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NEMESES I
INSPECTION NOTICE
City of Tigard Building Department '
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Ma-0-Phone), 639-4175 Business Phones 639-4171
Inspections - _/ _
J; Footing Plbg. Underslab Mech. Rough-in Appr/Sdwik
Found. Plbg. Top Out Gas Line FINAL:
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Poet/Beam Structs. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Mf, Plbg. Underfloor Water Line Gyp. Bd. ~ Meeh.
Date Requested//: �(/�a J J�� Ti.me: _--AM PM
Address: (lJS,�) LJL��d��c�- Per #:
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Builders
THE FOLLOWING CORRE I S ARE REQUIRED:
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Inepecto�s _ Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE i
Call For ReinsE.
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r4r r, INSPEC'PION NOTICE -
iw� city of Tigard Building Departaaent
23125 Sw Hall Blvd. Tigard. Oregon 972.23
' yffi"jyr Inspection Line (Rec-O-Phone): 639-4175 Buoinese Phone: 639-4171
,n31� d tiiti Inspection:__,
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Footing
Plbg. Underslab Mech. Rough-i.n Appr/Sdwlk i
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Plb To Out Gae Line FINAL:
Found. g• P
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Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line G Gyp. Bd. -M ch.
Date Requeetadt .�O _ / Time- LIAv� PM
IYA _141 Address �.- r, �°
Builders t1,1=29
THE
lV TBE FOLLOWING CORRBCTIOMS ARE REQUIRED:
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Inapaotors
APPROVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE
✓/ Call For Reinsp.
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CITY OFTIFARD ✓"
CMOFTWARD MECHANICAL
COMMUNITY DEVELOPMENT DEPARTMENT ORMON
13125 SW HWI Blvd. P.O.6-2,097,TigmM,Or"m 97223 (60G)M4176 PERMIT
PERMIT #. . . . . . . : MEC92-0250
639-4171 DATE ISSUED; 09/29/92
SITE ADDRESS.. . . : 09655 SW MURDOCK ST PARCEL: 2S111BD-00404
SUBDIVISION. . . . ; DARIYIEL 1\10. 3 ZONING: R-3. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :22
CLASS OF' WORK. . :ALT FLOOR FURN. . . EVAP COOLERS:
TYPE OF USE. . . . :F;F UNIT HEATERS. . ; I
VENT FANS.
ULLUPANLY URP. . .-P— VENTS W/O ADPL: VENT SYSTEMS:
S'TORIES. . . . . . . . . i BOILERS/COIYIPRESSORS HOODS. . . . . . . :
FULL TYPES---------- 0-3 H[-'. . . . : DOMES. INCIN:
:/GAS/ 3.—15 HP. . . . : COMML. INCIN:
MAX 1 NPUI BTU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS":). . : 30-50 HP. . . . : WOODSTOVES. . :
GAS PRE56UHL. . . : 50+ HP. . . . t CLO DRYERS. . :
NO. OF AIR HANDLING UNI 'rS OTHER UNITS. :
FURN ( 100K BIU: 1 10000 cfm: GAS OUTLETS. : 1
FURN ) --100K BTU: 10000 cfm:
Remarks:
Owner: ------------------- FEES
DONALD RAMAEKERS type amount by date recpt
9655 SW MURDOLK PRMT $ 2!7. 00 JH 09/29/92
5PC:,1 $ 1. iR5 JH 09/29/92
Lontractorm
OWNER
--__.__—_---_.__.___..._______.______.__.____
Phone 26. 25 TOTAL
Reg
NEQUIRED INSPECTIONS
ihis permit is issued subject to the regulations contained in the Final Inspection
riyard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. this permit will expire if work is not started
within IN days of issuance, or if work is suspended fat, more
than 180 days.
1 'ermittee Signature-:!,--�
Issued By:
--
Loll for, inspection 639-4175
N 4"
Permit No:
Address: S� � � � -
• re z Issued by:_� _ Date:
_._..FOR OFFICE USE ONLY.
STATEMENT:
INFORMATION "InTICE 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 resid(:ntial building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under URS 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 . ZC1 1 own, reside in, or will reside in the completed structure.
i
2. I 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.L_ I 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.
OR
3. B. 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 notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the abc we Information is correct and that I have read and understand
the Information Notice to Property Owners about Cr nstruction Responsibilities on the
reverse side of this form`
"Illogn—ature off er� licant Date
RP
CONSTRUCTION CONTRACTORS BOARD
0244) 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
w�a
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Constructk ,i Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Oregon Legislature. .,.
If you are acting as your own contractor to construct a new home or make a substantial improvement ti, an o
existing structure, you can prevent many problems by bring aware of the following responsibilities and areas
of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Boarc' 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:
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.
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 DHR
at 378-3224.
_Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtair 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.
You will be liable for the tax payment even if you didn't actually withhold the tax. For r information, call
the Internal Revenue Service at 221-3960.
j
OTHER RESPONSIBIL.ITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any fai!ure to meet
code regiiirernents that may by 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 punc-
tures, fire, or work that must be re-done.
Time t0 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 97310-0151
0244) 10/24/89 Phone 503-378-4621
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CITY CIF '1'1 Gf)PD RFC:C P'f" OF PAYMENT RP-C I I PT NO.
NAMEFBF h(tC'I:C12 i, L)gNf�l...i) CHECK, AMOUNT
,. CASH AMOUNT ►6XI,.. 92;"
ADI)PF'S F, -S655 SW h1FDOCK FAYMCNTDATE 09900
OR 9!;'x;'4••• i1.JBD 7 V 1 fi l ON
1''UF2F''C1SIC' OF PA"Y'M!~N'I' �
PIMOUNT 4-:441D f,`L,jRPW3 OF PAYMENT (1140 011 PAID
MECHANICAL P,F . ..._. ....__,_................�w..
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