9025 SW OAK STREET �sa1'aM+M��i xR^w,il*�M+n�r'ar'•'w"in�M�M.�� ��V, �M.��*I,�''}}��IR}A+M� •`qa.�r` M�.�F�M�'M'MMl�1wR'wn+•wwww��»wr•w:+^,. w �. .�w.
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INSPEgSION Nd�C CE S
City of Tigard Bull. Lng DOPOLIMoet
13125 an Ball Blvd. Tigi", Oregon 9722
inspectionine (Ric-t)-Phone): 639-4175 Business Poe 63A-4171
Inspections c-
Footing Plbg. Undcrlab Vech. Rough-ii App lk j
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Found. Plbg. Top Out Gas FIN
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Poet/Bean Struct. San. Sealer framing� l/ B_ld
Post/Beam Mach. Rain Drain Insulation - a�-
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PIDg. Undierfloor Nater Zino Gyp. ad. M
Date Requeoted;
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Addresat C� ,^ Permit I
Builders-12/7
TBR FOLLOWING CORRECTIO S ARE PLIRSDI
Oef_. -21
APPROVED DISAPrPOVRD APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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j.SPECPION NOTICE '
City of Tigard Building Department
13125 ON Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639--4175 Business Phone: 639-4171
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Inspection: i 1 =�� --
oatinj Plbg. Undaralab Mech. Rough-in Agpr/Sdwlk
(F Plbg. Top Out Gas Line FINALs
Post/Beam Struct. San. Server Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water L.Ine�j Gyp. Bd. 'MeOif• r
Date Requested: d` Times
Aedre■es �� `' c�l� <J` Permit h
Builder: '
THE FOLLOWING 061MU C?IONN AM IRBDs
In"ct.orr/:_� Date:
F' APPROVED D1:9APPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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CITY OF TIGARD Mra , rrR PERMIT •
COMMUNITY DEVELOPMENT DEPARTMENT r'l-RM 11-
13125
1 13125 SW Hall Blvd.T'gard,Oregon 97223.8199 (503)839-4171
L) J DATE C SSULD r 10/,?5/9;3
PAI-',CEL.: 1 S 1.3 013---I11'21710
3T tl' AT)C)ral '.ss. , . 09025 SW OAK ar
aUBD I V I S I ON. . . , t ASHDROOK FARM 7.ON I NC t R-4. J
C:tLOCF:. . . . . . . . . . . LOO . . . . . . . . . . . . . : 10
__...,.__.___..___..._-._......_._...._....__,.._....._.....__._.. .._.__._. BUILDING _....._._.-__._....__...__.__.... _..._.-..._.._._._.....__. .____.....__...____._._.
?E.1SSUE: DWELLING UNIT'6:0 x'ASi`IrL.NT. . . . . . .. . :0 sf
`,LASS OF' WORK. :NEW BEDRMS:O afr•rH5:0 6ARAGE. . . . . . . . . . .42 1 S
Cal= USF_. . . :0Cw5 FLUOR r� CAS - __�._...___._.__- REQUIRED
I YPE: OF CON1,3T. :5174 F I p,T. » . » c:f LE-:FT. . :0 ft R I C3FiT. :IZl ft.
Or;f;UPANCY RP. ^M1 3r C.CIrID. .. „ :r21 ref F'RUNI . .0 ft RE i-lfi. . :'ZI f'r
o-I- RI .,. . . . . . . ' 1 ft tOTHIRD. . . . :0 sf
a rLa R 1�..:>. . . . . . . I
Of
"' l`AL.-.•- :0 s f SMOKE DE.T E.CTORS. ;
--LOOR LOAD. . . . :416 psf VALUE. 6800 PARKINI_; SPAGES. . :1i'I
Remarks ; DETACTCFi UPROGE 4-20 50 1 1
PLUMBING
. . . . . :V.1 F"LOOR DRAINS. . . . :121 BACKFLOW I`REVNTRG. . :0
i_AVATORIES. . . . . -0 WATER HEATERS. . . :121 rRAF'S. . . . . . . . . . . . . . .0
TUB/SIIOWEPS. . . . .0 I...AUNDRY 'I'RAYI,`7. . « :U, C'1=ItC:Fi BOSIN3. . . . . . . .0
4ATF_R CLOSETS. . -0 SEWER LINE (ft ) . r O GREASE TRAPS. . . . . . . :1r
')I:=ih{WI-a:aHERS. . . . IZI WA1E.�R LINE' (tt ) » :121 Ci'TIJF.'I'Z Fl.XI"UIIECa. . . » . :JI
3ARBAUE DI'SP. . . ZO RAIN DRAIN (ft ) . :0
WP!3H I I\IL• MACIA. . . !0 9 - RAIN DRA 1 I\I!3. . :0
_ MECHANICAL. _.__.__._.._._,_...__.....___._......._-- FEES •._.._.___•w..W._�..._...._._.
FLIE'L TYPES-- _.....__.._____. UNIT I-ITIRS. . :0 tyle -kmai..cnt icy d,7ty
VENTS . . . . . :0 BPRT $ Fti 't-0 JLH J0/16/93 93
MAX INPLIT:VI 14"I'U VEi:NI' F'AI\11�. . :121 1APL-C:: * 4121, f:3 ,J'LH 10/1h/93 93--245r54
1---tJRN C IOL1K . . t 121 HOODS. . . . . . ..0 $ 3. 1.3 JL1 i 1o/ 18/93 93
I"URN > 1 Q10K. . . VI WOOL:+STOVC S. °III
FLOOR FURN. . . . :0 CLO DRYERS. 0
raI31L/CMP < 31-AP:0 CJ"r lit'r? UN1TS07.1
OAS OUTLETS:0
DILIANE V MC;;K I NILLY
1.31'7 5 Cato H(V
BEgIVER l'ON OR 97005
Phony 4#: 50,3`641•-875
OWNE R
Phorte #:
`
This permit is issued subject to the regulations contained in the - - - RE:'QL 1 Rk-D INSPECTIONS
-- - -
Tigard Municipal Code, State of Ore. Speciaitti Cndky and all other Facot/fc)alnd Insp
applicable laws. All world will tt done ?r accordarce with approved F"ramirlg Insp
plans. 4his permit will expire if wort, is not started within 180 E1�c i l d i n q F"i na l _,___•__._ •,•.� .. __ _.
days a$ issuance, c•r if worl+ is suspended for more thaiOk ca.vs. Er^nsiurl L;cantr^al.
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Residential Building Permit Apilication ti • •
City of Tigard
13125 SW Hall Blvd.
' Tigard, OR 97223
(503) 639-4171
Jobslte Address:_
Office Use Only
Subdivision: Lot#
Plancl(/Rec #,,1)4-,,/0 �
Valuation
Permit # 5 '
Owner: /�'iC /2/"-1C/✓�/G��-1 _ Reissue of +�
Address:
� Approvals Re ulred
Planning
Phone: r— ✓� �/ — c 7S `�_
Engineering I
Contractor: _ ` Other
i }Y.
Address: /�� 7S
K
Items Re wired K �frY
Subcontractors
Phone: --+/j'7
Truss Details
Contractor's License #
(attach copy of current Oregon license) tetter
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Subcontractors: i
Plumbing:
Mechanical:
(attach copy of current OR Contractor's License)
ArchitectlEnglneer:
Address:
Phone: _
COMMENTS:
C T z dry 1..�� e Q e te,s
Applicant Signature & Phone number
Received by: Date Received:
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Permit # Account Descriptlon Amount Amt. Pd. Bal. bue
IA,5'4j_. 5_S' Bldg. Permit (BUILD) ,�..� '� �•
Plumb. Permit (PLUMB)
Mech. Permit (MECH) _
{ IF
i State Tax (TAY)
I r
l Bldg:
Plumb: _
Mech:
Flan Check (PLANCK) `
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R) _
Mass Transit TIF (tIF-MT)
Commercial TIF (TIF-C)
Industria TIF (TIF-1)
i
i Institutk,,,, I TIF (TIF-IS)
iOffice TIF (TIP-0)
Water Quality (WOUAL) _
Water Quantity (WQUANT-)
Fire District (FIRE)
jTOTALS:
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—_� Permit No:
Address:
Lu► :�*- z Issued by:—_ — Date:
••• � ----_-FOR OFFICE USE ONLY-_-__
STATEMENT: 4,
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, OR S 701.055(4) , requires r�sidential construction permit
applicants who are riot registered with the Con:,'ruction 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. l-;censed Architect and Engineer applicants, exempt from registration
under ORS 701.010(7), need not submit this statement. This statement w'll be
filed with the permit.
Fill in 'he applicable 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.
3. A.L _1 My general contractor is -_-_---_- --_--_-- —__
Contra^tor 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.EK_I I will be my owo general contra lor.
If I hire subcontractors, I will hire only subcontractors registen"d with the Construc-
lion Contractors Board. If I change my mind and do I-ire a general contractor, I will
contract with a contractor :vho is registered with the Construction Contr, --s Board
and I will immediately notify the office issuing this building permi, 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
re verse side of this farm.
��lgnatu�re of Permit Appl cant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILF
PINK COPY TO APPLICANT
I
INFORMATION NOTICE TO PROPERTY OWNERS •
j ABOUT CONSTRUCTION RESPONSIBILITIES
MOTE 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
.xisting structure, you can prevent many problems by being aware of the following responsibilities and areas
)f concern.
i
EMPLOYER RESPONSIBILITIES:
If you hire persons riot registered with the Construction Contractors Board to do labor in constructing or assisting �
in the construction or improvement of a residential structure, YOU wi!I, in most instances, be rulea to be an
a "employer'' and the people you hire will be ''employees''. As the employer, you must comply with the following:
Ore ons 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 r.ay a tax for unemployment insurance
purposes on the wages of all employees, For rnore informatics, call the Oregon Employment Division DHR
�.
at 318-3224.
Workers' COVIDensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and mur t 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 373-74,34, ;A ,
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.
at
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, You are responsible for resolving any failure to meet A
,
r.oCIP requirements that may be brought to your attention through inspections.
s
Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance r '
coverage for accidents and omissions such as falling tools, paint oversprny, water darnage from pipe punc-
tures, fire, or work that must he re-Hone.
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
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