10375 SW HILLVIEW STREET-2 �E
i
ADDRESS:
d
f'.
iAre.cords\micro lm\targetstuilding.doc
!"i F {r
i
�y�ryr y, ti
CITY OF TIGARD BUILDING INSPECTION NOTICE
M1
Inspection Line 'Rec-O-Phone): 639-4175 Business Phone: 639-4171
is t t / •� �,/ Y -,1 G ..
Inspection: z:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
I Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech. V
r tl� k s
Underflr. Insul, Shear Wall Gyp. Brf. ect.) s�
Date Requested: j Time: AM
PM
Address:
BUllder: O Permit #:
��Z~�IJL� G�..�,�
THE FOLLOWING COR CIONS AR EQUIRED: r '
r
Y f67'r''fk li ri•'' 'fir.
i
l f
h tr '
r
J' IY
S.
{, r � I rs�ei Lw f��� YYa• l x
0C
/
s;r
Inspectori Date:
AAPPROVED
�DISAPPROVED APPROVED SUBJECT TO ABOVE
to i ��
N�� _Call For Reinr.p.
/U6I lC
7t°t' * '�rt .4Q'tra
v x d
t
�
�l''�'l..:Ti'�' �f.+ ra z � _ Y F��F?•rt� r T� Ofi �
a} 1aI
IF
x.rf �1i1 Yfi"r%ijr 1�
1W
a Y Fs 3
ygyY Yi � kl�?
7 �
A f
'+N9vry�!.a 9 I�N4v:. at.....v.� ,.fir:^mf x.,•.hky .1^hhu a ,,.1x'138'I�It ',
i
- ^�-;r,y� rK �r1 I '7ih d 5., 1 s ° '� @n.` 'tea '7. r a , tip• �' i. l
k.+ "�a rfYS�r ft illi. 1�U ma� x e
- �. �C ��riNw �• �>„Mjs v��r erys�,�, 9r��` rv::
e3 I
I
ARD BUILDING INSPECTION NOTICE
CITY
OF
TIG
I
-O-Phone : 639-4175 Business Phone: 639-4171
Inspection Line (Rec )
P III IIS
d
Inspection: _
I^S
s Footino Susp. Ceiling Sprin!,. Rough-in Appr/Sdwlk t
Foundation Plbg. Underslab �Me�h. Rough in Fireplace x
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulatiun
Underilr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: l 7 [ ��—Time� 44M PM
Addr-ss:
Permit #:
I
TI FO+_ G C RRECTION�A E REQI�R�X�— c���✓!'L(C_
7 l i
ZL
(a =�_� 7
_A
Inspector:
4%—IPPROVED DISAPPRO✓ED _APPROVED SUBJECT TO ABOVE '
Call For Reinsp.
r eft � +I
AK,
�"Tp
?.w.Yva'
°fir, ly t' °'i'�r!171r F4 i IG r fr ur ���
41
I •. Za
yf� �
• TIGARD
i�lECl-i��hl I CG"-1L_CITY OF PCR'11IT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT . . . . . . . .. MEC95- V L-J ,
13126 SW Hall Blvd.Tigard,Oregon 97223.8190 (503)8394171 DATE I '''Ur17" 07/Q.13/95
PARCEL: 2S 102CC--01400
1"C iai)ilid[ �a. . . . 1D3i'� bJ it1t �_ VIEW 57
_UPDIVIS'_'CN. . . . : FRELE ON HEIGHTS NO. c ZONING: R-3. 5
BLOCK. . . . . . . . . . . LOI.. . . . . . . . . . . . . � 1I �
CLOGS—OF—WORK. „ ALT FI_OQR FIJRN. . , . , EVAP COOLERS:
TYRE OF USE. . . . :SF UNIT HEATERS. . . VENT FANS. . .
OCCUPANCY GRP. . :R3 VENTS W/O ADPL: VENT SYSTEMS: �
STOPIES. . . . . . . . . BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL. "f Y1=Lw� __..._.__....._._._ .. __ .. 0 Hf) . . . . : 1 DOMES. INCIN:
: /(3AS/ / / 3-15 {-1F'. . . . : GOMML. I NC.I N:
MAX INPUT BTU 15-30 HP. . . . : RUPA I R UNITS: w
FIRE. DAMPERS''. . ; 30-15.II HP. . . . : WtJODS'fEVES.
� .
GA PRESSURE. . . X171-1- HP. , . . . CLO DRYERS. . s
NO. OF UPJ I"f 5—---__...__..__... AIR HANDLING UNITS OTHER UNITS. :0
F URN i 1001; LATU:0 <= 10000 r_f m : GAS OUTLETS. :0
FURN ) =100K BTU: > 10000 cf'm :
Remarks : Install. ai.r conditioner.
Owner . ___�.....__.___.___ __._,....�w_____—_.�_--________.__ ..__...______._._._ FEES
GLENN RIPLEY type +mol_tnt by date recpt
10373 SW HILL VIEW ST PRMT $ 25. 00 .JD Q.17/03195 95•-2675.1 '1
5PCT 4� 1- 25 JD 07/03/95 95--267514
T IUAP.D OR 07223
Phone #: 624-9;"06
CONTRACTOR NOT ON FILE Qw�1
Phone #• L 26. 25 TOTPL
Reg A'. . : c �.
REQUIRED INSFEc"rIONS __._._.._..
This permit is issued subject to the regulation; contained in the Final Insspwction
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All wort- will be done in accordance with
approved pians. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than ld8 days.
Per-m i t t e e G i y n._i t 1.1 r,e :
Lail for inspection 639--4175
10
•
City of Tigard MECHANICAL PERMIT Planc'VRec. #
.13125 sw Hail Blvd. APPLICATION Permit #
Tigard, OR 97223
(503) 639-4171
�••�� Description �
Table, 3A Mechanical Code 01Y PRICE AMT -
Job «. r
i I v(���� _ 1) Permit Fee -0- -0- 10.00
Address
C?- VZ, 72Z3 2) Supplemental Permit 3.00
•m• w„ . +�«• — Furnace to
11 incl. ducts &vents 6.00
a •« °AFurnace 100, -9177+-i
Owner 7 J 2) incl ducts &vents 7.50
• bFloor Furnance e�
4 �J•(r` CL y C
1,41c-
cj 77Zz, 3) incl vent 6.00
•m• m• •»M« // uspende e7 ater, w-n -heater
-k-S C< 130 c' 4) or Floor mounted heate 6.00
Occupant 5) appliance permit 3.00
•• .V epair o7Feating, re rig.
6) cooling, ansorption unit 600
•m•
Boiler or comp, heat pump, air r no.
7) to 3 HP; absorp unit to 1 OOK B�U 6.00
• v «• •^•
Boiler or comp, eat pump, air con .
Contractor „•• 8) 3-15 HP; absorp unit to 500K BTU 11 00
or Pr -comp, heat pump, air con
ON 1�-JO HP; absorp unit .5-1 m,' , rU 15.00
•a•°•b
:,IV Bus T•• a offer or comp hat Pt�mp, air conav
10) 30-50 HP, absorp -mit 1-1.75 mil BT,j 2~1 50
ereFyac nowle,ge that I have ..e this app icatror, t aiTt-iFe -- ----S-oiler or comp, heat pump, air c�onr,
information given is correct, that I am the owner or authorized 11) >50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans sobmitted a-e in compliance with Aii an ing uni to
State laws, that I am registered with the (-,ons!ruction Contractor's 12) 10,000 CFM 4.50
Board, that the number g-ven is correct. (If exempt from State Air hsndling unit
registration, please give reason below) 13) 10.000 CTM + 7.;,0
Non portable
1 h) evaporate cooler 4.50
----Vent fan connected
15) to a single duct 300
Ventilation system 1.0t
16) included nnliance permit 450
,,�. . . M.°•n, _ •• 7 Hoodserved
17) mechanical exhaust 450 J
escn a worTc - new a ition Q .10ee aticn r pair Commercial or n ustria - I
to be done residentl non=rresidential Q 18) type incinerator 3000
xisting use i?-- - Other i.e., wo s�z, water
building or property 19) heater+ solar, clothes dryers. etc. 450
Proposed use of �. f, C-A, 20) Gas piping one to four outlets 200
building or property ( C
Type of fuel -oil () natural gas Q LPG Q electr.• 1� 21) More than 4-per outlet (each) 2.00-
Mi imum Fee $25.00 SUBTOTAL I
�J l�C•
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED ':vITHIN 180 DAYS, OR 5%SURCHARGE l G 4
IF CONSTRUCTION OR WORK IS S JSPENDED OR
l.BANDONED FOR A PERIOD OF 18c DAYS AT ANY TIME PLAN REVIEW 25% r" SUBTOTAL
AFTER WORK IS COMMENCED.
TOTAL ��e C 1
Special Conditions -�
Sate ssuAd -- by
H 1.01IN C51 31'AFCHO6A•
brim
' I
I
1. .Ne.
WL
Permit#: G L-G 9 S- 013 9 5-
Address:
Address: /03YS
^,.
iseued Date:
Statement: information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), require.. residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a buildi. -,permit can be issued. This statement 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, appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
2. I under,,Land that I must registe a-; a construction contractor if the structure is sold or offered for sale
beton or upon completion.
3A. My general contractor is
t_1 (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.
4,
ti I hire subcontractors, I will hire only subcontractors registered with the Coastruction Contractors
Bo;tid. If I change my mind and hire a general contractor, I will contract with a contractor who is
,r
registered with the CCB and will immediately notify the office issuing this building permit of the
name r`the contractor.
I hereby certify that the above information is correct and that I h ive read and do understand the Information
Notice to Property Owners about Construction Respon.4bilWes on the reverse side of this form.f ti
(Signature rmit app, � ate)
v
(White copy to issuing agent, permitfile,
pink copy to applicant)
I
u:
r
information Notice to Property Owners
` About '�unstruction Responsibilities
Note: This Information Notice to Property Owners about Construction Resp:lnsihilities
was developed by the Construction Contractors Board in accordance with ORS 101.055(5). �
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing stricture;
you can prevent many problems by being aware of the following responsibi!ities 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 w
' construction or improvement of a residential structure,you will, in most instances,be ruled to be an employer and the people
you hire will be employees. '1s the employer,you must comply with the following:
t Oregon's withholding tax law: As an employer,you must withhold income taxes from employee wages at the time employees 4,
are paid, You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more 3
F 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 a
wages of all employees. For more information,call the Oregon Employment Division at the Department of Human[resources
at 378-3524.
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
y 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, is
call the Workers'Compensation Division at the Depar►ment 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. F:;r more information,call the internal Revenue Service
at 1-800-829-1040.
' OTHER RESPONSIBILITIES AND ARRAS OF CONCERN:
i
Code compliance: As the permit holder for this project,you are res onsi'-;le for resolving 7 failure to meet code requirements
p P P J Y p g' Y 9
that may be brought to your attention through inspections.
1 .'
k: Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverag(l fen
accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures,fire,or work that must he
t re-done.
K�
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor,to coord;gate 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 or call the Construction Contractors Board(PO Box 14140. Salem,OR 97309-5052,
503/378-462The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
1/94
r
s4i
i
i .
i
a
CITY OF TIGARD RECErIPT OF PAYM[•NT RECEIPT NCI. A671*51A'
l C14;C;K AMOUNT s 6 3. 00
I NAM[: A R l r-,LE.Y y Gi. D. CASH AMOUNT 0. 00
ADI)RE'G c3 A RIPL_E:Y, R. r. PAYMENT DATF A 07/03/95
+M. .. 1.037`-• SW HILLVIE,W SUBDIVISION
T I GARD OR 979223.-
'I PURPOSE OF PAYMENT AMOUNT PA I D PURPOcFE CIF PAYMENT AMOUN"f v.,A 1'T)
l MEaCPAN I CAL. PE MEC,``),: 3 00 ST. Bu I LI) PER 1. 25
-1 ELF CTRICAL PFRMIT a;a. 00 ST. BUILD PER 1. 73
K ,
10375 SW HILLVICW
,y TOTAL_. AMOUNT GAIT) _ _ ._ ._) 63.
:9
Community Development ELECTRICAL PERMIT APPLICATION
13',25 SW Hall Blvd.
Tigard, OF 97223 Plan--k/Rec. #
Permit # - L_C- �ni'3��-i
Phone (503) 639-4171 Date issued -o 3-CJI s
FAX (503) 684-7297 Issued by
CITY OF TIGARI) _
TDD No. (503) 684-2,72 (----
Inspection (503) 639-4175 _
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development _ Number of Inspections per permit allowed rl
Address tt Q 32 � ���) � i ' V`u("i b 1" Service included: Items Cost(ea) Sum ul
City/State/7-ip ]—1 [),(t V14 4a. Residential-per unit 4
1000 sq It or lase $11000 V
Name (or name of business) G u��. t - �.� each additional reaq II o• �—
rr--�� portwn thereof
$2500 1
Commercial IJ ResidentialLimited Energy $2500
��' \l Each Manul'd Home or Modular 2
t)wellmg Service or Feeder $00 00
2a. Contractor installation only: 4b.Services or Feeders
Installation,alteration,or relocat,on e
Electrical Contractor 200 amps or lase $6�Liu 2
201 amps to 400 amps -_ $BJ 00 _ 2
Address
�, 401 amps to 000 amps $12000 2
City "tate ____ Zip 001 amp;to 1000 amps -- $180 00 2
Phone No. Over 1000 amps or volts $34000 2
Contractor's License No. v Reconnect only $5000
Contractor S Board Reg. No. _ 4c. Temporary Services or Feeders
Installation,alteration,or reloca:.on 2 -
* . Signature of Supr. Elec'n� 200 amps or leap $5000 2
L.ICense No. Phone No. 201 amps to 400 amps �_ $7500 2
-� —�— — — 4G1 amps 10 000 em pa $10000
'Jver 900 amps to 1000 volts
2b. For nwner installations: ,ae*b•above
Print Owner's Name V 1 ' — &0 ?�'� 4d. Branch Circuits
�`� t
Now alteration or extension per panel t
Address I Q .`.'�fti �/ (.(, r n)The fee for branch circuits with
City. T t ca k "~ State ) ? Zip �(7 Z ?_� purchsee of eervles or Feeder tee. 2
Each branch circuit $500
Phone No. 5 C�'� C,`.Z9 — (?2 b)The tae for branch c cotta without The irstallation is made on property I own which is purchsee of service or Feeder fee. � 2 (�
not intended for sale, lease or rent. 'vst branch circuit I $35 00 2
E rich additional branch circuit $500
4e. M scellaneous
(Service or feeder not included) 2 i
3. PIAn Review section (if W red):
Each am 1p or tiehon circle $4000 V 2
Each sign or outline lighting $4000
Signal circud(s)or a limited energy 2
Please check appropriate Mem and enter fee in section 5B. panel,alteration a extension $4000
4 or more residential unitK in one structure Minor Labels(10) $too 00
Service and feeder 225 amps or more I
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable Ir- any of the above
as described in N.E.C. Chapter 5 Par inspector $3500
Per hour $5G 00
Submit 2 sets of plans with application where any of the above In Went $55 00— —
apply. Not required for temporary construction services. 5. Fees:
->�7�QZ
NOTICE 5a. Enter total of above fees $
5%Surcharge(05 X total fees) $ -- 5
PERMITS BECOME VOID IF WORK CR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT' Fnter 25%of line A for
COMMENCED WITHIN 180 DAYS, OR IF Sb. plan Review if required(Sec 3) $ _
CONSTRUCTION OR ,'YORK IS SUSPENDED OR ABANDONED FOR Subtotal $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS ----
COMMENCED 0 Trust Account lie $
Balance Due s
rentr•..rMv,.�Mrpm ter+
e
�F4;1 I Mai�� k� �