Permit CullYOF TIRD ^ c t
CITYOFTWARD BUILDING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT omooN PERMIT # ° BUP92 -0280
13125 SW Hall Blvd. P.O. Banc 23397, Tigard, Oregon 97223 (503) 839 -4175
— 41 / 1 VHIt 1bbUtV: lei /1:i /9e
SITE ADDRESS...: 12099 SW LINCOLN AVE PARCEL: 2S1O2AB -00603
SUBDIVISION NO.TIGARDVILLE ADDITION AMEND. ZONING: R -4.5
BLOCK LOT •63
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION —
CLASS OF WORK.:NEW FIRST • sf N: S: E: W:
TYPE OF USE.. °:SF SECOND...: sf PROTECT OPENINGS?
TYPE OF CONST.:5N THIRD • sf N: S: E: W:
OCCUPANCY GRP.:M1 TOTAL 0 sf ROOF CONST: FIRE RET ?:
OCCUPANCY LOAD: BASEMENT.: sf AREA SEP. RATED:
STOR.:1 HT.:14 ft GARAGE...:32O sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD psf LEFT:2O ft RGHT: ft FIR SPKL: SMOK DET..:
DWELLING UNITS: FRNT:2O ft REAR: ft FIR ALRM: HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE.$: 5760
Remarks: 320 SO FT DETATCH GARAGE
Owner: FEES
RONDA WRIGHT type amount by date recpt
12099 SW LINCOLN AVE PRMT $ 56.50 JH 09/15/92 —
PLCK $ 36.73 JH 09/15/92 —
TIGARD OR 97223 5PCT $ 2.83 JH 09/15/92 —
Phone #: 503- 624 -0127
Contractor:
OWNER
Phone #: $ 96.06 TOTAL
Reg #..: 00000
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Foot /found Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Framing Insp
applicable laws. All work will be done in accordance with Rain drain Insp
approved plans. This pereit will expire if work is not started Final Inspection
within 180 days of issuance, or if work is suspended for sore
than 180 days.
Permittee Signature
Issued By: ,r
Call for inspection — 639 -4175
CIS OF TIGARD 1 3125 SW Hall Blvd. PLNCK /RECT #
['O Box 23397 PERMIT # B14
COMMUNITY DEVELOPMENT DEPARTMENT Tigard, Oregon 97223
(503) 639 -4171 DATE ISSUED
JOB ADDRESS: )2_079 W C. ,`il(r,/N Ave TAX MAP /LOT 0251 0aA.8 -006o 3
SUB: A/or1/ 7;i4,4 vi AU. ans.0),(LOT: 9 LAND USE:
VALUATION: E '760. 00
OWNER SPECIAL NOTES
NAME: LLD µ > N( 1 1 u� (1-� G \n,�� REISSUE OF:
ADDRESS: 17 ( -R W , L t a.L((,f M AV 'e LAST REISSUE:
` (5\ita a (9 2 . FLOOD PLAIN/
PHONE: S 03- (a 2-4 - & V2:7 • SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: - ( • 7 Cu 1 .e ( • PLANNING:
ADDRESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: LIST /SUBCONTRACTORS:
MECH: • BUS TAX: •
ARCH /ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: • OTHER:
PHONE:
PROPOSED BLDG. USE: Th ? 5 a P X2,14 -A
COMMENTS:
APPLICANT SIGNATURE
Received By : _ Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. "DUE
St,P4r_o2Yd 10 -432 00 Building Permit Fees 5(', SSG .5 —q
10 -431 00 Plumbing Permit Fees
10 -431 01 Mechanical Permit Fees
10 -230 01 State Building Tax (5 %) 0?-?3 �3
Building .
Plumbing
Mechanical
x
✓�Y =' _3
10 -433 00 Plans Check Fee 3/°
Building 3 673
Plumbing
Mechanical
10 -230 06 Fire
30 -202 00 Sewer Connection
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
25- 448 -05 Mass Transit TIF Fees
52 -449 00 Parks System Dev Charge (PDC)
31 -450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24- 445 -01 Water Quality (Fee in lieu of)
24- 445 -02 Water Quantity (Fee in lieu of)
TOTAL • ?‘-
nm /3587P.WPF
o F Permit No: /5241
'`' Address:
z Issued by Date:
g• 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: i•7 *Bil I own, reside in, or will reside in the completed structure.
2 . I 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 . 1 I My general contractor is
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. I will 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.
mip
Signature • Permit App ica 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 RESPONSIBILITIES:
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 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 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 RESPONSIBILITIES AND AREAS OF CONCERN:
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