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INSPECTION NOVICE
,l City of Tigard Bui!aing Department
13125 SN Hall B1-.d. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone):
,1639-4175) Bueineae Phone: 6 -4]71
Inspection:` —....,.-- / W
Footing Plbg. Unders,ab Hoch. Rough-in Appr/Sdwlk I
Found. Plbg. Top Out Gas Line FINAL:
Poet/Deem Struct. San. Sewer Framing -Bldg.
Poet/beam Hoch. Rain Drain
Insulation -Plumb.
Plbg• -Hech.
Underfloor Water Line Gyp. ed. 11 1-4
TimePH
: A►�
Date Requested.,
�y��n��+
Address: �,L�`_� ' '!""C�ln J. Permit f: r yy`
"1
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1
/ Dater_..=t J L
Inspector —
i
i DISAPPROVED APPROVED SUBJECT TO ABOVE
APPROVED
call For Rei.nap.
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CIIYOFT167ARD
CITY M BUILDING F'E=RMI.f
COMMUNITY DEVELOPMENT DEPARTMENT olnoou WFRMI; #. . . . . . . . SIA-)92-017171
13126 SW FWI Blvd.P.O.Bax 23397,TOW.Onpan 97223(603)03"176
'-31 TE ADDRESS. . . : 16330 SW MATADOR LN FEAT(',EL: 2 7116r4r--15017.1C'+
_SUBDIVISION. . . . : ZONI!,,!t,•
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . .
RE I SLUE: FLOOR AREAS-_.._.__ ._.._.._ EXTERIOR WALL�C ON aT'RU(.1'1011
CLASS OF WORK. :ADD F I RST. . . a s f N: S. E e W.-
TYPE
:TYPE, OF USE. . . 3E.CONU. . . : S f PROTECT
TYPE OF GONSf. :5N THIRD. . . . : sf Na 5: E. W:
0CGUPAINIC:Y GRP. :R,3 TOTAL. 0 s f ROOF CONST: F=1 RF_ RET
0MUWRNCY LORD: BASEMENT. : Sf AREA SES'. RATED:
TO R. HT. : ft GARAGE. . . 5f OC:CLJ SEF'. RATED: 1
LASMI" MEZZ?: RECD SE'rE+RCKS-__-___.__ HEUUIRED—_-_.-_- ____._,_.._ .__.
1 L.UCJR LC1Ar. . . . : r5f i_f.FT . ft WCiHT : ft f-IR (='I:Lr SMOR DET'. .
0WI-LL_INC UNITS: FRNT: ft REAR: ft FIR ALRM: HNDICP ACC::
IaN I?RMS: 13ATH9: IMI-1 $ UHF AC:,1= : PRO L ORN: PARK I NCS e
VALUE::. 500
fiemar"I<S : INS-TALLING NEW WINDOW MUST MEET NEW C:OL)E STANDARDS U--V+. 4171 MIN
wHILENA LAIRD type amoLlot by date recpt
1 C'i380 ' iW AI_DERL;ROOK CIRCLE 1_ld l t, is 5. 111111 JLH 06/09 i`2 Li Fac:t 6
PL.GK $ 16. 25 JLH 06/1219/92 228218
TIGARD OR 97224 '=,F'C'T 4 1. 25 JL_H 1716/01sf92 2 13CJ1P i
Phone #e 620-0969
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G''h o n e #- $ 4211. 50 'TOTAL.
Req #. .
_._._.__.._ RLOUIRLD INSPECwTIONS
This oermit is issued subiect to the regulations contained in the w ram,.nq Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Int,.tlat .ion Insa
applicable laws, All work will he done in arcrmlance with Gyp Board Insp
?pproved plans. This permit will expire if work is not started F in,-�1 'Ins prectinn
within leo days of issuance, or if work is suspended for more t
char 190 days.
e r m.i t t e e r.^
i.Ss1.1pd By ! �J ,
for -in, cmct ii on E;i�i-417`3
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f� PLNCK RECT # a-rp
ClNIor TIGARD 13125 o�27
lioBxJ397 PERMIT # �«Pyl -o�7'U
i Tigard,Oregon 9721)
COMMUNITY I)IiVl:l.t�l Rtl?N1'DEPARTMENT
(503)639-4171DATE ISSUED �- - —
S
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�06 ADDRESS: /� 3 u I .'�. Zl � +--t TAX MAP/LOT
SUB: tl� C LOT: _ LAND USE:
.VALUATION:
OWNS SPECIAL NOTES
NAME: V 1. 1(e c, _i �� . L �`� 0 REISSUE OF: _—
ACDRESS: 16-3 i-O GJ- LAST REISSUE:
FLOOD PLAIN/
PHON v 1 C SENSITIVE LAND: —
CONTRACTOR APPROVALS REQUIRED
NAME: , �� .-.- _ PLANNING: _ —
�� ADDRESS: -- ��ZZr ''_ . ENGINEERING:
FIRE DEPT:
PHONE: —_ OTHER: _ ---- _
CONTR,_ BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: _ _ _ __ BUS TAX: _
ARCHIFNGINEER CALCULATIONS: — --_-
NAME: _. TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
PPLICANT SIGNATURE
Received By: Date Received:
_ -
��IpyMMywn...w..........nrw... . ..........................�......< ,.-.Q-ww..n11MrI'.11111Mlilly`NICMIM�N}A`Rt19C':"rYY'M..0 JTix,•,MAY'•_ h'W'rY4Pi�Paw..x rM,niwMnw.+r..
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PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
017010-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees —
10-230 01 State Ru:lding Tax (5%)
I
Building
Plumbing
Mechanical _
]0-433 00 Plans Check Fee
Building I
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
i 52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee it lieu of)
TOTALi� ''� o r
nm/3587P.WPF
-777-7
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Permit No:./.'u/,9
y _
s
Address:
z Issued by:
Date:'� �z-
�••' i ___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 3B:
1 . [ 1 own, reside in, or will reside in the completed structure.
y
. i understand that I mush register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.Lr. 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.
' OP
. B.Ems_ _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 c ge 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
-^ I hereby certify that the above information Is correct and that I have read and understand
the Information Notica to Property Owners about Construction Responsibilities on the
reverse side of this form.
Signature of Permit Applicant U e
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
i
Ir
a
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
a
NOTE: This Information Notice t, 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.
%.j If you are acting as your own contractor to construct a new home or make a substantial improvement to an
r 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 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". As 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 are paid. You will be liable for the tax payments even if you don't actually withhold the
+'+ tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390.
I
Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment Insurance
I purposes on the wages of all employees. For more information, call the Oregon Employment Division DHR
at 378-3224.
-- employer,'Norkers' Compensation Insurance: As an ern to er, 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.
Y66 Wfffb liable for the fax 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:
'.,ode_Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
.ode 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
j 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.
a
Time to Supervise Employees- Make sure you have sufficient time to supervise your employees.
} �ertise: Make sure you have the expertise to act aseneral own our
Y g 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.
t If you have additional questions, write to:
Construction Contractors Board -
700 Summer St. NE, Suite 300 4
Salem, OR 97310-0151
fi 0244J 10/24/89
Phone 603-378-4621
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INSPECTION NOTICE
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-phone): 639-4175 Bunineaa Phone: 639-4171
Insperti.on:
Footing �`--'Plbg. Underelab -M6ch Rough.-in \I W Appr/Sdwlk —
Found. Plbg. Top Out Gas Tine FINAL:
k
Poet/Beam Strutt. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb. !
Plbg. Underfloor hater Lina Gyp. Bd. -Neth. `
Date Requested: —Ar- Tisses AM pH
Address:- / ��
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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1.PPROVED DISAPPR01"M APPROVED SUBJECT TO ABOVE
r,a Call For Reinnp.
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C11Y OF TifirA RDCrFYrlrW I�.HAn,I CAL. I
TWARD
COMMUNITY DEVELOPMENT DEPAWMENT o GON PERM 1 T'
13125 SWHd1Blvd P.O.Bao 23371,Tipad.Oregon 77223(15W)539-417F -'E RMI'f#. . . . . . . m MEC92-0125
DATE ISSUED: 06/15/92 '
SITE ADDRESS. . . ; 30 SW MATADOR LN PARCEL: 2S116AD-15+000
SUBDIVIS101U. . . . : n�h� C%fy ZONING:
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . . ■
—LAE�S :ADU FLOOR F'LIRN. . . . . EVAP COOLERS:
TYPE OF* USE. . . . CSF UNIT HE ATER . . VENI FANS. .
AP W/O
VENTS L: VENT SYSTEMS:
tJC:CIJVAt'1FCY GRP. . »R?, r APPL:
'T'0P: `i. . . . . . . . . BOILERG/C0MP1`4f:.5t30R-5 HOODS .
FUE0-w3 HP. . . . : 1 DOMES. INCIN:
: /GAG/ELFT/ ! 3--15 HP. . . . : C OMML. 1NCIN'
MAX I PLi-r» B"r U 15-30 HP. . . . : REPAIR UNITS: �
r IRC. DAMPERS3?. . : :30-••50 11P. . . . W3OD5T0VE5. . ,.
60S PRE:SEURE::. . . : 50-1- HP. . . . : CLO DRYERS. . :
NO. OF UNITS- --_ _.__.._.__ A 1#"+. HANDL..I NG UN 1 I !") O HER UNITS.
-UHN < 100K BTU: 1 <= 1O000 cfm: GAS OU'rLE`TS. : 1
FURI'd ' =-1 C.10K BT(..!- r f m :
Remarks: GAS F'URNA(-,E ANI) AIR CONDITIONER. NOISE REt'DING FOR A/C REQUIRE D.
F EE S
I-1HILENA LAIRD type amoo.rnt by date rer.pt
15380 SW ALDFRPROOT! CIRCLE X1R111 11; 2!5. 00 71_1-1 06/17/92 --
i
5PIC 1 $ 1. 25 JLH 06/15/9c' --
TIGARD OR 972124 MISC J`01 00 J1..H 06/157/9l�
1-11-rone #: 620-••0969
L;ontr,actor; ____..____.__.__._..._.___ ._._.._.__........_...... .__.
COLUMBIA 1 EO TTNO,
8900 `r;W BURNHAM
3PAC E E 1 10
1 T.GAR1) OR 972,,''3,
76359
ki.UUIRE D INSPELTIONS
This perait is issued subject to the reyulatlons contained in the Final Inspection
Tigard Municipal Code, State of Ore. Soecialty Codes and all other
applicable laws. All work will be done it accordance with
approved plans, this perait will expire if work is not started
within 1130 days of issuance, or if work is suspended for core
than 180 days.
�r•m i t is Pe S_i i y r1 a t 1.:r e . � `►"�>�.._.�” ._ .._._..__ ._....._____.._.__ __.__...._ ~_ _�..____A._.._.
I s"!.t e!td LAY
Call for- inspEacti.an -- 639•-•41'7S
CITY QF 'T I GARD _ RCCE I P"F' OF t`: )YIIENT RECEIPT NO. .9&'—c2;P3'20
CHECK AM(]UNI 92. 50
F•.IAME I-OL UMR I A W-`.AT I NG CASH AMOUNT a 0. 00 �
A1)Vf;E GS a PAYMENT 0",FE: 06;i 1,11 Sim:
v
�'i`r+�r, C'/�•1 f3LJPD I V 11:(r',N{ : �...
F-NJFIPOSL (".N= rAYMENT AMOUN T PAIL) PURPOSE OF PAYIHE.:NT AMOUNT PAID �
IYIE Cl Ari r rA{.. r,v, ari, 00 MECHANICAL PE' � 25.00
hl'tSG'E LL.ANFOUS 20. 00 MISCELLANEOUS 20. 00 �
13T.
BUILD PER 1. .."93 SoT. BUILD PER
1
16830 SW MATADOR
`
1649n SW ROYALTY PKWY
I f(ITAI� AMOUNT" PAID _ _.) 9 5
I
C11" OF TI(3NF?F) r�u.CE:It''r OF PAYMENT RFr,,f tPT NO. HPIa
CHECK AMOUNT 4,:;, 50
�'J iME a L.A I RD. Pry I LE'NA CASH AMOUNT
f 00F)FTF=SS a 15380 SW AL.DERLAROOK CIRCLE PAYMENT DATF : 06!09/9G,
aLJBD191SION r,
TIGARD, (W
OUFlf'-1 SE: OF PAYMFNT AMOUNT PAII) PURr"CJS Or—' PAYMENT nMOL.JNT ;"-,AID
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, 12,1. 00 PLAN AN CHECK P 16. P.5
I 1. 25
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I16630 SW MATADOR
TOTAL AMODWT Vln]C)
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