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w PTz03tGT MR,' JIM MARIA FOWLER
-brr� NAr� . a Avy oN
bC,AL%: i e)i35 SW ! M ANC" a CT
'NPA O I OV- q 7z24 Monk'. G2 -
OeL 4LSON C4 TR-VCw 'T` IaN
8435 SW La Mancha Court
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection line: 639-4175 Business Phone: 639-4171 c
Footing Rain Drain Cover/Service " a
Foundation Water LineCeiling -Plumb. '
Post/Beam Mech. Shear/Sheath Framing r'-'w@MD►,
` Plbg.Und/Fir/Slab Plbg. Top Out Insulation Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd,
San. Sewer Gas Line Appr/Sdwlk Reins.
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Address:
Tenant: —_, —D/
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CITY CIF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Busioess Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb. ,
Post/Beam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Fir/Slab Plbg.Top Out Insulation Elect.
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San. Sewer Gas Line Appr/Sdwlk Reins.
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Address: f
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i Inspection Line: 639.4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach, Shear/Sheath Framing -Meth.
Plbg,Und/Flr/Slab Plbg.Top Out Insulation Elect
Pw t,Beam Struct, Mech. Rough-in Gyp. Bd. Id ,
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THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _
Inspector: Date: 73
_._-APPROVED —D ROVED/CALL FOR REINSP, CF CO
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Inspection 'ne: 639-4175 Business Phone: 639-4171 r ,�'}„'� . .M
Footing Rain Drain Cover/Service FINA
Foundation Water Line Ceiling -Plumb.
P sUBeam Mach. Shear/Sheath Framing Mach.
PIbg.Und/ r ab Plbg.Top Out Insulation -Elect.
sUBeam Mach. Rough-in yp. Bd
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Date: � S A.M -,_P.M. Entry: 4s'�, ""r •
Address: -� — -- I r�'��' aiu�iyV.
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Inspection Line: 639-4175 Business Phone: 639-41711
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CITY OF TIGARD BUILDING INSPECTION NOTICE
I%pection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover,'Servic > FINAL:
Foundation Water Line Ceil,ng -Plumb, IY
Post/Bean1 Mach. Shear/Sheath --Ff min n:0 Mach.
rlbg.Und/Flr/Slab Plbg.Top Out ` ion 1� -Elect.
P r _ Mech. Rough-in Gyp. Bd. -Bldg.
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Inspection Line: 639-4175 Business Phone: 639-4171fe '
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Footinp Rain Drain Cover/Service FINALAl
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Post/Beam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line ,P,ppr/Sdwlk Reins. ;�yt,�;^
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Address:
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THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR.
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CITY OF TIGARD MASTER FERMI ,
y r'[:R11I1" it . . . . . . . . MST96-01 I9
COMMUNITY DEVELOPMENT DEPARTMENT DAFE ISSUED: 04 1896
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171
1::IARCH=1_: ._'S 1 —06100
S I 7 E. ADDRESS. . . . 084::33 SW I_A MANCHA CT
SUBDIVISION. . . . : L.A MANCHA Es-FATES ZONING: R-4. 5
BLCICIC. . . . . . . . . . : LOT. . . . . . . . . . . . . : 14
Remarks: ADDING FAMILY WOOM 368 SO FT PATH I
---•----------------------------------------------------------- BUILDING ------------------------------------------
REISSUE: STORIES.......: 1 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS- REQUIRED-------------
LLASS OF WORK.:ADD HEIGHT........: 13 FIRST....: 368 sf GARibZ.....: 0 sf LEFT..........: 0 SMOKE DETECTRS:
TYPE OF USE...:SF• FLOOR LOAD....: 40 SECOND..,: 0 sf FRONT.........: 0 PARKING SPACES: 0
TYPE OF CONST.:SN DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 5
OCCUPANCY GRP,:R3 BDRM: 0 BATH: 0 TOTAL------: 368 sf VALUE, f: 233795 REAR..........: 0
--------------------------------------------------------------- PLUMBING --------------------
9INK5.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.; 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES,...: 0 DISHWASHERS..,: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: 0 GARBAGE DISP..; 0 'DATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0 ■
OTHER FIXTURES: 0
---------------------------------------•--------------------•--- MECHANICAL -----------------------
FUEL TYPES----------- FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS...,.: 0 CLOTHES DRYERS: 0
/GAS/ / / FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS....,....: 2 WOODSTOVE.S....: 0 GAS OUTLETS...: 0
----------------------------------------
--------------------- ---- E'ECTRiCAL -----------------------------------------------•----------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS--- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- •--ADD'L INSPECTIONS--
1000 SF OR LESS: 1 0 - 200 amp.,: 0 0 - 2v0 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRiCATION: 0 PER INSPECTION: 0
99 EH ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY,: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA AD►L 24 CIR: 0 SIGNAL/PANEL.,.: 0 IN PLANT......; 0
MANc HM/SVC/FDR: 0 601 - 1000 amF.: 0 601482ps-1000 v: 0 MINOR LABEL -10: 0
" 1000+ amp/volt.: 0 -----• -------- --- -------- --- PLAN REVIEW SECTION -----------------------•-------.--
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Reconnect only.: 0 >=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC JCC:
------------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY -------------•-------------------------------•--------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL------------------------------------------------------•------------------------ ,
AUDIO 6 STEREO.: VACUUM SYSTEM..: AUDIO b STEREO,: FIRE ALARM,...,: INIERCOM/PAGING: OU DOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC...........; LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE QDENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........; OTHR:
HVAC...........: DATA/TELE COMM,: NURSE CALLS....: TOTAL. # SYSTEMS: 0
Owner: ----------------------------------Contractor: ----------------------------- TOTAL FEES:$ 421.41
JIM FOWLER DEL OLSON CONSTRUCTION CO
08435 SW LA MANCHA CT P 0 BOX 4979
TIGARD OR 97224 POPTLAND OR 97208
Phooe #: 620-5166 Phone #: "
Rea C.: 049381
This permit is issued subject to the regulations contained in the Tigard Municipal Cede, State of Ore. Specialty Codes and all other 9
applicable laws. All work will be done in accordance with approved plans. This per n t will exprn: if work 1s not started with?; 180
days of Issuance, or if work is susperded for more than 180 days.
---- ---------------------------------------------------- REQUIRED INSPECTIONS -------------------
Footing Insp Mechanical Insp Rain drain, Insp
Foundation Insp Electrical Seri Electrical Final
Post/Beam Strurt Framing Insp Mechanical Final
Post/Beam Mechan Insulation Insp Building Final
Crawl Drain Gyp Board insp Erosion Control `�---
l'��r mi. ti;ee SignKkti_tre : � X . _ 1s 1.red k1Y :
C=-111 for- inspection - 639--417 ;
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Resident Building Permit Application u-tb
City of Tigard
13125 SW Hall Blvd. -I$ha�
Tigard, OR 97223 -7Q x Lo f ; 06 /00
(503) 639-4171 15[ n
Jobsite Address: h4.�C- �SS,O L.
Office Use Only �
Suhdivision: ,�_,i /%lot lic, Mate- Lot# j'>l
Contact Date _ / / -Initials
Valuation: ��� �79�1. F� Result
New Construction Only: (Square Footage) Planck/Rec # 4
Permit #
House: _ ,� !+ Garage: i_ Reissue of A"'1A
Map & TL # �"� Ilc�(�C - �'�1�i° �
Corner Lot? Y N) Flag Lot? Y Zone ,e Li•s
�^ Plat # c 3- -
Owner: 1 i'121 w � ,-,n �7Jui��r --� �i.•.. ;1 t oe<
Approvals Required
Address. x .35 ,5�� xa.
Planning Setbacks Solar s4A
_ /ie:,•.1 � CL �57� Engineering _�r
—� Other _
Phone: j S�3 ) lr. o S1(.k f
Items Reg_uired
Contractor: J11 fel un sf, , �},�,-, Cy__
Subcontractors
Addre3S: ) 9 79 — Truss Details
Other
Notes/C7 �
Phone: 1 Sl�� ) _�38 �R�a jy� 77y�
Contractor's License #
(attach copy of current Oregon license)
Contact Name: DICE,,
Contact Phone:
Subcontractors: Arch+tectiEngineer: A/+ _
Plumbing: NA JF,G9''j" Address:
Mechanical:
(at' vch copy of current OR Contractor's License)
l 1, , i �,,I : _.� ?nr., Phone: ( )
JOB DESCRIPTION: 008 &jr1j. (r ' (o
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Applicant Signature ApNucant Phone number
Received by: _ �a_ Date Received: 9,9
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Permit * Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) �•'Y� �1�' ��DY' S�
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_ Plumb. Permit (PLUMB)
I -
Mech. Permit (MECH)
State Tax (TAX)
Plumb:
Mech: _�' LS, _
Ce C o
Plan Check (PLANCK )
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Bldg:
Plumb:
Mech:
f�
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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 (T1F-1) _
Institutional TIF (T!F-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
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Erosion Planck/USA (ERP LAN)
Erosion Pl.inc!JCOT (EROSN)
TOTALS:
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Permit#:
Address: yT35 SW LA MAlyCHA
Issued by: J `�d��D ate: tJ✓Z7�(O
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Statement: Information Notice to Property Owners
. w, About Construction Responsibilities •
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
t cants who are not registered with the Construction Contractors Board to sign the ■
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
rpt f}�y•;
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
® 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
_, ❑ 3A. My general contractor is —
` (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.
t: I OR
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3B. I will be my own general contractor.
h' If I hire subcontractors, I will hire only subcontractors registered with the Construction 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
A,
name of the contractor.
' + I hereby certify that the above information is correct and that I 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,
pnk copy to applicant)
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Information Notice -to Property Owners
About Construction eesponsibilities
Note: This Information Notice to Property Own:.-s about Constructim Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(511.
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 PIESPONSIBILiTIES:
If you hire persons not registered with the Construction Contractor, 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 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 Dept.of Revenue at 945-8091.
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 at the Department of Human Resources
at 378-3524.
Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compe:,sation Law,and mint
obtain workers'compensation insurance for your emplc;tees. 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 informal ion,
call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888. r
U.S.Internal Revenue Service: As an employer,you must withhold federal income tax from employees'wages. You will he
liable for the tax payment even if you didn't actually withhold the tax. For more information,call the internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Cale compliance: As the permit holder for this project,you are responsible for resolving any failure to meet code 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
re-done. '
Time to 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
tr.ndes, 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 Bomd(PO Box 14140,Salem,OR 973109-5052,
503/:78-4(,21). The Board is located at 700 Summer St. NE Suite 300,in Salem.
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