13800 SW FERN STREET ADDRESS:
i:lreccrdslmicrcflmltargetslbuilding.doc
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection tine (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: `)� C [' ►�.�f�_ r.7�t Ynl C7'
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer`.' Gas Linb -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wal! Gyp. Bd. -Elect.
Date Requested: 7 2 r Time: AM PM
Address:
Builder:_ t IL3 Permit 0-4!
i
THE FOLLOWING CORRECTIONS ARE REQUIRED,
Inspector: Date:
APPROVED —DISAPPROVER _APPROVED St iBJECT TO ABOVE
l Call For Reinsp.
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_PHONE3('3Q )842-2531
-- -) FAX:(503)542-2534
?1800 S W FARMINGTON ROAD
BAKER ROCK Rt AVI-RTON,ORFGON 97007
R E 5 •O U R C E 5
s w DATE DELIVERY TICKET NO.
4l�L14/9" is!$..-_ toll.]
SOLD'ro SHIPTO L-F arm Rd, L-Clark Hi 11 Rd, L-
All ►-'haze Const.
CAPh :1010-13300 5W Fern St 5uholle Ferry Rd, 1t-1 jSLh, R-
Tigard, Ortepon Fern 5L to address an the left
PROJECT SW h'er n �'t.
CASH SALE 13600
ORDER NO. ACC •NG. r 4f.No. I CUSTOMER P O.NO. ZONE OTv.ORDEFIED DELIVERIES TODAY 1 V !.IV�RIES TO gATE.
000200 0. QI a. :% 0. (0_0 11;•
DRIVER GROSS WT. TARE NST Wr.
2333. 238 MOUNTAIN TRUCKIlit1 LU S2� 08 t&' Ab3 1 UNIT PRICE TO}k
PRODUCT 25. !fm CY_
3/4" -0" Cru shed P,r -,
DEPART AR I DEPART ARRIHOURLY HAUL CHARGE
PLANT Jvs STAND BY WILL BE CHARGED
FOR ALL TIME IN E)(CFSS OF 5 t 1
i r : 17 MINUTES PER LOAD C0 --*►
REC
EXTRA DUMP CHARGE - - - - - - - - - - - - - - - - - - -
A�' X
r morith(equal la 18%per anrum)Service /
CITY OF TIGARD BUILDING INSPECTION NOTICE ��
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection.
Footing Susp. Ceiling �--
Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in
Post/Beam Struct, Plbg. Top Out Elec. Rh Fireplace
Rough-in FINAL:
Post/Beam Mech. San. Sewer
Gas Line -Bldg.
Plbg. Underfloor Rain Drain
Framing -Plumb.
Alarm Water Line
Insulation -Mech.
Underflr. Insu!. Shear Wall
Gyp. Bd. -Elect.
Date Requested:__ �j �� /�j Time: AM
PM
Address: Q (�
Builder._
�_—Permit!t:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
Inspector:
– _ Date: r
__APPROVED _DISAPPROVE APPROVED SUBJECT TO ABOVE
all For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:__ —
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rcugh-in FINAL:
Po eam Mech. <&dn.Sewer Gas Line -Bldg.
b r11 Rain Drain Framing -Plumh.
Alarm Water Line Insulationfvlech.
Undertlr. Insul. Shear Well Gyp. Bd. -Elect.
Date Requested: `)/�- 1/ `f S� Time:�AM /" PM
Address: 3 iec
Builder: / _. Permit #: .
THE FOLLOWING CORRECTIONS ARE REQUIRED:
l'`F� SLG ✓`� ' –�gr�.�'��/��' '
Inspector:_ _ Date:
_APPROVED _DISAPPROVED / APPROVED SUBJECT TO ABOVE
Call For Reinsp.
SEWER CONNECTION
C 4016, A
_ C11Y %01 TI%7p RD PERMI-1 #. . . . . . . : SWR95-00S
PER111 r -7
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/03/95
13125 SW Hall Blvd.Tigard,Oregon 972239810C t603)639-4171
PARCEL:
TE i-IDDPI�,.SS. . . 13800 ;W FERN ST
UBDIVIS,. 0N. . . . HANDY ACRES R-6
BLOCK. . . . . . . . . . . L 0T. . . . . . . . . . . . . :26
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . . :
GLASS OF WORK. . . :ADD DWELL I NG UN I TS. . : I
( YPL OF' USE. . . . . :SF NO. OF BUILDINGS:
INSTALL TYPE. . . . rSUGWR IMPERV SURFACE_ : : st'
kernat-ks: Connect existing house to existing sewer-. Septic tank must be• pitmpeo
filled and inspected.
Owner-. FEES --------------
STEVE BRUNEAU type amol.int L)y date t,ecpt
1,3800 SW FERN VIRMT $ X200. 00 BON 03/03/95
I NSP t 7-, 1-,,) r"koj
IIUARF) OR 137223
1-11-ionp #,
Lontr,actur,:
OWNLR
-------------------------------------
F)hcjr%e 0: 4 2235. 012) 10TOL
Reg #.
-------- REDUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations �3ewer, Inspectiun
of the Unifie,- Selvage Agency. Tte permit expires 180 days from 13,epti.c lank Fill
the nate The total amount paid will be forfeited if the
permit expi-Fs. The Agency dyes not guarantee the accuracy of the
side seller laterals. If the sever is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a 'Tap and Sid; Sewer" Permit and the Agenc wi
P"a r-M i t t e e E_)i at, P
—41 _i4o
I sstird Ely VOW
C a I I f o t- inspection 639--4175
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT' NO. 1 95—P 6.'245 t?
CHECK AMOUNT c P-;?35. 00
NAME : Al._!_ PHAZE CONSTRUCTION CASH AMOUNT c IA. 00
ADDRESS : 13b@O SW FERN ST. PAYMENT DATU c 03/03/9!7j
TIGARD, OR SUBDIVISION
972013—
PURPnSE Or PAYMENT $1MOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
P2001 (AQ) SFWFR INSPECT 35. rAo
13800 SW FERN ST.
'TOTAL. AMOUNT PAID 00
Residential Building Permit ApPllCation
City of Tigard
13925 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: ��
�. Office use Onl
Subdivision:�1f�.,V�-t- -�� y Lot#_
Planck/Rec #
Valuation: _
Permit#
Corner Lot? Y N
Reissue of
Flag Lot? Y N
Map & TL#
Owner: ����V (A 4,,,,j tA. Approvals Required
Address: F�e.Y K !!:jA_ — Planning M_ 1"00i q
y a Engineering
I I,
Phone: `1' t%��UV Other
T
All , (Aen^: v__tkt4_ iee?%^
Contractor: 'tel 11/`� Lt�� W'�L _ Items Required
Address: --- Subcontractors
Truss Details
Phone: f ++ -- Other _
Contractor's License # ti�rCXJ
(attach copy of current lregon license)
Contact Name & Phone'.
Subcontractors: Arch ltect/EnginPer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License)
Pb
JOS DESCRIPTION:
Applicant Signature & Phone number a
Peceived by: �J ' MAAiLd*'^- _ _` Date Received: (S
Permit# Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permii (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA) _ --7,WD
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) —
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT) —
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL) _
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) _
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: � � % 6
Pernut#: _ `'L� – O c
Address: �JL
✓ Issued by: Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, DRS 701.05.5(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
,for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration inkier ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
/ Fill in (lie appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
1Z1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a constniction contractor if the structure is sold or offered for sale
before or upon completion.
Y g —ra
3A. M general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, 1 will hire only subcontractors registered with the Construction Contractors
Boaid. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this huilding permit of the
name of the contractor.
1 hereby certify that the above information is correct and that I have read and do understand the information
Notice to Proper y Owners about Construction Responsibilities on the reverse side of this fm m.( nature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note: This lnforrnahon,Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORa 701.055(5).
If you arc acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many pru iems 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
construction or improvement of a re;cidential struct,.:re,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:
Oregon's withholding tax law: As an employer,you must withhold income taxes from enq loyee wages at the thre employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your emplo,,ees. For more
information,call the Oregon Dept.of Revenue at 945-8091.
Unemployment 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 at the Department of Human Resources
at 378-3524.
Workers'compensation insurance: Asan 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 at the Department of Consumer and Business Services at 945-7888.
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 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project,you are responsible for resol v i ng any failure to meet code requirements
that may be brought to your attention through inspections.
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 punctures, fire,or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have thee xpertise 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:o they can perform the required inspections.
if you have additional questions, write or call the Construction Contractors Hoard(PO Box 14140,Salem,OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St.NE Suite 3(X), in Salem.
prop-own.pm4
1/94
CIT( OF TIGARD BUILDING INSPECTION NOTICE
Inspection L ne (Rec-O-?hone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Susp. Ceiiing Sprink. Rough in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beari Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. Gas Line -Bldg.
(`15Iby_13ndertl6or Rain Drain Framing Plumb.
Alar at�Iine Insulation Mech.
Undertlr. Insul. Shear Wail Gyp. Bd. -Elect.
Date Requested:_/ f ! Time: AM PM
Address:. Z�
Builder_ jS' G� l� ;2/j/L Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
�7
Inspector:
'� Date:. _�� �y s
APPROVED __DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Cal! For Reinsp.