . . : CLO DRYERS. . - NO. OF UNITS---__--_—.—_. A I P, HANDLING UN I TS 0 THE R UN I TS. : I FURN ( 100K BTU: I 10000 cfm: GAS OUTLETS. :2 FURN ) =1001( BTU: > 10000 cfm: Remarks : NEW GAS LINE, FURNACE & WATER HEATER Owner: ----------------------------------------- FEES STEVE GOLDEN type amol.ty-It by date recpt 11210 SW FAIRHAVEN PRMT $ 2,5. 00 JH 09/30/92 — 5PCT $ 1. 25 JH 09/30/92 — TIGARD OR 97223 PtIon' #: (—ontreact ors OWNER 1410ne $ 26. 25 'TOTAL Req REQU?RFD INSPECTIONS ------- This permit is issued subject to the regulations contained in the Final Inspee ion Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable Isms. All work will be done in accordance with approved plans. This perrit will expire if work is not started within 184 days of issuance, or if work is suspended for more than IN days. Permittee Signature : � .W_ __` �. __ _. 11s s Li e d B y - Call for inspection 639--4175 Permit No: a 14!c- Address: f1� � 112 �J 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 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 313: 1 . 1 -] 1 own, reside in, or will reside in the completed structure. 2. 1 understand the ust register as a constructiur, contractor if the structure is sold or offered for salt; oefore or upon completion. 3. A. My My general contractor -----_-_..__...---- 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. f- _ 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 no, `y 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. At -2 a 9 � I ;!�z I q . -- Signature of Permit App cant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT LE PINK COPY TO APPLICANT INFORMATION NOTICE TO PROPERTY OWNERS , ABORT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners About Construction Responsibilities I was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. It 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 the .,)nstruction or improvement of a re- structure, you will, in most instances, be ruled to be an ''employer'' and the people you hire will be ,, _,. a As the employer, you must comply with the following: Ore on's Withholdin Tax Law: As an employer, you must with,hoIJ ,3ome taxes from employee wages at the time employees are paid. You will be liable fox the tax payments even if you don't actuaily withhold the tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment lnsuranc(-: 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 378-3224. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Corn pensation 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 far all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division IIF at 373-7434. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. Yqu will beble foliar the tax payment even if you didn't actually withhold the ta,t 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 requiremen!s that may be brought to your attention through inspections. Liability and_PropertProperty 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 punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure ,,ou have sufficient time to supervise your employees. Ex ep rtise: 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 Summer St. NE, Suite 300 Salem, OR 57310-0151 Phone 503-378-4821 0244) 10/24/89 CITY OF TIGARD RECEIPT OF PAYMENT RECFlPT NO. t 92-0".3217'1 CHECK AMOUNT 26. 21 NAME s 601—DEN, CHR ISTIE CASH AMOUNT 0. 00 1 4/92 ADDRESS Itc- 10 SW FAIRHAVEN PA'YOJENT DATE 09/3L SUED I V I S I fliq TIGORD, OR 97223— PURPOSE OF PPYMENT AMOUNT PAID PURPOOE OF PAYMENT AMOUNT PAID MECHANICAL 2:5. @0 ST. BUILD PER 1. 25 TOTAL AMOUNT PAID 26. P5