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LIL 144095 S.W. LJNCO t-N AVEtIL)C-
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9-742-3
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TAX ►_.csr r.ia 006104
LIAhI LM: lite City of Tigard, Oregon, or W5
em��fu��ees, shell rot be responsible fop
v�hk„h miv annear herenn.
12093 SW Lincoln Avenue 83
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If this notice a111)evrs Clearer Ihan file
ducument, the d�Icunlenl is of 11111-ginal quality. MAY 1 ;) �y� -
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. C ing Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace > a
Post/Beam Stiuct. Plbg. Top Out Elec. Rough-in
Post/Beam Mech. San. Sewer Gas Line t; ,,,�S
Plbg. Underfloor Rain Drain Framing -Plumb. gr°',
Alarm4t �►
Water Line Insulation -Mech. �( .
Underflr. Insul. Shear W II Gyp. Bd. Elect.
Date Requested: � ' )lrr Time: AM PM
Address: ��- C � � f—•� -1-- /`t—��' �?ur r'
Builder. Per, it U
THE F=OLLOWING CORRECTIONS ARE REQUIRED: tj
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A16 GLe5GT2��'/aL 1�c97�GL."t7 �i�r24a:
——!��J�r7o,✓ �X11
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Inspector: Date:_ Z/
�ROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Call For Reinsp. f
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
e t
1 Inspection: t'
Footing Susp. Ceiling Sprink, Rough-in Appr/Sdwl„
iFjundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINA'
Post/f3eam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Fra /' -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect. ;
Date Roquested:
Time: AM PM � �
Address: �.7 Cfi c` �� ,� ,>✓ °i
`sa,+el� 7 +r
er: �_3> '�9S� Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date: d 2 5 r
_APPROVED _DISAPPROVED IL44PPROVED SUBJECT TO ABOVE
Call For Reinsp.
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' *S` CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
oot Susp. Ceili Sprink. Rough-in Appr/Sdwlk
F1 F
ndation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Fough-in FINAL: sEN `
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
I �Y
Underflr. Insul. Shear Wall Gyp. Bd. -Elact.
Date Requested:_ Time: AM PM
Address
— C� armit#:
Builder:_ —_� J I
IN
I THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date: .�
Z_'1(15PROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE ` �, 1
Call For Reinsp.
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BUILDING CITY OF TIGARDBUILDINGPERMIT
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 07223.8189 (503)838-4171
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'.TE ADDR177L. : 1ZO')3 aW i_.IN!_1,t.N
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lJBI)TVISTON. . . . : NO. TIGARDVILI_C PDDITION AMEND. 20NIi`G., FR- 4. 5
Lr)T. . "
i l:I' c;tlF II FLOOR ARF�AS--_-._ .. ��. , EXTERIO"I. Wf)L._L CONSTRUCTION i
' GEARS JF' WORK. :A;_T F'IR2*T. . . . : sf NII S: C: Ws
TY;-`C: or um, . . r.,:r cXCCND. . . . s F PPOTECT aPEI`itNGG•, ...... _...__. _.....
TYPE OF' CONST. :5N THIRD. . . . : af N; 5: E: W:
;7CLI Pi'INCY 0,` . . TOTAL S f Roor CON OT: FIRE PET" : •
IXUPkINCY LOr4l): DnOEMUNT. : sf ARf:A rEr'l. MTED:
T]RSf ;AC4 iOCCu OLP. RATLD
:Xr?: ME:I Z?-. READ GETBACKE3•w--.-___._ RtiGIU I RCL►--— .•__ ..__.__ _._._...W....
,.00R LrY)D. . . . :56'I ti!:'+` I_.EFT': Ft RGI IT: Ft FIR SPI`L 0010K DET. . �
DWELLING UNTTG: F-RNT: -Ft REAR: ft FIR At_(7M: HNDICD Acc:
DEDR"1'05'. r,nTITM!`, ;!. Rrrgc ': P p 0 C111"R; r,r:ir?f;I!\ic
"ILUE:. $s 2500
CIRK I(ONRAD rF3c? .mu.,,.' i Y citi+:e
2093 SW LINO^t-N ST PRMT 38. 1-40 GW 05/25/9w -
Pt..G' 1 "11 05/1 /9'S
MARC OR 1)71: :'3 Fir—, � 1. 73 f:W 05r 3/97j
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REQUIRED I NOPECCT I ONG
hit Pei-lit ii issued subject to the regulations contained ir, `he F'i a,ni r;q IreSt;
.gate Mvicipal Cade, State of Gre. Specialty Codes ar:d all 7ther Ir) k_�3 .:+t ion 1 ns1:i ____..._..__.__._.__.. ..
ulicab'e laws, All stark Neil be done ir, accordance with Iris:p _.....�_. ._.__._.. ;'
proved plans. This persit will, expire if worm is not started rinl�l. Ins pec:tiUri
,';hin IN days of issuance, er if Hm'l,' is auspepded far we
-an In days.
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Residential Buildinqg Permit Application r�
City of Tigard
13125 SW Hall Bled, 44.4 @d-Lt 'ut.cz� t t-
Tigard, OR 97213 �� •�'d-�- , /�'/itiet %SSGc G .i.
(503) 639-41'71 pvtrt.uf ,(,taC 'd rrqjc
.lobsite Address: C/I'll 3 s w �; r►CoI✓1
,� (V'3 Q L) Office Use Only
Subdivision: �r. � Lot #
,�`��� (, (r'k- -m<ii�� � Planck/Rec #
Valuation: _
Permit # G 14e 3
Corner Lot? Y
Reissue of
Flag Lot? Y N
Map & TL # �51p AA6 -ooboq
Owner: M(LAI k " r Tis Approvals Requ:rRd
Address: ( &_1C:q -sa r,( n Planning _
e < Engineering _
Phcne: � 1 — !� �j L) _ Other _
I
Contractor: � �i- Items Required
Address: _ �C�XYI S c:,- r7 V Subconn actors
1 Truss Details
Phone: n-i--) (, L)V_ Other _
l
Contractors License # _
I (attach copy of current Oregvr+ license)
Contact Na,ne & Phone: o W V\J-W
Subcontractors: Architect/Engineer: (19ne -
Plumbing: r)c-, b' ' Address: _
Mechanical: (Wy
(attach cop!t of current OR Contractor's License)
Phone: _
JOB DESCRIPTION: �u t t I r\0. C_ �' S e 4 oo
CL H Cc c-',6
Applicant Sigfiature & Phone number
Received by ___ _c L Gtr Date Received:
Permit# Account Oescriptioli Amount Amt. Pd. -3a1. Due = i
331dg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECN)
Stats Tax (TA.
Bldg: 'r
Plumb: _
Mach:
d
Plan Check (PLANCK) '
Bit J: r
Plumb:
Mach:
Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
i Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
i
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
I Erosion Planck/COT (EROSN)
TOTALS: �ra- -
C`
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Permit#: 4bw f)cin 01
Address: --2-, l.V
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Issued by: Date:
rt•
Statement: Information Notice to Property O yners
About Construction Responsibilities .,
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the w
following statement before a building permit can be issued. This statement is required
j for residential building, electrical, mechanical, and nlumbing 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 l and 2, and either box 3A. or 3B:
1. I own, reside in, or will reside in the completed structure.
=i
2. I understand that I must register as a construction contractor if the structure is sold or off;.red for sale
N"rJ before of upon completion.
l� 3A. My general contractor is
l—I (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.
If I hire subcontractors, I will hire only subcontractors registered with the Constriction Contractors
Board. if I change my mind and hire a general contractor, I will contract with a contractor who is ;
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that 1 have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
l
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V �
Information Notice to Property Owners `
About Cc, , struction Responsibilities
Note: This Information.Notice to Propel tv Owners alurut ' i:siraction Responsibilities
was developed by the Construrlion Connvactors Board in accordance with ORS 7"1.055(51'.
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. n
EMPLOYER RESPONSIBILITIES: •
If ycu hire persons not registered with the Construction Contractors Dowd to do labor in constructing or assisting in the
construction or improvement of a residential strucurre,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 he liable for the tax payments even if you do-i't actually withhold the tax from your employees. For more
information,call the Oregon Dept.of Revenue at 945-8091.
Unemployment insurance tax: As an employer,you are required to pay a tax for unempksy-ticnt insurance purposes on the .
wages of all employees. i=or more information,call the Oregon Employment Division at one Depbrtment of Human Resources
at 378-3524.
Workers'compensation insurance: Asan 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
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, i
call the Workers'Compensation Division at the Department 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. For more information,call the intermit Revenue Service
at 1-8()0-829-1040.
OTHER RESPUNSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for i hi project,you arc responsible for resolving any failure to meet coxae 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 coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire,or work that must be
t
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
I�
Expertise: Make sure you have the cx pertise to act as your own general contractor,to coordinate the work of rough-in and finish C
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,
503/371,-4621), The Board is located at 7(N)Summer St. NE Suite 300, in Salem.
prop-ownpM
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CITY OF rl(;'ARf) - RF'CE'IP-f OF PAYMF14T REGI~fP-T NO.
CHECK AMOUNT a 40. 43
NAME=. N KONRAD, MARE; (3, CASH AMOUNT 14. 00 � •
0F)D 2ES S e 12093 SW LINCOLN AVE: PAYMENT DA"FE: 0.'i/a5/,4'ti
T I GARD, OR SUBD f V T S I ON a
97Pc'3--
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I='I_jRp(')GiL7 OF-* PAYMENT AMOUNT F A I D PI..IRPOSE OF PAYMENT AMOUNT f-,(-I t D E�E
AUILDING PF=RM SUP95-0.163 2';b- 50 ST. BUILD PFR 1. 93
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1 f"0'33 11-7W LINCOLN a
C)TAL. AMOUNT PAID - i 40. 43
CITY OF- T I WIRIt f�:f !�1':f l"'F or c'AYMFNT RU-1 CF :lPT NO. a 950---,'?655rj4
CHF-"Ch nM()I.N"F s 25. 03 {
TAMC' KONRAD, MPRV: CASH PMI: 1-11\4) a 0. 1AW)
il)DpF:=SS I. INC.Ol'N Ovu. PAYMENT DATE=. x 0`..'i/17/')ti r
�;UEaf)fVTST01`1 t
TIGORD, OR
1I-,UUK)SF OF PAYMFNT AMOUNT F'W1) I'I_IRPOlt'i-. OF PrWME=NT ()MOUNT PAID
IF'L.FiN C'.HF C:K FE "!'-63/F?
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'1i3ITF 1.209. 3 W 1. INI:OI.N
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�TOIAL. AMOUNT Pn11.)
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