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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 634-41?3 Business Phone- 633-4171
Irspection: Y71'�'jy;oC�,� Uj \
Foo',ing Susp. Ceiling Sprink. Rough-in Appr1S -�k
Foundation Plbg. Underslab Mach. Ruugh-in Fireplace
Post/Beam Struct. Plbg. Top Out Eier. Rough-in FINAL:
Post/Beam Mach. San. Sewer Gas Line -Bldg.
PR- Underfloor Rain Drain Framinq -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
r4uostod: �� --C1 Time: AM PM
A, ss: y l0 ?.� v -. ✓
B,jolder._ `7 Permit #!:`�l �
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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IX—SPPPROVED
ctor: �/ Date ...
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_DISAPPROVED APPROVED SUBJECT TO ABOVE
ft _Call For Reinsp.
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WASHINGTON COUNTY INSPECTION CARD Pro)ect No /
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- DEpAjMMj r of LAND USE AND n AOMPIORTATION PERMrr NO. QS"D fa J,�
FOR INSPECTIONS CALL: 640-3561, 7.4 HOURS
/FOR INFORMATION CALL:
/6640-3470�i DATE
PERM'.TEE
ADDRESS
DIRECT IONS Pr10NT NO.` -� --
INSPECTIONS: STRUCT ®PLUMB []MECH ELECT ----- --
j'� CALLED IN BY
®APPROVED. 7
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OHOWEVER
REOUE>3TE0 �T��O NOTE: (`�7,/
NOT APPROVED: " amu _
IX]PrPAIR OR REPLACE AND RE-INSPECT:
S-OP WORK tl*M : � A i�—
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INSPECTOR
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DEPARTMENT OF LAND USE&TRANSPORTI4TION
WASHINGTON LAND DEVELOPMENT SERVICES DrvISIO%
155 NO11TH FIRST,III113A7RO.OR 97124
UFCOUNTY, IVsSPE(MON REOUEUTS: 303/640-3551/893-4415
OREGON PHONE- 503/648-8761 Page : 1 of 1
Date : 07/21/94
Time : 11 : 28
Permit 'Type Residential Electrical Permit Permit # : 05056124
Permit Status : APPROVEU Applied : 07/21/94
Situs Address 13632 5W MOUNTAIN RIDGE C'1 'T'1 issued : 07/21/94
Permit 'Title SFR - ELEC/NEW HOUSE & LV Completed :
Permit Uescr. To Expire : 01/17/95
Project 'title SFR - ELEC/NEW HuUSE & LV Pruject # I P0042350
Project Uescr. * EROSION
Parcel Number 2SITI - Land Use District :
valuation 0
Legal Uescr.
Owner INSPEC'T'ION - TIGARD Construction OTH
Ap'?licant Name MORENO, HERBERT Classification 900
Applicant Addr. : 14590 SW MCFARLANU BLVD Occupancy R3
'T'IGARD, OR 97'1.24 Validated by JS
Applicant Phone : 639-7725 Inspector Area :
Fee description Units Fee/Unit Ext fee Data
------------------------------------------------------------------------------
Square Footage [Enter Sq . Ft . ] 4300 285. 00
Limited Enemy 1 25 . 00 25 . UC
Subtotal Electrical Fees : 310, 00
State Surcharge of 5% 15 . 50
Total Electrical Fees : 325. 50
*** Fees Required *** *** Fees Collected & Credits ***
---------------------------- --------------------------------------------
Method Check # Receipt No. Date Payment
CK 2258 07/21/04 325 . 50
TO'T'AL THIS DA'Z'E ********* 325 . 50
Fees : 325 . 50
Adjustments: . 00 Total Credits : . 00
Total Fees : 325 . 50 Total Payments : 325 . 50
Balance Due : . 00
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W NOTICE: This permit beco-.ees null and void If the work or construction for which 11 Is Issued to nal commenced within 109 days. Once construction has started,
J the permit bscomea null and void If construction Is Interrupted for a period of 180 days. I eertlty that the Information
provided by the applicant and
his agent or agents In support of this permit Is tris and correct to the best of our knovAedge. I acknowledge that it*lullding Dapartment's rellence
upon false and mlalerding Information may Invalidate this nermM. Ah provlsMm of applicable laws and ordinances governing the construction and use
of this building or structure will be complied wh-i whether or not sperlflsd on the plans or noted on the plane collection shooW I acknowledge that
the gnrding of a permit does not grant authority to sccsss private property or to use easements. 1 further ackrtowledgs 11M the use or occupancy of
the structure or building permitted depends upon my calling for Inspsctlons at vedaus times during the process of con bucllon and the building
Ings- Ion staff verifving compliance with the various codes. Use or occupancy of the building or stnKlum permitted prior 10 approval by the
Building Department is solety at the risk of the applicant and such use or occupancy Is revocable until all Inspecilon requirements are satisfied and
appuaval Is given by the Building Official. I further ackwwledge that a lien may be placed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structure Is provlslonal and revocable until the satisfaction of all Inspection requirements.
APPL.ICANT'S SIONATUIIIF
`Dopar meat of COUNTY ELECTRICAL PERMIT
Department of Land IJae dr Transportation ,
Electrical Inspection Section
155 North First Avenue,14350-12 APPLICATION
Hillsboro, Oregon 97124
Information: 503 1540-3470 Fax: 503 893-4412
Project/Permit
Number ? � � _ Date 17 -�� `�
4. Complete F SgPeduie toi. Location of Installation !AddressL3(j1. � � ar
sow
Buildi g Service Included: Items Cost(ea.) Sum
City 77,/' ,,4 1� Suite No. /1�
Tenant Name A. Residential-per unit
(N commerclrtQ -- — 1000 sq.ft.or Ices _ __ $110.00 4
Each additional 500 sq.ft
Tax Lot y Map No. __ or portion thereof $25.00
Umlted Energy _ $25.00 1
Thomas Map Book: Page: Se 10 :. Each Manufd Home or Modular
Directions-!20 Sl Dwelling Service or Feeder ,— $68.00 2
Oh S.
w. IMT e,/ e B. Services or Feedors
Commercial ❑ Residential Cauef. Installation,alterations or relocation
200 amps or less $60.00 2
2a. Contractor Installation only. 201 amps to 400 amps $80.00 _____— 2
Y 401 amps to 800 ernpo _.e 6120.00 —_____—..__ 2
Electrical Contractor 801 amps to 1000 amps $180.00 — 2
Address Over 1000 amps or volts 5.'140.00 2
Date Job Number —� Reconnect only --- $50.00 2
Property Owner C. Temporary Services or Feeders
Contractor's License No. Installation,alteration or relocation
Contractor's Board Reg. No. 200 amps or loco $50.00 2
201 amps to 400 amps $75.00 __ 2
Signature of Supr. Elec'n � 401 amps to 800 amps $100.00 2
License No. _ Phone No. Over 600 amps to 1000 volts aee'B'above
2b. For owner Installations: D. Branch Circuits
^ ��g io 3 p_ 7 T� New,alteration or extension per panel
Phone fJ e) The fee for branch circuits with
Print Owner's ams t O purchase of service or feeder fey.
Each branch circuit _._ $5.00 2
7831
Z Z b) The fee for branch circuits without
city ��ta— p purchess or service or feeder lees.
First branch circuit -- $35.00 __ _ 2
The installation is being made on propeq), I own Each add'nl branch cirrult-- 55.00 2
which is not intended for sale, lease or ren E. Miscellaneous (Service or Feeder not included)
Each pump or Irrigation circle_ 140.00 2
Owner's Signature �6Ll� r � � —, Each sign or outline lighting $40.00 2
Signal circuits)or a limited
3. Plan Review section (if required) energy panel,alteration
Please check appropriate Nem and enterfee In section 58. or extension $40.00 _ 2
a' 1 & 2 family dwellings over 320 amps s/c meter F. Each additional Inspection over the allowable
HIn any of the above
4 or more residential units in one structure Per Inspection $35.00
N _ Service over 225 amps; feeder 400 amps or more Per hour $55.00
System over 600 volts nominal In Plant _— $55.00
_J Building over 3 stories In height 5. Fees
m ` Building over 10,000 sq. ft.
Occupant load over 99 persons A. Enter total of above fees $
W� Manufactured Structures Park or Recreational 5% Surcharge (.05 X total fees) $
Vehicle Park; new, addition or alteration Subtotal $
Classified area or structure containing special B. Enter 25% of line A for
occupancy as described in N.E.C. Chapter 5 Plan Review if required (Section 3) $ — -
Submit 2 sets of plans with application where any of the Sub total $ _._.
Less Bulk Label Fee
above apply. Not required for temporary construction
ervices. Balance Due $ gos
For Inspections call This permis e.corne•mull and vek a the week•utlrerleed by the prams Is nd eow~med
640-3561 Or 693-4415 wkhln 180 days from dab d mms t.nres d etich peror it aro work•rullmde•d is
ouop"W a•b•rrderr•d d Wy Neu•Iter work leoowworeod Wr m pwW d tso d•ye
24-hour recorder,one working day In advance of need IRWAI I pernrlr we noft4ound•kN WA noMnn•Nrow
5193
• w ' - DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 4350-12
155 NORTH FIRST, HILLSBORO, OR 97124
C�)uNw, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-Ml or 6934415
r..•: :..ic w . ,, iw:. wtaluz: . AFr•.*kwi4� ilagg. 1 ,;t
Apt - /;. . /nr +,. :? 07/� ./94 Cxg ..res t??/17/9 ' ;)/;' 1 /•14 05 31
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T EL.,_ '/NEW WJj,3E & LV
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A} . : HEPSERT
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JLWER CONNECTION
(11017Y
OF T' . . . . .PERMIT'
PERMIT #, . . . . . . SWR93-0475
•` DA'.L ISSUED: 10/L6 973
COMMUNITY Di:1iELOPIIAENT A ��
13126 8W Hal(Blvd.Tigard,Oregm 97=99199 (503)'639-4171
PARCEL: 2S 1 tD9Bl=?-006(D0
SI rL (-DDRESS. . . . 13032 SW MOUNTAIN RIDGE CT
'3UBDIVTSIDN. . . . 3 THREE MOUNTAIN ESTATES ZONINGS R-7
BLOCK- - . . . . . . LOT. . . . . . . . . . . . . : 14
tF.NANI NAML. . . . . :
JSP NO. . . . . . . . . . : FIXTURE UNITS. . . a
i:.LASTS OF' WORD. . . ::NEW DWELLING UN I'1 '3. . a 1
TYPE OF USE. . . . . :SF NO. OF BUILDING5: 1
INSTALL TYPE. . . . :BUSWR I MPERV SURF=ACE:. . : a s f
,lemarks: PATH I NEED STREET OPENING PERMIT FROM ENGINEERING DEPARTMENT
EES
HLRBLRT MORENO type amol_int by date rerr l,
14590 SW MCFORLAND 13L.VD F'RMT $ .20,00. 00 JNA 10/26/93 -
INSP $ 35. 00 JH 10/26/93 -
1IGORD OR 9'7224
'hone #: 639-7725
:'ant Tactor:
"ONTRACTOR NOT ON FILE:
------------------------
'hone #.- 1i 2235. 00 T()TnL_
yeg #. . .
RE QUI RED I N PE=C H UN5 -- -
ais Applicant agrees to comply with all the rules and regulations Sewer ?;,spection _
the Unified Sewage Agency. The permit expires 10 days fro@
-`re date issued, The total amount paid will be forfeited if the
ermit expires. The Agr;,:y does not guarantee the accuracy of the
°ide sewer laterals. If the sewer is not located at the measurement p
y.ven, the installer shall prospect 3 feet in ali directions from
,he distance given. If not so located, the installer shall purchase
ap and Side Sewer" permit and the Agency will install a lateral. _ -+
c c,it:tee Si gnatur•e+ :
.t e u 13y:
n' Call for ins>pection - F� ,q--4175
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Permit No:
I/ Address:
1 Issued by:_ _ Date:
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FOR OFFICE USE ONLY_
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, URS 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 requh*ed 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 at nd either box 3A or 38:
I own, reside in, or will reside in the completed structure.
2. C�---1 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--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 agistered with the Construction Contractors Board.
OR
3. B.l_ .I 1 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
IL contract with a contractor who is registered with the Construction Contactors Board
and I will immediately notify the office issuing this building permit of the name of
f- the contractor.
y
I hereby certify that the auove Information Is correct and that I have read and understand
m the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Srgnat ire of Permi' ppl cant Date
CONSTRUCTION CONTRACTORS BOARD
0244) 8/91
WHITE COPY 10 ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT 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),
passed by the 1989 Oregon Legislature.
If you arle 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 perso not registered with the Construction Contractor Board to do labor in constructing or assisting
in the constructio or improvement of a residential structure, u will, in most instances, be ruled to be an
"employer" and th people you hire will be "employees As th�employer, you must comply with the following:
Oregon's Withholdi Tax Law: As an employer, you must withhold income taxes from employee wages at
the time employees N paid. You will be liable for the.tax payments even if you don't actually withhold the
tax from your employe s. For more information, call the Oregon Department of Revenue at 378-3390.
Unemployment InsurancTax: As an employer,,you are required to pay a tax for unemployment insurance
purposes on the wages of a employees. For olore information, call the Oregon Employment Division DHR
at 378-3224.
Workers'_Compensation Insurance' As an employer, you are subject to the Oregt:in Workers' Compensation
Law, and must obtain workers' compensation insurance for your emplr5yees. If you fail to obtain workers'
Ecom, ensation insurance, you may be �Wbject to penalties-end will be liable for all claim costs if one of your
employees is injured on ttm jc*r. For more-Intmmaficn, ca!I the Workers' Compensation Division DIF at 373-7434.
U.S. Interna. Revenue Se_r_vice:,,As an employer, you must withhold federal income tax from employees' wages.
You will be liable fog she tax 4c yment even if you`Oidn't actually withhold the tax. For more information. call
the Internal Revenue Sep6ce at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsime for resolving any failure to meet
code requirements that may be brought to your attention through inspetti _&
Liability and_fP�lil600rty Damage Insuranbd: Contact your insurance 2gent to stye 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 you have sufficient time to supervise your employees.
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 Summer St. NE, Suite 300
Salem, OR 97319-0151
Phone 503-378-4621
0244J 10/24/89
Residential QieatiOn
City of,Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobslte Address:
Subdlvislon:�M j-±4 'S "- Lot
f'tantWRbc _
Valuation: IS Q e en l 12A2 LAIL ¢
�— Permit
Owner: J1,16%, e e a_f A n iZ E nr d ssua vt: `
Address: _ q O W-St .-�Q�
Phone: �.� `�— 7 7 Z 5
1 a
Contractor: /1�1— ! r-=L�A - ---- .22
Sf R t
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Address: Ze At
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Phone: 16 -------
Contractor's License NNoense)
(attach copy of CWW#Oregon
Subcontractors:
Pkimbing:
Mechanical: ---
(attach copy of current OR CoftacWs LR,snse)
a' Archltect/Englneer:__ "A,,d —� r% "
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N Address: , S-W ��---�
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w Phone: �^
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COMMENTS:
scant gnature & Phone number
Received by: __ Date Received: 10 -ZO
Permit tr Account Description Amount Amt. Pd. Bal. Due
hlyt D SSU E30g. Permit (BUILD) �v�r. S� (pcv� v
Plumb. Permit (PLUMB) 7 .S v
Mech. Permit (MECH) j 91
State Tax (TAX) (O
Bldg: 4 /
Plumb: Ar
/
Mech:
Plan CherAc ( NCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SW A) j,fc°2 2,oti
Sewer Inspection (S INSP) -3� � .3.5-
Varus Dov Charge KSDC) IVV .spiv
Storm Drainage Chg (SDSDC) a
Residential TIF
(TIF-R) /
Mass Transit T (TIF-MT) v _
Commercial IF (TIF-C)
Industridl TIF (rlF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WOUAL)
Waier Ouantlty (WOUANT)
Fire District (FIRE)
TOTALS: