Permit _ • /'
I -'_IdI 1. t 'c�. n o o n u r 04, 1.7;J"_�!u}"7 �
. COM�IVIUNITY DEVELOPMENT DEPARTMENT'. Df�T IUED f�8 / 1 / /, . •
' 13126.S1N' "Bl Tigar ; Oregon 97223 A5
• .� , • • PARCEa_.:o rl. re- kz10tf.' - •
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•
CITY 13125 sw H,n Bl PLNCK/RECT # - / 7/� • _ OF TIGA1R1D T 97223
PERMIT # 115 O i l '
COMMUNITY DEVELOPMENT DEPARTMENT
(503) 639 -4171 DATE ISSUED
JOB ADDRESS: I D Z OD SW Aliedi p S% TAX MAP /LOT a S 12 BB - o& 5 -Po
SUB: LOT: LAND USE: R - 5:91e 5
,‘„ y Ref.
VALUATION: C o,
OWNER / / 1 �/ SPECIAL NOTES
NAME: /\ / e h /I S v //vet` REISSUE OF:
ADDRESS: ) 2 3 "7,6 SW 1,2 `l/ LAST REISSUE:
• ?Oop 6,q FLOOD PLAIN
PHONE: 1 /3- 92. ES . i 6 6 � ty SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
A J -/-ei 0-q i� ti,— w 0 i s / PLANNING: i 1aiore5 OZ W/O MAI1 /0 -
NAME: 190 �
ADDRESS: ^ _=
A � � _ . _ Lgify ENGINEERING:
1 f CAP eli I . FIRE DEPT:
?HONE: „fie/ 0 R- q '7 32.-. OTHER: -cif'
CONTR. BOARD #: 3 32. EXP 0 /0 7/ i t3
V ITEMS REQUIRED ,/
SUBCONTRACTORS: PLUMB: LIST /SUBCONTRACTORS: fiat
MECH: • BUS TAX: -
ARCH4ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: OTHER: 's-
fPPUCAAv1 #71•5 a-V ,4 6 1)r
PHONE • 4()t 7o s�PPIY F04 re----)066c PG? �+� r
Moe- gc -GmG� Q6CE/v /ML- A- 3 /dg
ra iiig ADD i 9in/`
PROPOSED BLDG. USE: -1I S L1 P 4t) ( P111 s l , eahtet: wilt/ G( G0r+- .- `` •
COMMENTS: /7, <j. , .
- i p■._•• - - / L
/
APPLICANT SIGNATURE
Received By:. __ Date Received: 1 ^C -
•
PERMIT II ACCT # DESCRIPTION AMOUNT AMOUNT P0. BAL. DUE
/71$H1. 10 -432 00 Building Permit Fees /US .41W- / 05.
10 -431 00 Plumbing Permit Fees S 0'7
10 -431 01 Mechanical Permit Fees " Z 0
10 -230 01 State Building Tax (5 %) •r-‘
Building
Plumbing , 1 5
7
Mechanical
10 -433 00 Plans Check Fee
Building �
Plumbing
Mechanical
10 -230 06 Fire
56, 9i -OPy 30 -202 00 Sewer Connection 22-60 /
30 -444 00 Sewer Inspection
25- 448 -02 Commercial TIF Fees
25- 448 -04 Industrial TIF Fees
• 25- 448 -06 Institutional TIF Fees
25- 448 -03 Office TIF Fees /
25- 448 -01 Residential Traffic Fees /17/0 /y /o /
25- 448 -05 Mass Transit TIF Fees // d
52 -449 00 Parks System Dev Charge (POC) S U ti 37)
31 -450 00 Storm Drainage Syst Dev Chrg / 126 160
(SSDC) 0
24- 445 -01 Water Quality (Fee in lieu of)
24- 445 -02 Water Quantity (Fee in lieu of)
TOTAL f73 ?. ?{ 5 71 /6 , a���
nm/3587P.WPF .
0 F ,, Permit No:
i. Address:
a , • "it • z Issued by: Date:
■ 5 � . FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. LIB 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 o„ - 'on.
3. A . I I My general contractor is AV
,
rte"
Contractor registration number .
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B WM I w be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do 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 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.
O
Signature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91 -
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(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 RESPOtfSOBOLITIES:
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 be an
"employer" and the people you hire wifl 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 Department of Revenue at 378 -3390.
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 DHR
at 378 -3224.
Workers' Compensation Insurance: As an 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, 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 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 221 -3960.
•
OTHER (RiIESPONSO f UTEES AMID AREAS OF COO \fCERM: -
Code 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 punc-
tures, 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 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
Phone 503 - 378 -4621
0244J 10/24/89
rilj,
CITY OF TIGARD
7EGCM4)
VOLUNTARY COMPLIANCE AGREEMENT
I, Kenneth Tolliver, do hereby agree to provide at least one on-
site covered parking space and one additional on -site parking space
for the manufactured home to be located at 10200. SW Kathreine
Street in the City of Tigard within 90 days of the issuance of the
Certificate of Occupancy.
I understand that if I fail to satisfy the terms of this Voluntary
Compliance Agreement I may be subject to receiving from the City of
Tigard a Notice of Complaint and a Summons to appear in court and
that I may be fined up to $250.00 per day for every day the
required on -site parking, as described above, is not provided.
1 g7/ /r3
Signature Date
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
Page No. 1 LOG NOTES FOR CASE NO.: MST93 -0447
KENNETH TOLLIVER
10200 SW KATHERINE ST
12/08/98
By Date Text of log note
JT 04/28/97 on 4/9/97 ken tolliver responded, in writing to inactivity
letter. through site visit by Rick Bolen and several
conversations with David Scott; no one is using the addition so
an extension is granted until October 1, 1997. However, there
is no extension granted for this permit for manufactured
dwelling or the electrical permit. According to Rick, there is
someone living in manufactured home.;;Contacted Mrs. Toliver this
date. Told her extension for addition was granted. She must
call for an inspection of electrical and manufactured dwelling
within two weeks of this date. Gave her the 24 -hour number.
•
Page No. 1 CASE HISTORY FOR CASE NO.. MST93 -0447
KENNETH TOLLIVER
10200 SW KATHERINE ST
12/08/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
MSTA007 Application received / / / / 08/09/93 PASS JLH 10/19/98 TLP
MSTA010 Plan check deposit paid / / / / 08/09/93 PASS JLH 08/16/93 BLT
MSTA020 Plan check by 08/16/93 / / 08/16/93 PASS RT 08/16/93 BLT
MSTA030 Check for prcl. restrict. / / 08/16/93 08/16/93 PASS VG 08/16/93 BLT
gSTA092 (F) Issue combination permit / / / / 08/17/93 PASS JLH 08/17/93 JH
MSTAl25 PERMIT EXTENSION REQUEST / / / / 07/22/97 PER DAVID PERMIT EXTENSION FOR MFG FAIL JT 07/22/97 JT
tih DWELLING, DENIED MUST HAVE INSPECTED BY
MAY 1997. SEE RICK'S 4/16/97
INSPECTION. LETTER WAS RECEIVED ON
4/9/97 TO REQUEST AN EXTENSION ON
ELC95 -0661, MST93 -0447, MST93 -0448.
DAVID WANTED TO KNOW IF SOMEONE WAS
LIVING IN MFG, SO THAT'S WHY RICK DID
THE OBSR /SITE VISIT. DAVID ALSO TOLD ME
THAT THEY MUST NOT BE USING THE
ADDITION. RICK CONFIRMED, NO THEY ARE
NOT (4/16/97), "IT'S STILL OPEN FRAMED."
JT
MSTAl25 PERMIT EXTENSION REQUEST / / / / 11/25/97 Upon receipt of letter of agreement to PASS HAP 11/26/97 JT
finish work and have final approval of
this permit within 6 months
(May29 -97), this permit is extended
until that date The owner agrees to
pay full fee reinstatement or reissue if
not complete by 6 -29 -97 (See letter in
file)
11/25/97 letter received from
K.Tolliver, to confirm above
conversation; agrees to provisions.
MSTAl27 PERMIT EXTENSION REQUEST / / 01/01/96 08/11/95 extend till 1/9/96 APPR DS 08/11/95 DS
MSTA705 Foot /found Insp / / / / 08/27/93 SEE REPORT PEND RB 08/27/93 RB
MSTA735 Gas Line Insp / / / / / / 08/16/93 BLT
MSTA755 Rain drain Insp / / / / 09/15/93 need to drop water down before you exit FAIL MS 09/16/93 MRS
valve box
MSTA760 Water Line Insp / / / / 09/21/93 PASS MS 09/21/93 MRS
Page No 2 CASE HISTORY FOR CASE NO MST93 -0447
KENNETH TOLLIVER
10200 SW KATHERINE ST
12/08/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
MSTA770 Misc. Inspection / / / / 04/16/97 observation inspection- OBSR RB 11/25/97 J *H
exhaust venting at bathroom, collar tie
ridge rafters,
egress windows req'd
see note on MST97 -0448
MSTA775 MFG Home Set -Up Final / / / / 09/29/93 MARRIAGE LINE OK PASS RB 03/24/98 TLP
MSTA795 Mechanical Final / / / / 09/24/93 SEE REPORT - MANUFACTURED HOME FAIL RB 09/27/93 RB
MSTA797 Plumb Final / / / / 09/24/93 SEE REPORT- MANUFACTURED HOME FAIL RB 09/27/93 RD
MSTA799 Building Final / / / / 09/24/93 SEE REPORT - MANUFACTURED HOME FAIL RB 05/28/98 TLP
MSTA799 Building Final / / / / / / 10/19/98 TLP
MSTA799 Building Final / / / / 10/19/98 PASS TLP 10/19/98 TLP
MSTA970 Case Finaled / / / / 10/19/98 PASS TLP 10/21/98 J *H
MSTB706 Erosion Control / / / / / / 08/16/93 BLT
MSTE770 Misc. Inspection / / / / 03/27/98 - heel rock separation completed. MEMO TLP 05/28/98 TLP
Building final approved on addition
only.
see Hap's extension note of 11/25/97
MSTE770 Misc. Inspection / / / / 05/28/98 NOTE TLP 05/28/98 TLP
OWNER CALLED DRIVEWAY NOT INSTALLED
NEEDS 90 DAY
EXTENSION TO POUR DUE TO FOUL
WEATHER
MSTE775 MFG Home Set -Up Final / / / / 10/19/98 driveway okay PASS TLP 12/08/98 JT
street opening permit was acquired
see log note
MSTE960 (F) Issue Cert. of Occupancy / / / / 10/19/98 12/08/98 JT
fl tA
�i CITY OF TIGARD BUILDING INSPECTION DIVISION
Aredd , /4,41,.7 lc)
l ') 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: / . . � ' 9 (5 A.M. (• P.M. MST: C 73 3 -O 4 (1. 7
Location: l d . ii hei m.e,) , ,#/77p: q3 -- 0 s 7
Tenant: ��//,,� � ,, �I Suite: / p Bldg: MEC:
Contractor: K-0A1 . kie C L�e.JL. J Phone: & it `- 0 PLM:
Owner: ELC:
I Phone: _ `� � �
ail_ 12 '4?U.�i emit.de? L. , ELR:
(SP- 1'Z442.. /110- d L GL :MS7?3 -qt- /j) SIT:
BUILDING <BLDG (con't) PLUMBING 4/ MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
"I Masonry Ceiling Rain Draiin. A/C UG.S1ab.,
Shear /Sheath Fire,._ Crawl/Found Dr , Heat Pump Low Volt
�;,� pr oved
A Approved ; a Approved Approved Approved
r /Sdw .—
pp �p� ved Not Approved ..� Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
igil ilk tilette. kl itk S t:(itiet(e d'AzoLez04/ am Lsoaiffir:/
u � 0 u
Re 4 � i EcT7O1Lf - J// e , 4 ' /L nazi cc t-9
Co / ere-, cc % zpL, we &L
ter, , . 1 r-'e , I / T To /A C /i
. I I
5 IA. 11 d , C2 - x-e' - ' , 7-411111 Miff
. _.......... .1.-- Lir- ,
- al Lik47:M ..WINMFAMIIF
I__ err - , _________
___------ _Iii„..._ ___ ___,,....„...._ ....,
,.....
,- --....,,,
ertimmin
yiim
(\"----------__ I
O Call for reinspectio 11 ' einspection fee of $ required before next inspection CI Unable to inspect
Inspector: I ; Date: � Page of
Irrier
. .
, , -- -