Loading...
16120 SW GRIMSON COURT-1 F- 0) N Q U) C G� Ln O Z n 0 C I I 1 i i I 16120 SW GRIMSON COURT CITY F TIGARD MECHANICAL DEVELOPMENT SERVICES PERMIT ' PERMIT #. . . . . . . : MEC97-0308 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 08/ 15/97 PARCEL: LIS 1 14BA-01900 SITE ADDRESS. . . 16'. SW GR I MSON CT SUED I V I C 10N. . . . , PICKS LANDING NO.` ZONING: R-4. 5 BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . : 120 JURISDICTION: TIG CLASS OF WORK. . :OTR FLOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE Of' USE. . . . :3F UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :R3 VENTS W/O AF'PL: 0 VENT SYSTEM':-:): 0 STCIRIES. . . . . . . .: 0 BOILERS/COMPRESSORS HOODS. . . . . . .. : 0 FUEL TYPES---------- - _ - 0-3 HP. . . . : 0 DOMES. I NC I N: 0 7,-15 HP. . . . : 0 COMML. I NC I N: 0 MAX INPUT: 0 BTU 15--30 HP. . . . : 171 REPAIR UNITS: 0 FIRE DAMPERS''. . : 30--50 HP. . . . : T WOODSTOVES. . : 0 GAS' PRESSURE. . . : 50, + HP. . . . 0 CLO DRYERS. . : 0 NO. OF UNITS -----._._._.___ AIR HANDLING UNITS OTHER UNITS. : 0 FURN ( 100K FTU: 1 1.0000 rfm � 0 GAS OUTLETS. : 0 FUF'N ) -100V EATU: 0 > 10000 cfm : 0 Remarks : replace existing gas furnace Jwner: FEES -_--____------- RAY J DANIE_ type, amolant by date recpt 161:0 S. W. CRIMSON COURT PRMT $ 215. 00 CEO 08/15/97 97-298219 TIGARD OR 97224 5PCT f 1. 25 GEO 08/ 15/97 97-298319 Phone #: (50.5)639-1553 Contractjr: ------________.--•--•-_-----_-____ SUNSET FUEL CO PO BOX 42287 $ 26. 25 TOTAL. PORTLAND OR 97242 Phone #: 503-234-0611 Rpg #. . : 000023 ----------- REDO I RED INSPECTIONS - This peroit is issued sabject to the -egulations contained in the Gas Line I n s p _ Tigard Municipal Code, State of fire. Specialty Codes and al i other Mechanical I n s p _ applicable laws. All Mork will be done .n accordance with Heating Unt Insp approved plans. %is pereit will expire if work is not started DI-Ict Inspection within 108 days of issuance, or 'f work is suspended for yore Misc. Inspection than 188 days. ATTENTION: Oregon law requires you to follow rules Final I n spect i -)n adopted by the Oregon Utility Notification Center. Those rules are -- set forth 'n OAR through OAR %2-00148f18. Yrc Bay — ---- obtain copies of these rules or direct questiors to OUrC by calling _ 411 . -T ___ Permittee Signature : ++++++++•.++++++++++•f++++++++++-r-++++++++- +++++++++++++..++++i-+++++++++++++++.f++++ Call 6.39-4175 by 6:00 p. m. for- inspections need!,d the next bl.isiness; day 4+++-+++++++++++++++•t++-..+++++++++++++++++++++++++++++++++++•++++i ++++++++++++++++ City o Tigard MECHANICAL PERMIT F'lanck/Rec. 11 _ 13125 SW Hall Blvd. APPLICATION Permit # Tigard, OR 97223 (503) 639-4171 _�— .�..t1:r«.„�«r 00scnpi, Table 3A Mechanical Code QTY PRICE AMT Jola 1 11140 `5`3 ��" Mtk,4-t CA 1) Porrivt Fee -0 10 0c Address ze �-)e , 300 r � 2) Supplemental Permit --- aurraco l0 100,000 QTCi-- CZ LDU e-Q_ 1) incl.duds 8 vents + 6 00 � ()will t MSon 2) incl duds a vents __ 7.50 Floor umance \ Ci 3)3) incl vent — 6.00 _- - - N :wsJAIIN J wa;^r.woll renter 4) or floor mounted hewer -- 6.00 e�ntnot ind in OCcipant 5) appliancxr permit 301 Repair of heating,refrrg. t.) cooling,absorption unit 600 --- .M --- ----'— � •�iii(car or comp,i1vat pump,au cond. 7) to 3 till absorp unit to 100K BTU 6.00 --- _--,,„-- 13RIc--r or corn at P�m ,au conC P P O �x •7.,0-1a_�a'y1_pV 1� 0) 3 15 HP absorp unit to 600K BTU 11.00 Contract01 r,,, — d r Boiler or romp. t pump,au con 9) 1530 HP absorp unit.5-1 mil BTU 15.00 sw. i� -- •, Boiler` or comp,hea'pump,air coOd. a "1AA ,,�y 10) 30 50 HP absorp unit 1.1.75 mil BTU 22.50 T rove y acRii-MT,;g•eft iat lave readt.is ap 1�ic-a-lane,thaall Vie Boller or comp, at pump,air co nd information given is correct,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31 50 _ ci the ownor, tlkit plins submitted are in compliance with State Au ranching unit 1+0 - - laws, that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 4 50 that the number givon is conoc•t. (if exempt from State registration, -- anaing unit pkrase givo reason below) 13) 10,(00 CTM+ 7.50 -- �.- ---- Non portable - 14) evaporate cooler 4.50 --- ent Ian connectc� 15) to a single duct �— — 300 - ---e-n7b ation system not j �k r � t -v -�•y^ 1G) included in appliance permit_ 4.50 T�« ITr;ocT served y I17) mu!chanicail exhaus' 4 50 -Tscn �be w now7T- addition 0 altoration t✓ repair I ('ommeraa or ur strtrl to be donu residunual q"- non-(esrckn;ial(3 td) type irlmerato, 30.00 -- zisting use o(-----.�w t ref r Q,woo stove,watw building or property 19) heater,sax,clothes dryers,etch 450 Proposed use of 20) Gas piping one to four c(tlets - 2.00 building or property — ---- - _ �- -- 21) More than 4-per outlet Type of fuel - o1 0 natural gas( LPG 0 Mr-Irv ' ; ----"-- — -- OTIC Minimum Fee$25.00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUT14ORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE I r�� IF CONSTRUCTION OR WORK IS SUSPENDED OR —- ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL AFTER WORK IS COMMENCED. ((1�— - �— t �xl& Q, ----- TOTAL Special Conditions --S--_ nn (AC .�r �S � � V( Date issued` by-- -- CITY CSF TIGARD ELECTRICAL PERMIT D _VELOPMENT SERVICES PERMIT #: ELc9;-Oss9 13125 S W Hall Blvd., Tigard,OR 97223 (5A3)639.4171 DATE ISSUED: 08/22/97 PARCEL: 2S114BA--01900 SITE ADDRESS. . . : 1612O SW CRIMSON CT SUBDIVISION. . . . :PICKS LANDING NO. 2 ZONING: R-4. 5 BLOCK. . . . . . . . . . . LO'f. . . . . . . . . . . . . : 12O JURISDICTION: TIG Project Description: Add two (2) branch circuits to existing single family dwelling. -------------------------------------------------------- --RESIDENTIAL_ UNIT---- ----TEMP SRVC/F=EEDERS---- -----MISCELL_ANEOUS-- - 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . . 0 PUMP/IRRIGATION. . . . : 0 EAS!-4 ADD' I 90VISF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIONAI_/PANEL.. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601+amps-1OOV: volts. : 0 MINOR LABEL ( 10) . . . : 0 ---SERVICE/FEEDER----- -----BRANCH CIRCUITS------- ---ADD' L INSPECTIONS--- - c-_00 gimp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSP'ECTION. . . . . : 1Z1 201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 1 IN PL.ANT. . . . . . . . . . . : 0 601 - 1000 amp. . . . . : 0 - ----- --- --_-----FLAN REVIEW SECT I ON- _._-_-- 1000+ amp;volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner: -- ----- - -___-_____.____-__ .___.__-- FEES RAY J DANIEL type amoUnt by date recpt 16120 Vii. W. GRTMSON COURT PRMT $ 40. 00 GEO 08/22/97 97-298511 / TIGARD OR 97224 SPCT $ 2. 00 GEO 08/22'/97 97-2985/: Phone #: (503)639-1553 Contractor: -----------.--••-------------------- ----------------•---------------- WESTSIDE ELECTRIC $ 42. 00 TOTAL 7518 SW MACADAM AVE REQUIRE ) INSPECTIONS ---- PORTLAND OR 97219 Roi..igh-in Elect' I Service Phone #: 245-3385 Undergrol_Ind Cove Elect' l Final Reg #. . : 000133 This permit Is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicant a law,i. All work ;sill be done in accordance with approved plans. This permit will exp;.re if work is not started within 198 days of iseuance, or it work is suspended ior more than 198 days. ATTENTION: Oregon law require,, you to follow the rules adopted by the Oregon Utility Notifiratioc Center. Those rules are set forth in OAR 952-881-88i8 through OAR 952- 81-1997. You may obtain a copy of these rules or direct questions to OIINC by calling .58 246-1997, Permittee 51gylatI_ire : —�-- � Issi_ied By: ------.----____._______---------.OWNER INSTALLATION ONLY---------------------------------- Thi installation is tieing made on property I own which is not intended for sale, lease, or rent. OWNER' S SIGNATURE- — _ DATE: -- ---------------------CCINTRACTOR INSTALLATION ONLY--- -- --- --- - --------------- SIGNATURE OF SUPIR. EL.ECI N: DATE: LICENSE NO: F+++++++++-++++++++++++++++++++4+++++++++++++4•+++++++•F++++++++++++++++++++++++++ 5 hg_6.O1A ❑ m for an int Wort inn needed he next hii%inP%S ,,lav ++++++++++ +-++++++++++++++++++++++++++++�++++-1-++++++++++++++++++r++++++++++++++f CITY OF TIGARD Eiectrical Permit Application Plan Check H 13125 SW HALL BLVD. Recd By Date Recd_ _ TIGARD OR 97223 Date to P.E. _ Phone (503)639-4171, x304 Date to DST Print or Type c,. Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit a F L Fax (503)684-7297 Called _ 1. Job Address: 4. Complete Fee Schedule Below: Name of Development L Number of Inspections per permit allowed -- Name(or name of business) C c r 41 Le/ Service incluJed: Items Cast Sum Address /t� 1/ /%%/� 1% / 4a. Residential-per unit 1000 sq.it.or less $110.00 _ 4 City/State/Zip % �Ll/' 5yle < Each additional 500 sq,ft,or 13 Residential puruun thereof $25.00 Commercial Limited Energy -_� $25.00 _. Each Manul'd Home or Modular Dwelling Service or Fender � $681J0 _ 2 2a. Contractor installation only: (Attach copy of all,current Iic nags) 4b.Services or Feeders F lectrical Contractcr � 6, �((�i/C InstallaLon, or less or relocation �� 200 amps or less $60.00 2 Address v 4 201 amps to 400 amps - $80.00 _ - 2 City e/ i- Stats! _Zip '/�_ 401 amps to 600 amps $tact o0 2 Phone Na 7-S 1- 601 amps to 1000 amps _ $1 HO 00 Job NO. ( ' _ Over 1000 amps or volts $340.00 -_ 2 -- --- Reconnect only $50.00 _ Elec. Cont. Lice. No _7C /JJ Exp.Date __ -_ - - OR State CCB Rey. No. / Exp.Date.__- __ 4c.Temporary Services or Feeders COT Business Tax or Metro No. Exp.Date _ Installation,alteration,or relocation � �-- 200 amps or less $50.00 21 Signature of 5u r. Elec'n 201 amps to 400 amps _- $75.00 2 9 p - 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License Nr / � S~� E�Cp.Date_ ___-- see"b^above. Phone N 2 yt, i .� (� /J�it _Iri..ln' i - - 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a) The fie for branch circuits with purchase of service or Print Owner's Name- feeder fee. -- - " Each branch circuit $5.00 _ a Address _ --- -- b)The ten for branch circuits City , StateZip __ ___ without purchase of Phone No. service or feeder fee. First branch circuit $3500 2 The installation is being made on property I own which is not Each additional branch circuit $5.00 _ 2 intended for sale, lease or rent. 4s.Miscellaneous (Service or feeder not Included) Owner's Signature �____-___ Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 2 3. Plan .'levlew section (if required, ' Signal circuit(s)or a limited energy panel,alteration or extension _ $40.00 Minor Labels(10) $100.00 Please check appropriate item and enter fee in section 5B. _4 or more residential units in one structure 41.Each additional Inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described In N.E.C.Chapter 5 In Plant - $55.00 _ Submit 2 sets of plans with application where any of the above apply. 5. Fees: VC Not required for temporary construction services. 5a.Enter total of above fees $ - 5%Surcharge(.05 X total fees) $ NOTICE Subtotal $ - 5b.Enter 25°10 of line 51 for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review it reguired(Sec.3) $ - NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK SSubto $IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY C TIME AFTER WORK IS COMMENCED. Trust Account I$ G_ a Total balance Due r, f7 ht)SMELC96.APP AOY W96 RECEIVED AUG 2 2 1997 COMMUNITY UEVELOPMENi CITY OF TIGAIRD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 639-4175 Business Phone: 6394171 — -` Date Requested: - A. !/ P.M I,a,ation: I BUR Tenant:_ Suite: Bldg: _ MEC:77_C,-Uc? Contractor: Phone: �_ 3 —[� PLM: chvtter: Phone: ELR: _ _ BLDG(con't) PLUMBING MECHANICAL ELECTRICAL — BUILDINGSIT: SITE Site Post/Ream Post/13camP Cover/Serve a-"" Sewer/Storm Footing Roof l JndFl/Slab `' Rough In Ceiling Water bine Slab Framing l op Out 'Tr83Zine Rough-In 1 I Sprinkler Foundation Insulation Sewer Ilood/Duct Reconnect Vault lismt Damp Ihywall Sionn ,ft 'temp Service MISC. Mnsonry Ceiling Rain Thain C NCS UG Slab Shear/Sheath Fire Spklr/Alin Crawl/Found Dr — TTe-at Low Volt Approved Approved C roved Approved Approved Lpp,/Sdw1k Not Approved Not Approved Not vea ed Not Approved FINAL FINAL IFmmmm� NAi: LINA FINAL _ C� O Call for reinspection O Reinspection fee of S! required before next inspection C7 Unable to inspect Inspector:/ � _ wte: ' — �_ Page_ of CITY OF TIGARD DEVELOPMENT SERVICES ELECTRICAL PERMIT 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #: ELC96-0712 DATE ISSUED: 11/05/96 ':: ITE ADDRESS. . . : 16120 SW CRIMSON ri, PARCEL: 2SI14BA-01900 1-3UBDTVISION. . . . : PICKS LANDING NO. 2 ZONING:R--4. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . Pt,oject Description: Installing a service and 5 branch cit,cl-lits. ------------------------------------------------------------------------------------------- - RESIDENTIAL UNIT------ ---TEMP SRVO/FEEDERS----- -----MISCELLANEOUS—— 1000 SF OR LESS. . . . : 0 0 - 20LA amp. . . . . . . : 0 PIJMP/IRRiGp,rION. . . . : 0 EACH ADDIL 500SF. . . .- 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 -- 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0 -------SERVICE/FEEDER------ ----- BRANCH CIRCUITS-­­ -----ADDIL. INSPECTIONS——— 0 - 200 amp. . . . . . : 1 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : (1i 201 - 400 amp. . . . . . : o 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . : 0 EA ADD' L- BRNCH CIRC: 5 IN PLANT. . . . . . . . . . . : o 601. i000 amp. . . . . : 0 REVIEW SECTION------__-__--_-._ amo/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconneci: only. . . . . : to SVC/FDR ) := 225 AMPS. . - CLASS AREA/SPEC OCC. : Owner-: ------------------------------------------------------- FEES RAY VANIEL type amount by date t,ecpt 16120 S. W. CRIMSON COURT PRMT $ 85. 00 DR(4 11 /05/96 96-286148 TICARD OR 97224 5PCT $ 4. 25 URA 11/05/96 96-286148 Phone #: Contv,actori OWNER $ 89. 25 TOTAL REDUIRED INSPECTIONS Ceiling Cover Under,gt,oi_tnd Cove Phone #: SEF ABOVE Wall Covet, Elect' 1. Service Reg #. . : !his pervit is issued subjer'. to the rl?gulations contained in the Tr gT-,,t Tigard Municipal Code, Ste',@ of Ore. Specialty cialty Codes and all other - 2 Si gnat i..tt-e applicable laws. All wort will be done in accordance with approved plans. This pivit will exrAre if work is not started within 180 days of issuance, or if Pork is suspended for sort than 180 days. so-ted By INSTALLATION The installation is being made on proper-ty I own which is not intended for, rale, lease, or rent. (IWNERIS SIGNATURE: DATE: INSTALLATION SIGNATURE OF SUPR. ELECIN: DATF: LICENSE NO: Call for inspection -- 639-4175 CITY OF TIGARD Electrical Permit Application Plan Che,�� _- 13125 SW HALL BLVD. Nec d Bl&) Date TIGARD OR 97223 Date to P E. Phone (503)639-4171, x304 Date to DST _ Print or Type Inspection (503) 639-4175 Permit a Fax (503) 094-7297 Incomplete or illegible will not be accepted--Called _- 1. Job Address: 4. Complete Fee Schedule Below: Name of Development_ Number of Inspections per permit allowed Name(or name of business)V 1 6&1 __ Service inclur!ad: Items Cost Sum Address _ _ 1!_L 4- Residential-per unit C d�' -7.2 1 �/ 1000 sq.It,or less $110.00 _ 4 City/Stele/Zip_ ^,�„� � � _ Each additional 500 sq ft.or portion thereof $25.00 1 Commercial ❑ Residential Limited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 ? 2a. Contractor installation only: (Attach copy of all current licenses) Ins Services or Feeders _ Installation,alteration,or relocation Electrical Contractor - ----- -- 200 amps or less $60.00 2 Address-_ _ _-___. 201 amps to 400 amps $80.00 2 City_ State. Zip _ __ 401 amps to 600 amps ___._ $120.00 _ 2 Phone No. 601 amps to 1000 amps $180.00 2 - Over 1000 amps or volts $340.00 _ 2 Job No Reconnect only $50.00 2 Elec.Cont. Lice. No. -Exp.Date _ OR State CCB Reg. No.-------Exp.Date _ 4c.Temporary Services or Feeders COT Business Tax or Metro No.-__ Fxp.Date Installation,alteration,or rcloration 200 amps or less $50.00 2 201 amps to 400 amps $ Signature of Supr. Elec'n -__,�_, _� 100.0 _ 2 401 amps to 600 amps � $100.00 Over 600 amps to 1000 volts, License No _ __ -Exp.Date sea"b"above. Phone No._ �- --- 4d.Branch Circuits How,alteration or extension per panel 2b. For owner installations: al The fee for branch circuits with purchase or service or feeder lee. Print Owner'q Name j(-.Z Each branch circuit $5.00 Address1�r "' < ---�tr -- h)The fee for branch circuits city !a�z r� Stater 1 t:72-2- _... without purchase or Phone No._ /r service or feeder too. First branch circuit $35.00 _ 2 The installation 19 bel7ade on property I own which is not Each additional branch circuit_ $5.00 - intended for sale,I ase ent. 4e.Miscellaneous (Service or feeder not Included) Owner's Signature _ Each pump or irrigation circle i $40.00 2 Each sign or outline lighting $40.00 2 3. Plan Review se io panel,alteration oon (if required):' Signal circuit(s)or limited energyr extension .- $40.00 I Minor Labels(t0) $100.00 Please check appropriate Item and enter fee In section 58. 4 or more residential units In one structure 4f.Each additional Inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per inspection $35.00 -�- Classified area or structure containing special occupancy Per hour $55.00 _ as described In N.E.C.Chapter 5 In Plant $55.00 ' Submit 2 sets of plans with npplicatinn where any of the abovF.apply. 5. Fees: Not required for temporary construction services. 5a.Enter total of above fees $ 5%Surcharge(.05 X total fees) $ -- � N4TICt Subtotal $ - - 5b.Enter 25%of line Ba for PERMITS BECOME VOID IF WORK OR CONSTRUCTION ALITHORIZ..FD IS Plan Review it re i J-(Sec.3) $ - - NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ -IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Trust Account YV, 2-6 , TIME AFTER WORK IS COMMENCED. s Total balance Due _j 1ADSTSNELC9E.APP new 9/96 Permit #: 1:L Address: �' �� Issued by(z. OA'24� Date: Stat,ament: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 70/.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. Tris statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from reg stration under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. 1 own, reside in, or will reside in the completed structure. 2. 1 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. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If 1 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 cor,,ractor. I hereby cc�r•ti ' t the above information is correct and that I have read and do understand the Information Notice to C-'-�perty )finers about 'o struction Responsibilities on the reverse side of this farm. (Si ature of permit applicant) (Date) (White copy to issuing agenci-permit,/ile. pink copy to applicant) Information Notice to Property Owners ,about Construction responsibilities 't' f(' ' : .�•,'iff"r' ('n i'''j It 1_T 1"C!`?i�iF't-,;[;� (�ltl �. '75/I-ai-.`1/1t1 .�i�P+(�17/!t"1771�ifl C':. Wlfii ORS ?01.075�5). I . �,',, ,r?.il ,r!''„';ii I l ',1'•;Illl� .IIl11:11111 , ll1�IL lldit: alit.., a"t'-I- .3l 6'.-I1�.Gl U. EMPLOY EP FIES'aOiVlSIBILITIES: 'i11: 1i 1U'y ko:Itj ill AJC) I I)'1'AXI, i",,{1'.' Iulcd ”' N' ail old I{it' i1,h.-,{�l: t.i. 1.ry�, i. � ,- .1. �I i.., i. i' �. ir' �,i.,Itl l � '( .;!`.. .. •IIi. .,. . _ � .i .. � I'. 111. .t.,,l i -�{�., �.. i,i 1. 'IL i.11�li ,r Itis.' �1,J(�,I(�1•Rr.'ill'.,1 �{lliiliJ:1 Ill'>t1tl!'l U" � I 'tI 11N1�1 It � •� Ir,( Cl:, f." a,,1A'n I;; rii�. � . - „i 1111' lhl: 111,1! l?� it'.. ,. q l �_,If;All F TAS 11: ,111' I;ulul, J'!Il , -lig i I�ii}jyll� Ailf 1)iU :�:II,i Uatl.i;t `,tlltkltYlE1;p: t old 1 ;itl lhb lhlil. .11,.'i'l X1' :' 11 Y"Ill{G11k' ,tl{J,'gmtl,'.' lit:-.11130C. l..f...rll : ln.i �i,a.:! �•r :,tfl;i t I.fi.. t:.. Ir � :.,ilil t I i !il - "k I �1XIlil}:,.._ �:�'�ill {fIi1C ])llil�'lilfl'S. Itft'. l)I 1ti;rl�. t{I It Illll�l Vin' i i Ill_- t[i'r i1" �Y1�1,'1'Ir i.`�' 111{?il�:t I _ ^�.I 11 .. .I,i � •I. Iii: ;i'�. L, I:i ;i!'1 u' 1c+ .�II�I 11 I-,l ti,1l i. !`11�{�(41'i t'tL',ti. n � �,{tC•r�t�;{,• Al-i�,;� ;'1'" i Hl{1" 'ti1C';"'ill'I'�I°."�t"h'' `•AX1111'ftlt llr'r!lf`1'�i11_hillf;k'fiiP,Atli r.fitf�IlL�li�iht`tt'fll+o f�(Illt']1 ill i lllf�11111`1{1 l 1'r rl `I11',' 1 ll!{llilln 1 I`I('tril tl lilt' I{1ry i^1'I ll' iltllf", �n Illl`t'('?11 (lt'Tftlllll tlir:, 1'Cquirrc)lnc]1eC killnC. II IL1 ilClili(litl,,il t{ It.".i}, t' ;�i i�'iC ( t U,'ll, II',II ( "111111+.'�ttT� { CIi11`l{(]N 1 {lit, ]:�i'40, .ti'U]t`fll,�)]* � t-, 'I !ht l�i`:�,.� .c. 1 al '111 •�LIl1u,L ! '.i ^.�I ':uitc .11N1, n'1 5alrm. r �" CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line. 639-4175 Business Phone. 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mpch. Shear/Sheath Framing Moch. Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Elect. Post/Bearn Struct. Mach. Rough-in Gyp. Bu, -Bldg. San. Sewer Gas Line Appr/Sdwik Reins, Other: C — Date: `i ,_/ P.M. Entry: Address: -1-61 Tenant. .. __ Ste:_ MST: BUP -- Con/ —_ MEC. - - PLM: ELC:� THE FOL,OWING CORRECTIONS ARE REQUIRED: ELR: _- r Inspectort1f ie{ t E -- Data: APPROVED __DISAPPROVED/CALL FOR REINSP. CF 0