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Permit No:
Address:
ti
'z Issued by:___ —__ - Date:
OFFICE USE ONLY______
STATEMENT:
INFORMATION NOTICE TO PROPrRTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.05.,14) , requires residential construction permit
applicants who are riot registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is rEq,,;red for residential building, electrical, mechanical, and plumbing
permits. Li^ensed 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 . T� 1 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.
1
3. A.C - -- I My general contractor is----
Contractor
s_-Contractor registration number---
I
umber--_I will instruct my general contractor that all subcontractors who work on the strt.ic-
lure must be registered with the Construction Contractors Board.
OR
3. B.i- _X l I will be my own general contractor. ►°`
If 1 hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and du 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 herrbv certify that the above InformaJon is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
-"I -_X - I I // '.2
Signature of Permit Applicant Date
CONSTR ICTION CONTRACTORS BOARD
0244J 8/91
WHITE COPT TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
.�-;�,�,�,_. . ,.,.,,.,•�u. vrY��:rs�+,+r �ai��,��_n�1W:'!t� "�aa�' `��'.^�6i1� � .
INFORMATION NOTICE TO PROPERTY OWNERS -
ABOUT CONSTRUCTION RESPONSIBILITIES IL
NOTE: This Information Notice to Properly Owners About Construction Responsibilities
was developed by the Construction Contractors Hoard in accordance with ORS 701.0.55(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 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 persons riot 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:
Oregon's Withhuldirig Tax_Law: As an employer, you must withhold income taxes from employee wages at
Ike 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 inforniation, call the Oregon Department of Revenue at 378-3370.
Unemployment Insurance Tax: As an ewployer, 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 DNR
at 378-3224.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Lew, and must obtain workers' compensation insurance foi 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 w'il1 be liable for the tax payment even if you didn't actually withhold the tax For more information, call
the Internal Revenue Service at 221-3960. I
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
code requiremen's that may bp 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-
i-itures, fire, or work that must be re-done.
Time to Supervise Employees. Maki 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 19,,
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
lop
CITE' CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT'
13125 SW Hall Blvd.Tigard,Oregon 97223e8199 503)639-4171 PERMIT #. . . . . . . a MST9.3--056 i
639-4171 DATE ISSUED: 11/1/93
PARCEL: 1 S 1.33DA--06300
SITE ADDRESS. . . : 11025 SW SUMMLH LAKE DR
SUBDIVISION. . . . : AMART SUMMERLAKE ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .85
BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK :ADD BEDRMS:O BATHS:0 GARAGE. . . . . . . . . . :0 sf
TYPE OF UbE. . . :Sr FLOOR AREAS-- ---- -- REQU I RED SETBACKS--------------
TYPE OF CONST. ?51%1 FIRST. . . . :.240 sf LEFT. . :8 ft R I GHT. :20 ft
OCCUPANCY GRP. :R3 SECOND. . . .-0 sf FRONT. -.21 ft REAR. . -20 ft
STORIES. . . . . . . - 1 THIRD-.-0 sf REQUIRED---------------------
HE
EQUIRED---------------------
HEIGHT. . . . . . . . : 17 ft TOTAL--------- :240 sf SMOKE DETECTORS. :
FLOOR LOAD. . . . .-40 psf VALUE. . . . . t : 11040 PARKING SPACES. . :O
Remarks : ADDITION
-------- ---- ----- - _ -------------- PLUMBING __ -----------------
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATCRIES. . . . . t0 WATER HEATERS. . . :0 TRAPS. . . :0
TUB/SHOWERS. . . . :0 I-AUNDRY TRAYS. . . :O CATCH
WATER CLOSETS. . :0 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WATER LINE (ft ) , :0 OTHER FIX TURES. . . . . :0
SARBAGE DIE,P. . . al RAIN DRAIN (ft ) . :0
WASHING MACH. . . :0 SF RAIN DRAINS. . : !
--------------- MECHANICAL ----___..-------____-_._._.__-----__-•-- FEES ------ _.--------_-
FUEL TYPES--------------- UNIT HTRS. . :O type amount by date recpt
/GAS/ / / VENTS . . . . . : 1 BPRT 0 92. 50 RLL 11/12/93 -
MAX INPUT:O BTU VENT FANS. . :0 BPLC f 60. 13 JLH 11 /04/93 93-24572 �
TURN ( 100K . . :0 HOODS. . . . . . : 1 135PC f 4. 63 PLL 11/12/93 -
F'URN ) =100K . . :0 WOODSTOVES. :0 MPRT f 25. 00 RLL 11/12/93
FLOOR FURN. . . . :0 CLO DRYERS. : 0 M5PC $ 1. 25 PLL 11/12/93 -
BOIL/CMP ( 3HP:0 OTHER UNITS:O PPRT $ 37. 50 PLL 11/12/93 -
GAS OUTLETS:O P5PC $ 1. 88 PLL 11/12/93 -
Owner: --'- -- - -------------------
RYCHEN PADDACK
11025 SW SUMMERLAKE DR
V Nv
i !CARD OR 97244
Phone #. 503-524-8733
Contractor: -'-------•-----------------------
OWNER
Phone #:
Reg #, . : 00000 ------------------------------------------
$ 2i:'2. 69 TOTAL
This perait is issued subject to the r±gulations contained 1n the ------ -- REQUIRED INSPECT7,UNS -----•--
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/fOLlnd Insp Gyp Hoard Insp
applicable laws. All work will be done in accordance with approved Post/Beam Struct Rain drain Insp
plans. This perrit will expire if work is not started within 188 Post/Beam Meehan Mechanical Final
days of issuance, or if work is suspended for rare fhci 180 days. PLM/Underfloor Plumb Final
Mechanical Insp Building Final
Permittee Signature : Plumb Top Out Erosion Control,
Framing Insp Crawl Drain
Issued By-
_ Inculation Insp
Call for incopc-tior, - 6�q-4175
�--� -
I
j Residential Building Permit implication
City of Tigard
13125 SW Mall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: ,Iog 4<
Subdivision. ..�v�yf��.�;.rC _ Lot X 85- Office Use Only
P►andc/Rec# A �� �� •
Naluatlon:
Permit # W$/?.3 -
Owner: _ 4e.,A-1 IQW-dcle:-, Reissue of
Address: //�2�' �. leis a-&'AoivieA04-QA-4e %�2,
Approv_ais Required
r
Planning
Phone: _ a u3 �.2�'
Engineering
Contractor: Other
Address:
` items Required
Phone:
Subcontractors
r Contractor's License # Truss Details_
(attach copy of current Oregon license) Other
Subcontractors:
Plu ; 7
JJ 7 '
Mechanical _
(attach copy of current OR Contractor's License)
Architect/Engineer:
Address:
Phone:
COMMENTS:
i
Applicant Signature & Phone number
Received by: `-
Y Date Received:
q.J
F
Pe,'Tnit # Account Descripf':.a Amount Aunt. Pd. Bal. Due
•
g _� ti
S 3-DS 7
Bldg. Permit (BUILD) y�•SZ �'2. >
_ Plumb. Permit (PLUMB) 3j•Ja _ 3 7- Ty
Mech. Permit (MECH) ✓-
State Tax (TAX) _ 7P •
Bldg: _ • G 3 /
Plumb:
Mech: / Z
i
Plan Check (PLANCK)
Bldg: 6, 3
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (I IF-C)
Industrial TIF (TIF-1)
Insttrtional TIF (TIF-IS)
Ofik:e TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WOUANT)
Fire District (FIRE)
TOTALS:
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e •.
V
Page No 1 CASE HISTORY FOR CASE NO.: MST93-0567
RYCHNN PADDACK
11025 SN SUMMER LAKE DR �
04/29/98
Action Description Req/ Schd/ And/ Action Notes Disp By Update Upd
Cade
_ sent Dane Done - Date By
------- "'- - ---
i
i PASS JLH 11/05/93 BLT
' MSTA007 ApplicaticD received / / / / 11/04/93
M.9TA,R0 Plan check depoeiL paid / / / / 11/04/93 1A88 JLH 11/05/93 BLT
MSTA020 Plan check by 11/08/93 / / 11/05/93 PASS RT 11/05/93 BLT
MSTA030 check for prcl. restrict. / / 11/08/93 11/05/91 FABS VG 11/05/93 BLT
! MSTA705 Foot/found Insp / / / / 12/01/93 PUMP OUT ALL NATER BEPMRB YOU POUR PASS RT 12/01/93 BLT
M.4TA710 Post/Beam structural / / / / 12/07/93 protect girders from concrete asphalt PEND RB 12/08/93 RB
shingle, etc. under-floor access not
large enough for working access- only
mach. 6 plumbing.
M4TA71.1 poet/Beam Mechanical / / / / 12/07/93 PASS RB 12/27/93 RB
M8TA717 PLM/Underfloor / / / / 12/21/93 PART MS 12/21/93 MFS
MSTA725 Framing Inep / / / / 12/20/93 strap top platen at addit/house DIS OS 12/20/93 GES
-onnection
elec and plm cover
M9TA'726 Framing <PSINSP, / / / / 12/21/93 POFITIVE CONNECTION. ADDITIONAL SUPPORT PEND RD 12/21/93 RB
OF temp. TRUSS. I
MSTA726 Framing <RBINSP, / / / / 12/23/93 PASS RB 02/08/94 RD
MS'rA710 Fireplace Inep / / / / 12/23/93 CISARANCES SHALL, BS MRI w LF SIDE. PEND AB 12/27/93 RB
M3fAL STRIPPING a RT SIDE TO HEIGHT OF
8r. FLAME SPREAD. SHUT-OFF VALVE
RFWUIRBD NITHI14 3 r.
M.4TA715 Ga3 Line Inep / / / / 12/29/93 #87985 PASS RB 12/30/93 RB
NSTA740 Insulation Insp / / / / 12/23/93 PASS RB 12/27/93 RB
MSTA745 Gyp Board Iasp i / / / 12/29/93 PASS RB 12/30/93 RB
MSTA795 Mechanical Final / / / / 02/07/94 PMMING- "WAT TYPE OF FIREPLACE SYSTEM PASS RB 02/08/94 RA
ARR YOU GOING TO INSERT?"
MSTA797 Plumb Final / / / / 02/07/94 PASS RB 02/08/94 RB
MBTA799 Building Final / / / / 02/07/94 PENDING- WRATHEPBTRIPPING BACK PASS RB 02/08/94 RB
DOOR/GARAGE.
PENDING- OTHER ISSUES RE: MISSED
INAPECII0NS.
MSTA970 Case Finaled / / / / 02/07/94 05/26/95 JF
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