Permit :CITY OF TI:i�RD . CATER PERM VI' .
- , ' • COMMUNITY DEVELOPMENT�DEPARTMENT'' ' "' - • - ;PE ;AI • #,... -° ° MS,T ',_, 04,64
, 13125 SW Hall Blvd. Tigard, Wagon ;9722348139 (503)839 -41.71 t , , , '
63,9 -4171 DATE ISSt1EU'a 07 /Al / •
.''S -1TE ADDRESS...: 11849 3W 1 PI_ •• . . _ • "PARCEL,:. 1S133DD -�i c
r90 '
,SUBD,s'v'_SI ON. ... . o VILLAGE - AT SUMNER LAKE PARK 4 ZONING l• R ;4•.,S ' • . •
1,7:.,i,CA ' • - ' •• • LOT 166 , , •
,- - - - - -- - - - - -- BUILDING - -• - - -- -- - -- - -. ---- -�____ • . R: e 13SUE ' - DWELLING UN I TS BASEMENT...., ° • •° ° ° ° : F0 . . s f • •
CLASS . OF 'WORK.: ADD BEDRMS:0. BATHS :0 GARAGE - 10 • . sf ,
TYPE OF ' USE.. u : SF . • FLO 'AREAS ' REQU I RED SETBACKS, - - •
•
T'.YPE' OF' CONST. :5N - • - FIRST - • 300 sf • LEFT.. :5 ft• RIGHT. :,0 'ft • • r OCCUPANCY G RP. a R3 • SECOND...: 0 • , s f F RONT. : 0 ft; ' REAR., . r :.34, . ft
- TOR ° 1 •THIRD° ....:0 sf REQUIRED - __- -. ' • : _ • 'S , '
i _HEIGHT... .... •. 12 ft,' • TOTAL- - X00 • 5f SMOKE -DE TECTORSe -1Y • ' . •
' FLOOR LOAD • 40 ps f VALUE.' _ i a - 13800 ' PARK , SPACES.. 0
• ;Re ill ar'ks I - ADDITION' 300 SO- FT PATH I• ' ' . . , . , . , -,,
SIN!.-S8.1. - ' • q i • • ' - - FLOOR DRf%INS.•.. ° s 0 " ' BACKFLOtn1'•F?REVNTRS :. :0 ,
{ •
LAVA' LAVA1 ORIES ''0 ;WATER HEATERS. ..:0 - ' •, ' TRAPS "'• ' • ' :0 • , • •
r Z /.$1-,OW9;RS. .. :0 LAUNDRY TRAYS...:0 ' ' CATCH, BASINS °0t • • . , •
WATER CLOSETS.. ; 0 . SEWER LINE (ft) .:0 _ GREASE • TRAPS • , • 0 .
DTzii;iWP.3HERSe - • •WATER LINE (ft). e0 OTHER' F I X TURES °4T ,
GARBAGE• D,ISP..,.:0 - ReIN DRAIN (ft ).:0 ' - t• ••
WA aH INC -ir71" ct.1.; °.02.__ ' _ _SF__RA IN DRA_x ��S. � ! ._— -- —
. — . . , , __ - J MECHAN I -CA - -- - • - - -- - - �� EES - - - -• - _ = - • � _ .�
F`
U • TYPES UNIT HTRS.. ;lZ , type • amount,- . by' date' recpi; -_ _ ••
/: - ,f'' . '/ ,.1. VENTS S •• r - -0 - , B3PR'(' 8 31, 4. 50 JH 07/06/93. 7 '
• :14- -gin :4 ' P• UT•s'4'.• , -on:: VENT :FANS....: 0 • - BPL_G' $; '6 T. 93: J?-i 07—/OS 19:3 - • - • ' • I='ti ' < ,100K• .. ii 0 . • - • HOODS:'r - :, 1 : , i° : 0 ' • B5PC ± 2 •
' - 5. _ s• ' Jhl ' :. 07/061/3 -• - . ' ,-'
'I- URN, ) = "..akjt V . . WOODSTOVEL`'::%•0 t .)_ • . , - - ..
. FLOOR FURN.. :•0 , ' 'CLO DRYE,FRS. o ' '0. ' - -
I , • t O r'L / i;MP < 3.HP .O ' , ti '
. OTHER L1N IT5;>Z +' .
, • _ GAS • OUTLETS ^, - - , •
`i 'RI IY ',C`OURSOLLE'- • , _ .. ' '
7 11 3; ' L W 1 fH •PL ,
1 GA'qD OR 97rr_;J3
• PI `'#P: c51,13-5p4-74Z.:27 ` - . . • 4. , ' • C&ritract or.: _.__.._____�._ _.._ _ ` . • • ,
Phone : '
�� e, g #...s.: . X101 00 - - -_ _ _ ----- __ • ' - ' • . • • $ 177.:66 TOTAL •
i t -
•,'' This ,pernit ,is issued; subject to the regulations contained in, 'the, - ' ' ' RECUT RED; INSPECTIONS -• -•- ' - •
•`' •73ca >iunicipal'Code State of hr•=e. Specialty Codes and ail. other , '' '•Foot /found -• Insp Crawl 'Drain .
;' gable latrs., ill work will be done in• accordance with approved' Post, /Beale. Struck '
plans. This pdrait will expire if work,is -not started within 180 'Framing, Insp ' -
days., of •suanee, or if work is suspended for pore than Me,,' days. I n's.'u'l at i con; .I n s-p __ . _ .
' Gyp Board Insp '
e e'ir Ind t: t e e S i g ri at .•1- t` r. r4 r.�• -, p ' . '— , ' . • ' •- •was" Building d ails —
Building Final . . •
. Y- 51;J d
teQ ity. _ '• - Ere; o•
sin Control ,,, ,, • ,
. - . , Call., for- .in - 639 -4175
aV
Oiljk
M " HA [3hrd PLNCK/RECT # - " I _
CITY OF TIGAIRII) 13125 SW H
Ti 97223
PERMIT H 145f t:5 -0 36
COMMUNITY DEVELOPMENT DEPARTMENT
. (5°3) 639 -4171 DATE ISSUED
JOB ADDRESS: 11641 sw I 2 f(--- TAX MAP /LOT /51 3)12P- /296o
SUB: VI L S vNVrcsk - e-L r i (( LAND USE:
VALUATION : , ) 3 / go v
OWNER / SPECIAL NOTES
- %e•�`V' CiO
NAME : A'V4 --SdLLE REISSUE OF:
ADDRESS: MA C I SM IZ(Pb- e LAST REISSUE:
• • 11 ->? y ('� q 3 FLOOD PLAIN/
PHONE: 1 :; 2 - 1- i - - 4 22- SENSITIVE LAND: •
CONTRACTOR APPROVALS REQUIRED
NAME: Se r PLANNING:
ADDRESS: • ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
• SUBCONTRACTORS: PLUMB: LIST /SUBCONTRACTORS:
MECH: • BUS TAX: • •
ARCH /ENGINEER CALCULATIONS:
NAME: c426A /C L P$CG (, TRUSS DETAILS:
ADDRESS: / 4 . ( 3 S ' D ` I C5Ai' - S ' f 4 5 Q OTHER: •
46001 1∎0 i d IL 'Vi 22-3
PHONE: 74 —aCS20
PROPOSED BLDG. USE: 3S Iflt- 1 -
COMMENTS: .00
/ .
'LICA SIGNATURE
' eceived By: Date Received: 63/6-g://7
I•\
J�
,� PERMIT / # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE'
1 15/10,367 10 -432 00 Building Permit Fees /Gt/ / oy•.SO
10 - 431 00 Plumbing Permit Fees
10 -431 01 Mechanical Permit Fees
10 -230 01 State Building Tax (5 %) • Z 3 s. 23
Building '1,0
Plumbing
Mechanical
10 -433 00 Plans Check Fee q, &
9�
Building 62 4 7 1 / •
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 0ev 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 /17
nm /3587P.WPF
Permit No:
'� .. Address:
v�,'•"�' z Issued by: Date:
•.` •
•i ' 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 I 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.
I7(=
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 t i - r
1
11L1k4r • , " z$' q 3
gnatur: of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD •
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I
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 RESPONSIBOLITIES:
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 Rf SPOOISOiffiILITOIES AMD AREAS OF COKICERM: •
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
0244,1 10/24/89
INSPECTION NOTICE
(//
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec- O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Plbg. Underslab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requesteed: G� Time: All PM
Address: I l o l/ l ` L - i. Permit f:
Builder: Z`f - � { 2-27
THE FOLLOWING CORRECTIONS ARE REQUI D:
�., i O
AIPM=111.11
.
C-/
/ 6"
inspector: Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
JNSPECTION NOTICE ,
City of Tigard Building Department \� V /
13125 SW Hall Blvd. Tigard, Oregon 97223
InspectionnLine (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: � A ^-C
Footing Plbg. Underelab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: tlp, 1) I 3 Time: AM \ /./ PM
Address: 1 ( Cl I - / 1 1 G(p _o- i Permit I: V 151- 13--
Builder: •'e tr etr1,1,r ( 1 e S 2_ 112 2_7
THE FOLLOWING CORRECTIONS ARE REQUIRED:
e r - U\l U S ` ■T-e Q w' ✓\ Q-,_4( -
L c 2-* L-rN-, (. C w2__--A
V --- c „ ....) - Lp t:::-s\-- \\ � �f� ,-- C1-- � c -ems. \k�c1
`�U -ems( — G A' 0-6 �t- (, ,s T. -4--
c.`, - o,i.e.,a 5 .
e r ` w N . Le .---t "" V\z. s - t—)
s L-Q.Zz. (o .e% fie 4
1 Z 4 - e ..e. -1 d — - 7 �1 R S L-e-2�L�./�
S Nr Z. .A.,
■
v-- 9._ V '-\--- I N"- - ‘2,./ .- k-C-e- (? --r p
Inspector: Date: o 13 /
APPROVED DISAPPROVED `� APPROVED SUBJECT TO ABOVE
Call For Reinep.
/
INSPECTION NOTICE
City of Tigard Building Department
13125 Sid Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec- O- Phone): 639 -4175 Business Phone: 639 -4171
Inspections
Footing Plbg. UnderBlab !tech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Po et /Beam Struct. San. Sewer Framing -Bldg.
Poo /B Mech Rain Drain Insulation - Plumb.
P bg. Underfloo Wa ter Line Gyp. Bd. -Mech.
Date Requested: 7 - /5 --- ___ / Time: )( AM PM
Address: //6 l/9 4� 4 P - /et- Permit is 9. -- D3t `7
Builder: �O .,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
•
,
i .�7 i i ti/ i%
Zr
Inspector: '
Date: - - 2 -
` C> APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.