Permit '41111:
• CITY OF TIGARD S
MASTER PERMIT
DEVE SERVICES PERMIT Z 9B -0360
ISSUED: e - M ST
r
PARCEL: 2S 1 15AD-0060 0
SITE ADDRESS...:16740 SW 108•TH AVE
SUBDIVISION. • ..: W I LLOWBROOK FARM ZONING: R -4. 5
BLOCK . • . • . LOT... e e .. o • ....:030 e4> JURISDICTION: TICS
ReMarks: Repair to an existing accessory building.
BUILDING _- - - - --- ------ - - - - --
REISSUE: STORIES : 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS - -- REQUIRED-------------
CLASS OF WORK.:REP HEIGHT 15 FIRST....: 0 sf GARAGE • 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT : 0 PARKING SPACES: 0
TYPE OF COMST.:5N • DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT...,.....: 20
OCCUPANCY GRP.:R3 BORN: 0 BATH: 0 TOTAL - -- ; 0 sf VALUE..$: 100 "i' REAR • 0
SINKS • 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: 1 CATCH BASINS..: 0
TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER 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
FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS : 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS : 0 WOODSTOVES • 0 GAS OUTLETS...: 0
- ---- -- ------ -- - - -- --- - --- -- -- ELECTRICAI ----------------- -- - - - ----
-- RESIDENTIAL L4NIT - -- - -- SERVICE /FEEDER -- -- TEMP SRVC /FEEDERS -- ---BRANCH CIRCUITS --- -- MISCELLANEOUS - - -- —ADD'L INSPECTIONS- -
1050 SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp..: 0 W /SVC OR FDR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L'500SF.: 0 201 - 400 a ®p..: 0 201 - 4091 app..: 0 1st 14/0 SVC /FDR: 0 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 0 401 - 600 acp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL /PANEL...: 0 IN PLANT • 0
MANF HM /SVC /FDR: 0 601 - 1020 app.: 0 601 +aops -1000 v: 0 MINOR LABEL -10: 0
l000+ amp /volt.: 0 ----------------- ---- - --- -- PLAN REVIEW SECTION - - - - -- _---
Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR) =225 A.: ) 600 V NOMINAL: CLS AREA /SPC OCC:
-- — - - - - -- ELECTRICAL - RESTRICTED ENERGY .-------- - ----- — - --
A. SF RESIDENTIAL----------- ---- -- B. COIERCIAL _--- -- - - -- - ------------------------------------------
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM INTERCOM /PASING: OUTDOOR LNDSC LT:
BURGLAR ALARM,: OTH: .. BOILER..,....,.: HVAC • LANDSCAPE /IRRIG: PROTECTIVE SIG{.:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL • OTHR: ..
HVAC DATA /TELE COMM.: NURSE CALLS • TOTAL # SYSTEMS: 0
Owner: -----------------------------------Contractor: - - - -- TOTAL FEES :$ 168.36
NICHOLAS SICHENZIA NICHOLAS SICHENZIA This permit is subject to the regulations contained in the
3350 UPPER DRIVE 3350 UPPER DR Tigard Municipal Code, State of Ore. Specialty Codes and all
LAKE OSWEGO OR 97035 LAKE OSWEGO OR 97035 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
• Phone D: Phone R: 636 -3172 not started within 180 days of issuance, or if the work is
Reg C..: 000000 suspended for pore than 180 days. ATTENTION: Oregon law
- -- -- - - - - -- ---- -- --------- --- - -- requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952-001-0080. You nay obtain copies of these rules or
direct questions to OUNC by calling (503)246-1987.
--------------------------------------------------------- _ REQUIRED INSPECTIONS -------------------------- - —_____ - - - - --
Erosion 844 -8444
Fraaing Insp
Rain drain Insp •
Building Final
Issued Eby: 1L ' — P'ermittee Signature :`4b14-eeeV /
.• F° W- 1-- W-I--W�••- I- •4 ••�' -i--i- r���__}•• 1-- r•- W- hr- W- W- I°- I- i• i-' W^ W- i--...{ h• i-- I-- i-•§•- h.{.. �... �.- �-- h- P•-F•� ^- 'r.- i.- W-I• ^W•:- �-•i•• � - i-•W- r- r- t•-F._ .(-- W'W•t--'r -W �--r'I• -I - -i-
Call 639 -4175 by 7:00+ p.m. for an inspection needed the next business day.
Plan Check • 1 —. IV
CITY OF TIGARD Residential Building Permit Application
Rec'd By /I
131 SW HALL BLVD. New Construction Additions or Alterations Date Rec'd i - ' i
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. !o qY--
V 503- 639 -4171 9.—//— �i l � Date to DST y��v9' i ,, .t/
F 503 - 684 -7297 n t " Permit # fSjQ 9
� Print or Type Called 6
) 1,1 Incomplete or illegible applications will not be accepted 'A ",'" t -,dit'
cA \''
,e'l "I 4-c oW,624‹ 69,2/-4 '-r 3 ''
Name of Project CcorrA E Name /
a
Job ' "rsISLI 1( Mailing Address
Address Site Address Architect g /
� ` "- 510, 1 AVE., City/State Zip Phone
Name j ,}Lj o Il x G,I/ 14�1A ,
Owner Mailing Address ✓1`r , y Name
City/State it�Gate Phone Engineer Mailing Address
General Name 6,931340 City/State Zip Phone
Contractor CAA1C-[L Describe work New 0 Addition 0 Alteration 0 Repair 0
Mailing. Address 6 to be done: REPA112 C-1ST ACCESS6R�J
Prior to permit t , Additional Description of Work: - 3 t...p
issuance, a copy City/State Zip Phone ctopea. f4 IR(t -n ;:i7V(L4 (I•it5
of all licenses
are required if Oregon Const. Cont. Board Exp. Date PROJECT ,�-�
expired in
n COT Lic.# VALUATION $ / (� 9•00 •
Mechanical Name NEW CONSTRUCTION ONLY:
Sub- Ntia Sq. Ft. House: Sq. Ft. Garage
Contractor Mailing Address
Prior to permit Corner Lot YES NO Flag Lot YES NO
issuance, a copy City/State Zip Phone (check one) (check one)
of all licenses Restricted Audio /Stereo Burglar
are required if Oregon Const. Cont. Board Exp. Date Energy System Alarm
expired in COT Lic.#
database Installation Garage Door HVAC
Plumbing Name Opener Systems
Sub- Now (check all that Other:
Contractor Mailing Address apply)
Will the electrical subcontractor wire for all YES NO
restricted energy installations?
Prior to permit City/State Zip Phone Has the Subdivision Plat recorded? N/A YES NO
issuance, a copy
of all licenses are Oregon Const. Cont. Board Exp. Date
required if Lic.# Solar Compliance
expired in COT (Calculation Attached)
database Plumbing Lic. # Exp. Date I hearby acknowledge that I have read this application, that the •
information given is correct, that I am the owner or authorized
Name 0.0.1, agent of the owner, and that plans submitted are in compliance
Electrical I�+'®Mi��'' t[� with Oregon State laws.
Signature of Own-r /Agent A g ate
Sub Mailing Address / / •
Contractor Contact Person Name _ P - one # 1
City/State Zip Phone MK-140144c, ctC- t - _ /1Z l A 0'3 4 -
Prior to permit FOR OFFICE USE ONLY:
issuance, a copy Plat #: Map/TL #:
of all licenses are Oregon Const. Cont. Board Exp. Date ,S / /gX -.04 j}
required if Lic.# Setbacks: Zor 5 Solar: , /g /I
. expired in COT 7 7 . ` ,
database Electrical Lic. # Exp. Date
Engineering Approval: ga ytn �prpval: CIF:
y C rail/kV rJ1�2�'t:
5 I SFREM.DOC (DST) 4/97
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Permit #: MS7 '-) 0 6 0
or
A �' Address: /� 7V4 Set �v d' �V
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Issued by: " Date: 0,/9-,p)
�, 859 /
Statement: Information Notice to Property Owners
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
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),
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:
w pi 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.
1-7 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.
OR
p - I 3B. I will be my own general contractor.
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
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.
/
Cet � , 7 / 'Jg
of permit applicant) Date
(Signature P PP ) ( )
(White copy to issuing agency permit file,
pink copy to applicant)
` .
lInfor 0aden Notice to Propey Owners
@Jbm`u8ConstrucUci Respone^NHies
Note: This information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5)^
If you are acting as your own contractor to construct a new home or make a substantial improvemert to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLI)VER RF,SPONSEVLP77E-2:
If 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 he an mployer 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 1ax: 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 Cregon 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 ontbe'oh. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. fmternal 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 Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBLIMES AND AREAS OF COMCERM:
Code compliance: As the permit holder for this p ject, 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
accident.; 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.
Expe ise: Make sure you have the expertise to act uu your own general contractor, to coordinate the work of rough-in and fio\mb
trades, and to notify building officials at the appropriate times so they can perfoi in the required inspections.
If you have additional questions, write or call the Construction Contractors Board (P0 Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
\/94
•
6/19/00 Activities for Case #: MST98 -00360 . ��
1:44:07 PM • N
Assigned Hold Updated ►
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA005 Application received 8/5/98 BON RECD GEO 8/6/98
MSTA008 Permit Created 8/6/98 GEO DONE GEO 8/6/98
MSTA010 Check for prcl. restrict. 8/6/98 GEO DONE GEO 8/6/98 Planning approval per MJ
Roberts per 18- 132.3C.b on
8(5/98.
MSTA012 Plans routed to Plans Examiner 8/6/98 GEO SENT GEO 8/6/98
MSTA026 Plans approved by Pln Examiner 9/11/98 RT PASS BT2 9/11/98
MSTA030 Reviewed plans routed to DSTS 9/14/98 JHF APPR JHF 9/14/98
MSTA032 DST Post - Review Completed 9/14/98 GEO DONE GEO 9/14/98
MSTA700 Erosion 844 -8444 GEO 8/6/98
MSTA725 Framing Insp GEO 8/6/98
MSTA752 Rain drain Insp GEO 8/6/98
MSTA799 Building Final GEO 8/6/98
MSTA080 (F) Ready to issue 9/14/98 GEO PASS GEO 9/14/98
MSTA092 (F) Issue combination permit 9/18/98 DLH DONE DST 9/18/98
MSTA095 Issue plumbing signature form 9/18/98 DLH DONE DST 9/18/98
MSTA770 Misc. Inspection No Hold JMT 9/13/99 9/13/99 phone call. "accesssory
building not on septic and not
on sewer ". caller did not leave
name. Jeanne
MSTA770 Misc. Inspection 2/23/00 2/23/00 2/23/00 JMT DONE No Hold JMT 2/23/00 research inspection request
MSTA153 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
•
1 Page 1 of 1 ti i
s
12/1/2005
Case Activity Listing 11:04:29AM
TIDEMARK Case #: MST98 -00360
COMPUTER SYSTEMS. INC
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
MSTA005 Application received 8/5/1998 None RECD BON 8/6/1998
GEO
MSTA008 Permit Created 8/6/1998 None DONE GEO 8/6/1998
GEO
MSTA010 Check for prcl. 8/6/1998 None DONE GEO 8/6/1998 Planning approval per MI Roberts
restrict. GEO per 18- 132.3C.b on 8/5/98.
MSTA012 Plans routed to Plans 8/6/1998 None SENT GEO 8/6/1998
Examiner GEO
MSTA026 Plans approved by Pln 9/11/1998 None PASS RT 9/11/1998
Examiner BT2
MSTA030 Reviewed plans 9/14/1998 None APPR JHF 9/14/1998
routed to DSTS JHF
MSTA032 DST Post - Review 9/14/1998 None DONE GEO 9/14/1998
Completed GEO
MSTA700 Erosion 844 -8444 None 8/6/1998
GEO
MSTA725 Framing Insp None 8/6/1998
GEO
MSTA752 Rain drain Insp None 8/6/1998
GEO
MSTA799 Building Final None 8/6/1998
GEO
Page 1 of 2 CaseActivity..rpt
12/1/2005
Case Activity Listing 11:o4:29AM 9AM
TIDEMARK Case #: MST98 -00360
COMPUTER SYSTEMS, INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
MSTA080 (F) Ready to issue 9/14/1998 None PASS GEO 9/14/1998
GEO
MSTA092 (F) Issue combination 9/18/1998 None DONE DLH 9/18/1998
permit DST
MSTA095 Issue plumbing 9/18/1998 None DONE DLH 9/18/1998
signature form DST
MSTA770 Misc. Inspection None 9/13/1999 9/13/99 phone call. "accesssory
JMT building not on septic and not on
sewer ". caller did not leave name.
Jeanne
MSTA770 Misc. Inspection 2/23/2000 2/23/2000 2/23/2000 None DONE JMT 2/23/2000 research inspection request
JMT
MSTA153 Expired by limitation 6/7/2000 None DONE HAP 6/7/2000
AKJ
Page 2 of 2 CaseActivity..rpt
Tidemark Advantage [Waidi Olopade - WO] 1
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Master Permit -- MST98-00360 Status X . , '
Name: NICHOLAS SICHENZIA Updated: 911811998 DST I General A . 1.44'5,‘; ' ,,„, # ' ''' • 1 , sp-,i
1 I IFZ...1
Address:16740 SW 108TH AVE Jur: E ----- , nrel EM
Description: Master #1PLM97-00074 Project:: ILLOWBROOK FARM Bui/din ili
Repair to an existing accessory building. 1
Mechanical
,.....
City Contact 1 Plumbing II!'
Reissue:
,_. .
Class of Work: IREP D ates Electrical
El
Received: 8/6/1998
Type of Use: !SF 1
.___ Target: Electrical a
Type of Construction: ,N
r ----------- Issued: i3/18/1998 IOL
Occupancy Group: 1R3 r ,
E pi/17/1999 ----- Restt'lcted ' '
Total Valuation: I $10,000.00 _, _ Elecrical , Mi
Finaled: 1 ' Reclderttial M/
sE
E LC2005 I 16740 SW 108TH AVE MAY MART H)
: PLM2005-00294 I 16740 SW 108TH AVE MAY -.I
MAY l'*4/ C)
i 4r 1 8
Ready
.1 start. Tidernark -d'iar-ita- `‘,,,•'.., Novell t3roLici'kitlise ,,, g < ' 11:04 AM