12923 SW LAURMONT DRIVE-1 i
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Picone: 639-4171
Date Requested: — (� I A.M _ P.M. _-- — MS1': j _� C%✓ 0 3
I ocation: 9 1 2— _ L �, -- 1 --^ BlJP:
'tenant: _ Suite:_ Bldg: _ MFC:
Contractor: Phone: PI.M:
Owner:— Phone: ELC:
•ti SIT: _SI _
BUILDING $ �con't) PLUMBING MECHANICAL ELECTRICAL TE
Site ost/Bemn Post/Beam Post/Beam Cover/Ser;i%x Sewer/Stonn
Footing Roof UndFI/Slab Rough-In Ceiling Water bine
Slab Framing 'I op Out Gas Line R-ugh-In UG;sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vault
Bsmt Damp Drywall Stonr. Furnace Temp Service MISC.
Masonry Ceiling Rain Iain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/1'ound Ir I leat Ptmtp Low Volt
Approved Approved Approved Approved Approved
Appr/Sdwlk No�tA�>)roved Not Approved Not Approved No:Approved Not Approvel
�FTIVAL�, FINAL FINAL FINAL FINAL .j
✓Jr __ `' 5~ �!Jl%' C t f�d►�, � d f�
z s CBS►
O Call for reinsl ti C]tillectio of$ ---required before n•rt inspection l7 t triable to inspect
// _
Inspector. D ete:_ r Page_—__ol
CITY CSF TIGAR® MASTER PERMIT
COMMUNITY DEVELOPMENT D�P4RT4�14T F-ERMI1 #k. . . . . . . : 111ST93-0583
13125&W Hall EPA.Tigard,Oregon 97223.9199 '(503)639-4171 L)c)TE ISSUED: 12/02/93
PARCEL.: IS133DC- 15500
SITE kDDRLBS. . . : 12923 SW LAURMONT DR
SUBDIVISION. . . . : VILLAGE AT SUUMMER LAKE PARK ZONING: R-12
SLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 10
BUILDING
REISSUE: DWELLING UNITS: l BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. sALT BEDRMS.2 BATHSiO GARAGE. . . . . . . . . . ..0 sf
TYPE OF USE. . . :SF FLOOR AREAS—,_____—_-- REDUIRED -ETBACKS----------------
TYPE OF CONST. s5N FIRST. . . . s sf LEFT. . :O ft RIGHT. -O l",
OCCUPAN('.'r QRP. :R3 SECOND. . . : 10011 sf FRONT. :O ft REAR. . :O it
STORIES. . . . . . . :2 THIRD. . . . :0 sf REQUIRED—
HEIGHT. . . . . . . . :30 ft TOTAL------91000 s SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ li 1500 PARKING SPACES. . :121
Remarks : COMPLETI14G UP STAIRS
-------------------------------------- PLUMBING
SINKS. . . . . . . . . _-0 FLOO13 DRAINS. . . . CO BACKFLOW PREVNTRS. . :0
LAVATOR. 13. . . . . .0 WATER HEATERS. . . :0 TRAPS. . . . . �;. . . . . . . :0
TUB/SHOWERS. . . . :0 LAUNDRY TRAYS. . . :0 CA.*CH BASI . . . . . . . :0
WATER CLOSETS. . :0 SEWER 1-INE (ft ) . :121 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :0 WATER LINE (ft ) . :O OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . -O RAIN DRAIN (ft ) . :121
WASHING MACH.. . . :O SF RAIN DRAINS. . :O
MECHANICAL FEES --
FUEL TYPES—-------------- UNIT HTRS. . llO type -imount by date v-ecpt
VENTS BPRT b 25. 00 JH 12/02/93
MAX TNPUT:@ BTIJ VENT FANS. . :O BF —C16. 25 JH 12/02/93
FURN ( 11210K . . :@ HOODS. . . . . . :0 B5PC 1 . 25 JH 12/02/93
FURN )=100K . . :0 :ooDsToVES. -LA
FLOOR FURN. . . . .0 CLO DRYERS. : 0
BOIL/CMP ( 3HP:0 OTHER JNITS:0
GAS OUTLETS:O
Owner--.
MARK IJOLD
12923 SW LAURMONT DR
TIGARD OR 97224
Phone #: 503-692-5445
Coritt,actair-ii
OWNER
11 42. 50 TOTAL
This permit is issued subject to the regulations contained in the REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Framing Insp
applicable laws. All work will `p done in accordance with approved Insulation Insp
plans. This permit will rilpire if work is not started within 180 Gyp Board Insp
days of issuance, or if work, is suspended for more than INSys. Building Final
Per-mittee Signature:
Issued BY :
Lal I fur- inspection — 639-4175
Permit No: �_—
,� Address: - -- ------ --
�r �
Issued by: Dats:
•,. • L�___�__ --
FOR OFFICE USE QALY. --------------
STATEMENT:
INFORMATION NOTICE TO PROPERTY O NNLRS
ABOU'r CONSTRUCTION RESPONSIBI, ITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants 10o are not re,,;stered with the Construction Contractors Board to
sign the following statement before the building permit can be issued.This state-
merit is required for residential buildir- Plectrical, mechanical, and plumbing
permits. Licensed Architect and Engh plicaris, exempt from registration
uncles ORS 701.010(7), need not subn statr;ment. This statement will be I
filed with the permit.
IFill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 313:
1 own, reside in, or will reside in the completed structure.
2. i i understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A. My general contractor is - --
Contractor registration number
I will instruct my general contract,-)r th?t a;l subcontractors who work on the struc-
ture must be registered with the Construction; Contractors Board.
OR
3, B.A"t-] I will be any own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
Oin Contractors Board. If I change my mind and do hire a general contrac'.or, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify he office issuing this building permit of the name of
the contractor.
hereby certify that the above information 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. -�
JLI
.,i
Date
Kure of er lit Applicant
CONSTRUCTION CONTRACTORS BOARD
0244.1 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TC APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONS-'RUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners Abort Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 7010.55(5), +�
passed by the 1989 Oregon Legislature.
It you are acting as your own contractor to construct a new home or make a substantial irtinrovement to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
31 c..ancern.
EMPLOYER RESPONSIBILITIES:
It 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" anc: the peopfti you hire will Ido "employees" As the empi4ver, you must comply with the following
Oregon's Withholding Tax Law. As an employer, you must withhold income taxes Irorn employee wages o t
the time employees are paid. You will be liabie for the tax paym•3nts even if you don't actually withhold the
tax from your employecs For more information, call the Oregon Department of Revenue at 378-3390.
t)riernployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance
putIpo �.as on the 11 wages of all employees. For more information, call the Oregon Employment Division DF
at 378-3224.
Workers' Compensation Insurance: As an employer; you are subject to t1i3 Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers
c ompoi: (ion insurance, you may be subject to penalties and will be liable for all claim costs if one of your
employees is injured on the j For more information, call the Workers' Compensation Division DIF at 373.7434.
i
k.) .'; Intetnal Revenue_ Service .As an employer, you must withholl `ederal inconne tax from employees' wages.
)"'mwill'be l ab)e for thWtax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 2.21.3960
OTHER RESPONSIBILITIES AND AREAS OF CONCERN. �
C'r:io Compliance, As the permit holder for this project, you are responsible for reralving any failure to meet
ui( roquirements that may bA brought to your attention through inspections.
i_.i�ii iiiity and Property Damage insurance Contact yot,.rr insurance agent to see if you have adequate insurance
- rn 0t,rge for accidents and omissions such falling tools, paint overspray, water damage from pipe punt
i .io, lire, or work that must be re-done.
Time to 5up9.vise Employees. Make sure you have sufficient time to supervise your employees.
f Yhe�rti�a Make sure you have the expertise to act as your own general contractor, to coordinate the work
0 rough-in and finish trades, and to notify building officiFils at the appropriate times so they can perform
the required inspections.
It you have additional quesi,,)ns, write to: Construction Contractors 3oard
700 Summer St. NE, Surae 300
Salem, OR 97340-0151
Phone 503-379-48.1
0244,1 10/24/89
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639- 1171
I Il IS/ 33.�C- /5500
Jobsite Address: 3 lJ
I � Office Use only
� bl t i wr-n lM� � ��.K 2 (ko, Lot #Ji�
Valuation: _
Permit#
Owner: - + �i_ c � )I)J Reissue of
Address:
Approvals Required
_ c. (' � Up Planning `
Phone: _ S2 _ .
Engineering
Contractor: Other
Address:
Items Required
Suk contractors
Phone:
-- Tniss NUN
Contractor's License # _
(attach copy of current Oregon license) the f
ibc,3ntractors:
Plumbing:
N echanical: _
(attach copy of current OR Cot. -actor's L.icenset
ArchltectrEnglneer:
Address:
Phone.
COMMENTS:
c,-z`f —S¢uu
lica Signature & Phone number
Received by: _ __ _ — Cate Received: _
Permit 4 Account Cescripticn Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
_ Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb: 1
Mech.-
Plan
ech:Plan Check (PLANCK) --
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (rIF-R)
Mass Transit TIF (T!F-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WOUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
TOTALS: