10850 SW NORTH DAKOTA STREET-1 W A TL R .ES'r'c%qM C?.ITC N
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10850 SV!North Dakota Street ,A� � � � � r.l � ���
REVISED I
DRAWING NUMBER
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:_ t
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Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Meeh,
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Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect. 1
Post/Beam Struct. Mech. Rough-in Gyp. Bd.
San, Sewer Gas Line Appr/Sdwlk Reins.
Other: __ --
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Datell A.M. P.M.
Address: �-
Tenant: Ste: MST:�SLr��3
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n Own (' 41 amMEC:.-
-- �p ZV"A73 2 ELM
THE FOLLOWING CORRECTIONS ARE REQUIRED ELR:
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Inspector: _ NL - — —" Date:
A41APPROVED —DISAPPROVED/CALL FOR REINSP. CF
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection ll 639-4175 Business Phone: 639 4171
FINAL:
Footing Cover/Service
Rain Drain
Foundation Water Line Coiling
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Post/Beam Mech. Shear/Sheath Framing
PIbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect. tx�fi`'i
Post/Beam Struct. Mech, Rough-in Gyp. Bd.
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San. Sewer Gas Line Appr/Sdwlk Reins.
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Other:
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Date:
A.M. P.M._Entry:
Address: Olt
Tenant:-- —/— ----
Ste:__, MST: "V
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i Con/Own: -- '
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ELC: _THE FOLLOWING CORRECTIONS ARE REOU�IIRED: ELR:
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Inspector: -- _--- --- _ Date:
APPROVED __DISAPPROVED/CALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line:639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling Plu
Post/Beam Mech. SheaNSheath Framing
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd.
San. Sewer Gas Line Appr/Sdwik Reins.
Other:
Date: A.M. P.M, Entry:
Address:
Tenant: Ste: MST: ?.57,63
BLIP:
on/Ow �P Z O ...� .3 -� MEC: --
PLM: ---
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _
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Inspectorf Date: '-
_APPROVED __DISAPPROVED/CALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE II
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639' 1 f(
Inspection: e -rY
Footing Susp. Coiling Sprink. Rough-in Appr,'Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Fos!/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL.:
Post/Bearn Mech. San. Sewer Gas Line -Bldg. +�
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
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Underflr. Insul. Shear Wall hs�
Gyp. Bd.
Date Requested: L� ��L �rn Time: AM _PM
Address:
BttiidertG r�)1(I ti 11 (p Z C� —_�7 ?ice!Permit #:-a C'
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector Data:
ROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE i
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
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Inspection:
Footing Su;*, Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. LInderslab Mech. Rough-in Fireplace wvmm
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: ......
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wallyp. Bd. -Elect.
Date Requested: /L3Time: AM PM x
Address:
Builder: K- Permit#:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:
Date: /
';WTFZVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
I Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in P11Q Fireplace
Post/Beam Struct. Plbg. Top Out S/I� Elec. Rough-in�r13 FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg, I
PIbg. Underfloor Rain Drain
-Plumb. �
Alarm Water Line
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Insulation /' -Mech.
y�f L r Underflr. Insul. Shear Wall
Gyp. Bd. Elect.
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Address:�U
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8erilder. _ d 3 Z T
� Permit #: �S v r 3
!!, THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Dater
_APPROVED _DISAPPROVED 4APPROVED SUBJECT TO ABOVE '
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
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Inspection:
Sprink. Rough-in Appr/Sdwlk
Footing Susp. Ceiling
Foundation Plbg. Underslab Mach. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out �Ef ouah in-' FINAL:
Post/Beam Mach. San. Sewer Gas Line -Bldg. s
Plbg. Underfloor Rain Drain Framing -Plumo.
Alarm Water Line Insulation -Mach. —
Underflr. Insul, Shear all ( Gyp. Bd. -Elect. +
Date Requested: 3L L Time: AM PM
Address: 0 1 y �JL� V� - "`
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��lauildst: �n a U
–_2,-7 – Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: ` Date:
_APPROVED _DISAPPROVED _2�PPROVED SUBJECT TO ABOVE
Call For Reinsp. un h �
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslabech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out�l(,e Elec. Rough-in FINAL:
Post/Beam Mbch. San. Sewer Gas Line r -Bldg.
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Plbg. Underfloor Rain Drain Ct2m�g / -Plumb.
Alarm Water Line Insulation -Mach. •
Underflr, Insul, Shear Wall Gyp. Bd. -Elect. r ,
Date Requested: ( Z S Time: AM PM
Address: ! SCJ 1 X
Builder: Permit #: �S
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: ��� Date:
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`APPROVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE
KCall For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation P!bg. Underslab Mach. Rough-in Fireplace a,
Post/Beam Struct. Plbg. Top Out PasLine
ough-in FINAL:
Post/Beam Mech. San. Srwtr -Bldg.
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Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:/� L{ l(, 5J Time: AM 413M
Address: l L� 0 S� �l(9 �L �R �6`_t4�-F•A-
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ZU 272-2„L Permit #:f-?_c 2s--
THE FOLLOWING CORRECTIONS ARE REQUIRED: I
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Inspentcr. Date:
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_APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
`Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Lina (Ret O Phone): 639-4175 Business Phone: 639-4171 ,°f1hrG..
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Inspection:
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Footing Susp. Ceiling Sprink. Rcugh-in Appr/Sdwlk "1
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Cr1Uy. op Ou Elec. Rough-in FINAL:
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Post/Beam Mech. San. Sewer Gas Line -Bldg. .
Plbg. Underfloor Rain Drain Framing -Plumb.
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Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect. w
Date Requested: �1�1 Cj �_Time: AM PM
Address:
Builder: CO -2 d a- D _� '-A, Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED: -
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In recto : Date:
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ROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. •
Tigard, OR 97223 Planck/Rec. # '
Permit # _ C- t-,c
Phone (503) 639-4171 Date Issued
FAX (503) 684-7297 Issued by
CITY OF TIOARL) _^
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed •--
Address e,r Li t Service included: Items Cost(oa) Sum ,d
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Clly/State/Zlp L f 5 e-r (j . / C Z 3 4a. Residential-per unit C10 4
1000 sq ft or less 1111000
Name (or name of business '^ '� 'r'�v P r �i�� ac Each additional re600 eq 11 or
)� portion thereof $2500 V '
Limited Energy $2500
Commercial❑ ResidentialLimited
Manut'd Home or Modular r 2
Dwelling Service or Feeder $6800 i
2a. Contractor Installation only:
4b.Services or Feeders
Installation,alteration,or relocation r1C 2
Electrical Contractor _ 200 amps or lees _ I sm 00 2
Address 201 amps to 400 amps $8000 2
401 amps to 600 amps $12000 2
city State Zip__ 601 amps to 1000 amps $18000 2
Phone No. _ Over 1000 amps or volts $34000 2
Contractor's License N0. v e Reconnect only $5000
Contractor's Board Reg. No. 4c. Temporary Services or Feeders
Installation,alteration,or ralocar,on 2
Signature of Supr. Elec'n 200 amps or lose $5000 _ 2
License NO. Phone N0, 201 amps to 400 amps $7500 _—� 2
401 amps to 800 amps $10000
Over 600 amps to 1000 volts
2b. For o4W tar installations: sae'b*Above
r 4d.Branch Circuits
Print Owner' -acne �� 'y"�r�° e^ New,alteration or n,Aension per panel
Address U A S 01 SJ4J O r n)The tee for branch circuits with
Git a State ^� Zip 21_ purchase of emke or Meder W. e)C 2
y � �_ P Each branch circuit �D $5 ort 3�
Phone' No/ r) . � �r= b)The fee for branch arcwls wifhouf
The installation is being made on property I own which is purchase of senke or Nader nee. 2
not intended for sale, le' a or rent. Firer branch circuit $$600
6 00 2
Each additional brandy circuit $5 00
Owner's Signatur 11 '—`— �� 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $4000 2
Each sign or outline lighting $4000
Signal circut(s)or a limited anergy 2
Please check appropriate Item and enter fee in section 5B. panel,alteration or extension $40 oil
4 or more resideritial units in ono structure Minor Labals(10) $10000 _
Service and feeder 225 amps or more
System over 600 volts nominal 41. Each additional inspection over
Classified area or structure r:ontaining special oc.Ctipancy the allowable in any of the above
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as described in N E C Chnpler 5 P.,r o wa bon 11"5 00
_
r�r r,r,w _ _ 351100
In Plnnt $5600 r
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. J. fees:
So. Enter total of above fees $
NOTICE 5%Surcharge(.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $25%
of
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb. Enter Plan Review
w line A for
ew if required(Ser 3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS — —
COMMENCED ❑ Trust Account N $ ?
Balance Due $
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CY TY of CIGAEiD - RF.CETPT OF PAYMENT RFCEIF:,T NO. a95-269573
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CHECK AM0I..1NT t L?C^p. "';(A i
NAME e l4EL.':.;(. N, GTEPVIANTE J CASH AMOUNT 0. 0
ADDRESS e NELFX)N, EDOAR D PAYMF:N'T' DATE a 0f311�;/taF
10850 OW N DAKO"fF'a ST Oi IFtD T V I O I ON s
-r J OARD OR 97223—, t
PURPMiF OFF PAYMENT AMOUNT PAID P(JRPOSE OF RFi'YMFNT AMOUNT PAID
ELEf'TR�If. Al_' PF.RMI-r 250. 00 ST BUILD F'FR Sc P. 50
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10850 SW N DAKOTA
FLl-95--0;,x,37
T.O T AL_ AMOUNT P010 262. 50
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MASTER PERMI'r
CITY OF TIGARD I`'ERMIT• #. MST95 01,,4
COMMUNITY DEVELOPMENT DEi�H'tME'NT
DATE ISSUED: 06/19/95
13125 8W Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4171
r-'r-)RerL: 1.e 1 34DA-14200
311'E ADDRI_`,, ,. . ., : 117..1850 ',:,W NORTH DAKOTA ST
SURD I V I S I ON. . . . : ZONING: R-3. 5
BLOCK.. . . . . . . . . . . LOT. . . . . . . . . . . . . .
BUILDING
RE:I.55tJE:M(3T)3-'17112195 _ �,Q .144.:LL I I,,IG UN I TS: 1 BASEMENT. . . . . . . . :0 5 f
CLASS OF WC1R1- �
,. :, t9-Z BEDRMS:3 BATHS: 1 GARAGE. . . . . . . . . . :0 sf
TYPE OF USE. . . :SF FLOOR AREAS_____---__..-• REQUIRED SET BACK S- ----__._.___
TYPE OF CONST. :ON F1 RST. . . . ..816 s f LEFT. . : 17 ft RIGHT. :29 ft
ICCUPANCY GRI'='. SECOND. . . :O S FRONT. :67 -Ft REAR. . :99 ft
�3-'OR I Ea. . . . . . . : 1 F I NBSME:NT:0 a f REOU I RED--
IIEJGHT. . . . . . . . : 17 f1; TOTAL-------.-:818 S SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :4121 psf VALUE. . . . . is 5295E PARK 1NG SPACES. . :0
Roemarl.(s : 131(:3. 5 SO I""T' ADDITION TO HOUSE PATH I �
PLUMBING -------------------
31 NKS.. . . . . . . . . . :0 FLOOR DRAINS. . . . :171 BACKFI...OW PREVNI 3. . : 1
LAVATORIES. . . . . .2 WATER HEATERS. . . :O TRAPS. . . . . . . . . . . . . . :0
i
71JB/SHOWERS. . . . 1 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . :1Z1
Wn'FwR CLOSETS. I SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISI-AWASHFRS. . . . :0 WATE=R LINE (ft ) . :0 O'rl•-ER FIXTURES. . . . . :ill
(-ORDAGE: DISP. . . :0 RAIN DRAIN (ft ) . :0
WASH I NG MACH. . . : 1. SIS RAIN DRAINS. . : 1
ME:CI•IANI CAL - --____.____ .__.______..___._____._.._-_..- rEES
FUEL TYPES________-_._ UNIT HTRS. . :0 type amoo.tnt I.iy da•tn r-ecpt
"GAS/ / / VENTS . . . . . c6 BPRT t 292. 00 JF 03/29/95 -
11AX INPU'T.0 BTU VENT FANS. . :2 BPLC $ IB9. BO CW 03/20/9 95--26313'
F=URN ( 100K . . :171 HOODS. . . . . . :0 B5PC $ 14. 60 JF 03/29/95
F"IJRN ) =100K ., . .0 WOODSTOVEti. :0 MPRT $ 4'7. 50 .IF 03/29/95
FLOUR FURN. . . . :0 CLO DRYERS. s 1 MF'LC $ 11. 8E JF 03/29/9
1)011-/CMP ( 3LIF':0 OTHER UNITS;0 MSPC E 3B JF 03/29/95
GA".31 OUTLETS:O PPRT $ 93. 00 JF 03/29/95 -
Owner: - ...____._..__ ..__.______._•_.____._._._..___.-_-_--_--F' ;1='C 4 4. 65 JF 03/29/95 -
LD & STEPHANIE MEL.SON EROS 40. 00 JF 03/29/95 -
1.08517.1 SW NORTH DAi101"A f13 ERPC 4k 1.::3. 010 ,7F 03/29/95 -- i
ERPC 1; .[,:3. 00 JF 03/29/95 -
IIGARD OR 97223
''hone #: 62121-2'732
Contractor:
OWNE:_R
Phone #:
721. 81 TOTAL
This permit is issued subject to the regulations contained in the -- ---- REQUIRED INSPECT IONS; -- ---- - "'
Tigard Municipal Code, Ftate cf Ore. Specialty Codes and all other Footing Insp Uost/Peam Mechan
applicable taws. All work will be done in accordance with approved Footing Insp Post/Beam Mec.,han
plans. This permit will expire if work is not started within 190 Foo-tndation Insp UnclQrfloor insi_1l
days of issuance, or if work is suspended for more than 160 days, Foundation Insp Crawl Drain
MFG Home F"oot ing Crawl Drain
Fler-mitteei:;i.� n�tto.trk : Proofing Bsm PLM/Under floor-
Post /Ream Strtct Mechanical Insp
lsso-ted E3 _ f Post/Beam Struct Plo.rmla Top Out
Call for inspection 639-417;°,
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R,V+�Py @9Ppr+,. yh- ckf .M9Y. sr.. •w/h ,- Y?utx. n 'wIY
.. i0`�'�a•I�SMIM6MlN". .dIP.1�W!di' �k�7k1�a54a�+,ew,+kSYe,.�:. :,......,.•. ..,........ ........«._..,. ., ..,.... r+n
PLAN CHECK FEES LIST
PLAN CHECK# �T PERMIT#.A S-v 3_DATE
ADDRESS I) Sd J(c) Alt,k Osi k. TAX/MAP/LOT_/ S/ 3 I-L Aq– 1- 2
SUBDIVISION _LOT # LAND USE
VALUALATION c),�� -4 &P SETBACK FRONT REAR LEFT RIGHT
WORK CLASS —HEIGHT / 7 _ TOTAL AREA
USE TYPE f FLOOR LOAD /V' 1st FLOOR
CONST TYPE 51Y HEAT TYPE 6- ) 2nd FLOOR
OCCUP GROUP C'- > DWELL/UNITS 3rd FLOOR p
OCCUP LOAD BED ROOM ,2 BASEMENT
STORIES BATHS GARAGE
PERMIT # DESCRIPTION AMOUNT AMOUNT PD BAL DUE
BUILING PERMIT FEES _7y1. ,� )y. ✓ w " ,'
PLUMB PERMIT FEES
MECH PERMIT FEES �/7 .1 y �r�. '-z'
,a eti,
STATES BUILD TAX ;(l j 1ti•. 73
BUILDING
1y
PLUMBING �,�.,' r " *'
' MECH'ANICAL' ,)
PLAN CHECK FEES
BUILDI?•G
i b'Y rU x�
PLUMBING
MECHIANCAL
/N•�� Y
_ SEWER CONNECTION FEF _
SEWER INSPECTION FEE
PARKS
RESIDENTIAL TIF
f
MASS TRANSIT
WATER QUALITY
WATER QUANTITY
EROSION CNTRL PERMIT
EROSION PLAN CK USA _ / 3 y,,,,` _ ,k
EROSION PLAN CK COT
TOTALS :
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CITY UF" 7 1GART) RETE IPT OV PAYMENT RU.-f;FF I('FT NO, i"3,7'i-.2,AP,1) t 'l
NAME t NEL_SCIN, f-DGAR D CASH f,4PIOUNT i 0.
iDDRESS i NE'LSUN, S3 TPHANIC ,J t; OYME'NT vor4,rE:. oc,/19i'
10830 SW N DOKnTA IJ9D L U T.r-;I ON
TIL ARO DR 97223__
:-FUFtPOF)U OF PAYMENT AMOUNT PAID PUR!~OSF OF' PAYMENT OMULINT PA 11)
j BUILDING Pt--.RM Mff;"F"•):i_.@134 18. 00 ST. BUILD P R 0. 90
t�
Pt
_ON CHECK rK 11. 70 EROSION CONTROL. F=ERMITFrE 14. 00
i=.R(ISION rON'FRni.. 4. 55 EROSION UINTROL PLAN CK 4. !55
i)DL I T I CONAL. FEES
TGTAL_ 0MOUNT PAID - > 53. 70
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: \\\
F� Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation , Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Pibg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
w
w
Unri,nrflr. Insul, Shear Wall Gyp. Bd. -Elect.
Date Requested: n _� S// Time:--AM PM
• Address: �JfC� �c�✓ ,�1 /�/
Builder: the /Scrr� J _ Permit 013y
THE FOLLOWING CORRECTIONS ARE REQUIRED:
T
l �__2E
Inspector: �r Date:
_APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
I CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line_(Rec-O-Phone): 639-4175A Business Phone: 639-4171
Footing r Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
f
Foundation Plbg. Underslab Mech. Rough-in Fireplace
steam Stru . Plbg. Top Out Elec. Rough-in FINAL:
f�ost%B�eam Mec` San. Sewer Gas Line -Bldg.
('Ibq. Underfloor ! Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underfir. Insul. Shear Wall / Gyp. Bd. -Elect.
Date Requested: 1(( ( � _Time: PM •
Address:_
Builder: Permit #
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector.
_APPROVED DISAPPROVED �',"�APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE�J
Inspection Line (Rec-C-Phone): 6375 Busi ess Phone: 639.4171
i
Inspection:_ �y
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg, Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. �SSaan. Seewwe-rr Gas Line -Bldg.
Plbg. Underfloor •C Nain Drain � Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: Time:Y l;>� - Time:AM _ PM
Address: �U �. l � - �—
Builder:_ Permit k: S_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: i�. Date:
P—APPROVED _DISAPPROVED ,APPROVED SUBJECT TO ABOVE
`Call For Reinsp.
F
CITY OF TIGARD BUILDING INSPECTION NOTICE tt
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-4171 II\
�jInspection:
Footi ' Susp. Ceiling Sprink. Rough in Appr/Sdwlk
Faun Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plurnb.
Alarm Water Line Insulation -Mech.
Underfir. Insul. Shearall Gyp. Bd. -Elect. •
7
Date Requosted: �� Time: AM J(_PM
Address:
Builder: Permit #:0i ST jS- U/ 3
THE FOLLOWING CORRECTIONS-ARE REQUIRED:
1
�? c
inspector: Date:
_APPROVED _DISAPPROVED PPROVED SUBJECT TO ABOVE
_Call For Reinsp.
LL _ ...•—�
CITY OF TIGARD
I COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERM17
13125 8W Hall Blvd.Tigard,Oregon 07223•8199 (503)639-4171 PERMIT #. . . . . . . : Ma r`!b• ki i,6, t
6394i , DATE ISSUED: 03/29/95
F'NRCEL: l S 134DA—l0E,.i.,QA0
SITE: ADDRFSG. . . : 10850 SW NORTH DAKOI-A ST
SUBDIVISION. . . . : ZONING: R-3. 5
. : . . . . . . . . . . . .
BUILDING+
i
DWELL I NO Ute i I S: 1 LAPSEMEN T. . . . . . . .
RL l:SSUk;.:M5iT9,:a_00�la� :ID 5 f
GLAN 6 OF WORK.i.NEi.7" VP BEDRM`r:3 BATHS: 1 GARAGE:. . . . . . .
ryPE OF USE. . . . FLUOR AREAS--••____.._.__-.- REQUIRE=D SETBACKS
TYPE OF CONST. .5N FIRST. . . . :7 5 sf LE:FT. . : 17 ft RIGHT. -E9 ft
OCCUI='ANCY GRP,. R3 SECO14D. . . :0 sf FRONT. :67 ft REAR. . -99 ft
STORIES. . . . . . . : 1 F I NBSMENT:O sf REQUIRED----------------—_-._.-
HE IUH) . . . . . . . . .. 11 ft TC)TAL--------- : 735 sf UMOKE DETECTORS. :Y
FLOOR LOAD. . . . 1410 psf . . . . $ : 4'i5a5 PARKING SPACES. - :0
i
Relo:.+r,ks : 734. 6 tab1 FT (-4)L,1I I0N IG HOUSE. PA1'H 1
I-'LUMBINCj
SINKS. . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW P1<EVI14TR5. . : 1
LNVA"IURIE:S. . . . . :2 WATER HEATERS. . . i;0 TRAP'S. . . . . . . . a0
TUN/SHOWLRS. . . . : 1. LHUNDfo rRAY?�. . . : 1 C'.ATCH SAG!NS,. . . . . . . 00 1
WA I LH L:LOSE'I S. . : 1 SEWER I_INE (ft ) . :0 GREASE TRAPS. . . . . . . :0
1 I SHWASHE:RS. . . . :0 WO 1 E R LINT_ (ft ) . .0 O 1 HE R F I X'T'URLS. . . . . ..0
GAHBAGE D16P. . . :0 RAIN DRAIN (ft) . :0
WASHING MACH. . . : i, 'SF RAIN URA 1 NI.4. . : 1
MELHANICAL —.._____.__..._...__..__._.__..____.___. ._ ._.._._....._ FEE:
FUEL. TYPES_._.._.......... _ ___.__ UNI T HTRS. . -0 type amount by date recpt
/GAS/ / / VENTS . . . . . .6 BF'RT $ 2'74. 00 JF03/29/95 _
MAX 1r4F't_11':0 BTU VENT FAN . . : LAPLL t 178. 10 SW 03/ /`j 1 95--2i'631
►-URN ( 100K . . :0 HOUDS. . . . . . :0 B`r'C: $ 1:3. 70 JF- 103/x:9/95 —
jRN ) =100K , . :0 WOODSTOVES. :ld MPH'] $ 4/. .50 Jl 0,3/C )P);:
__UUR FURN. . . . :0 CLO URYEk�;. : 1 MF'LC $ 11. 88 JF 03/29/95
NUII_/CHEF ( 3HW:0 OTHER UNI-IS:O M31"1C; $ :. ,3U JF 03/29/95
GAS OUTLETS-0 PPRT $ 93. 00 JF 03/29/95
Owner-,; _...,.__.._,_._..__...___.._.._ _-- _...__.._._..._..-- F'5PC: $ 4. 657 JF 0-7/29/')5
ED 1.4 S[EPHANIE NEL ,UN EROS $ 00 JF 03/29/95 -
10F'.;0 SW NORTH DAKOTA 51 E:F2F=C $ 8. 45 JF 03/i9/95
ERPL: $ 8. 45 JF 03/c9/95
I I ARD OR 9 72L3
��G1'le 1E:
Lontl^eEiC:tGr^: _. ..„.___..__.._:_.._.._..-..__..._.__._. ._-_._.----_...-_.__
OWNER
a 6Ci1..3. 11 1 u'rAL
:s Gersit is issued subject to the regulations contained in the --- - REQUIRED INSV�ECTICINS --- --
:gard Municipal Lode, State of Ore. Specialty Lcdes ana all other Footing Insp l-naming Insp
applicable laws, Ai; work will be done in accordance with approved Foundation Insp I n r u l at i o n Insp
plans. This pereit will expire if work is not started within 180 Past/Beam L'tt-uct Gyp Board Insp i
days of issuance, or if work is suspandmid for Bore t n 180 Post/Beam Nechan Rain drain Insp
C . / I_r•awl l7r•ain Mechanical I-irial
I-'erm,tttee Gignratur�e �� (.� ,4 1='1..M/Uncler'flocai F'l�mb lino.!
Mrc,tianical Insp Building Final I
liasi..ted By: p'li mb lop Out Erosion C:onti,ol I
-111 t r-' inswect for er 9 -41 15
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Residential Building Permit Appiication
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
)4
Jobsite Address: !085(j •W
Subdivision: Lot# Office Use Only
7 SL �. Contact Date / / Initials
Valuation: --- � _ Result
Planck/Rec #
New Construction Only: (Square Footage) Permit #` n5t _S /r/-3
House: -734,4 Garage: _ Reissue of
Map & TL # 15 1 1-1 n - Z.Zc Q
Zone I� •S
fN Plat #
i Corner Loi? Y N Flag Lot? Y /
Approvals Required
Owner:
( /� �_�/ Planning Setbacks �V Solar
Address: U5 S,(� lV�� r � � �—' ' Engineering
9 9 --
T
c� 2 Z OtherL ( � .5
Items Required
Phone: cr 0. �-7 2, -2-- /- S 2.205—
,, � � Subcontractors
Contractor: L� �G S � � l Truss Details
Address: Other— –
Notes
Phone: LY )
Contractor's License # _
(attach copy of current Oregon license)
Contact Name: _ _ v!)Ic�(" OI_- 6--Ye e. 17—
Contact
—Contact Phone:
Subcontractors: Arch itectlEngIneer:
Plumbing: (,)U-J ) < Address:
Mechanical: ,">(_ r-) "
(attach copy of current OR Contractor's License)
Phone: L ) _
JOB DESCRIPTION: _II�C aGe ej /I Q(,
2-
Applicant Signature Applicant Phone number i
Received by: ��' . �.� ��t. i Date Received.
H Un�tllnVltyq
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Permit* Account Description Amount Amt. Pd. Bal. Dina, -
5�f) Bldg. Permit (BUILD) p� •`" ��1/� v
Plumb. Permit (PLUMB) `"0 �� ✓
�;-v
Mech. Permit (MECH) _
State Tax (TAX)
Bldg: /-3- o
Plumb:
I
Mech: 3� v
i
Plan Check (PLANCK)
A
Bldg:
i
Plumb:
Mech:
l rY D
Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R) — —
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C) --
i
Industrial TIF (TIF-1) — —
Institutional TIF (TIF-IS) `
I
Office TIF (TIF-0)
Water Quality (WQUAL) ---
Water Quantity (WQUANT) _ ------
Fire Life Safety (FLS) G,
Erosion CMrI Permit (ERPRMT) �----
Erosion Planck/USA (ERPLAN) �'`� 5
Erosion Planck/COT (EROSN) 4
� TOTALS: ��• �
r
Permit#:
Address:
'• Issued by: Date: "
Statement: Information Notice to Property owners
,About Construction Responsibilities �►
Note: Oregon Law, ORS 701.055(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. This statement is required
for residential building, electrtcal, 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,Jiled with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
ET1. 1 own, reside in, or will reside: in the completed structure.
�i2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale �
before or upon completion, a
❑ 3A. My general contractor is
(Name) Contractor reg;s. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
S '.
OR
3B. I will be my own general contractor.
If I hire subcontractors, 1 will lire 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 contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
�
(Signature of permit applicant) (Date)
(White copy to issuing ager Y permit/ile,
pink copy to applicant)
T
0
Information Notice to Property Owners
About Construction Responsibilities t
Note: This lnformation Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Hoard in accordance with ORS 701.055(5).
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 I'Alowing 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 he 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 Dept.of Revenue at 945-8091.
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 at the Department of Human Resources
at 378-3524. .',
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 at the Department of Consumer and Business Services at 945-7888. '
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 1-800-829-1040. 1
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
1
I Code compliance: As the permit holder for this project,you are responsible for resolving any failure to meet code requirements '
1111 that may be brought to your attention through inspections.
I �
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance overage for
accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures, fire,or work that must be
re-done.
i
i Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Mace sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and ftniA
trades,and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions.write or call the Construction Contractors Board(PO Box 14140,Salem,OR 97309-5052, t
503/378-4621). The Board is located at 7(N)Summer St. NE Suite 300, in Salem.
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'1
information Notice to property Owners
1 About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities k:
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).'
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. C
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 I
are paid. You will he liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the Oregon Dept,of Revenue at 945-8091. `
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 at the Department of Human Resources
at 378-3524.
Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compensation Law,and must a
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 at the Department of Consumer and Business Services at 945-7888, '
U.S.Internal Revenue Service: As an employer,you mint 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 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
i Cale compliance: As the permit holder for thi project,you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
t
Liability and property damage insurance: Contact your insurance agent to Nee if you have adequate insurance coverage for
accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures, fire,or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
sure you have the expertise to act as our own general contractor,to coordinate the work of rough-in and finish
>;xp.mise: Make, re y pc y g g
trades,and to notify building offidals at the appropriate times so they can perform the required inspections.
If you have additional questions,write of call the Construction Contractors Board(PO Box 14140,Salem.OR 97309-5052,
503/378-4621), The Board is located at 7(KI Summer St. NE Suite 3M. in Salem.
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CITY Of- T I CARD RE C E.l PT OF PAYMENT RECEIPT NO. a y:.-;- '„3
CHECK AMOUNT : 4112. 9::
NELSON, STEPHANIE CASH AMOUN T 0. 00
�EIl.�1�RE'SS PAYMENT DATE a 03/29/9
SUBDIVISION r
i
PURPOSE OF PAYMENT AMOUNT PA I D PURPOSE OF PAYMENT AMOUNT PAID
BUILDING PERM 274. 00 PLUMBING PERM -- --__. 93. 00
.
': MECHANICAL PE 47. 50 ST. BUILD PER 20. 73
PLAN CHECK FE 14. 00 EROSION CONTROL F+-.-RMT TFEE 26. 00
IFRnSION CONTROL.. PL ON CK 45 F"ROGJCIN CONTROL D, 4!5
,I
1
7
MR1'i5--0134
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y't o,FAL. AMOI.INT PAID - , 492. 93
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CAT'Y OF TIGARD -- RF.: X-.IPT (IF PFIYMF-:NT rqF.—.IC'T rin. 8915 Ecs, 14:
CHE::.Ci, AMOUNT a 175. 11.4
14 i(-,iIII d NEI._ C1CJ, Fi) CAF,li AMOUNT t IA. (btu
�1F.IL)Rr-' 533 s 1 t?h 50 SW NORTH DAKOTA ST f''AYIME NT DATE t 03/r!0/95
TIDnRD OP r..
r 9LlDI)I V I.,1 ON o
1PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT fIM01INT PAID
�I�1_AN�GHE'CE: Ft: .3•-41 R ....,.__..._--'175,. 111 ._..,._..._.,......,...__._..�_.........,._,.,.__._. _..._............._.,.,,....____ ,
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JPLAN( , IT -41P
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TUI cti W`01 1N T Flo,1 1) E 755. IS
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INSPBCTION,NOTICE �-
City of Tigard Building Depart—t (�
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspection Line ( -.0-Phone): 639-4175 Business Phone: 639-4171
Inspection:_ —. ---
G \
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwl.k
Found. Plbg. Top Out Gas Line r
Post/Beam Struct. San. Sewer Framing C -Bld�
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
•
Date Reque
ste
d:— 1 Time: _AM PM
Address:( t) _) �J 1`J �-�. Q_'� rmit �:_ I3
THE FOLLOWING CORRECTIONS ARE REQUIRED:
c+4 o
Inspector: -----�_.. Data: _2-
APPROVED
APPROVED DISAPPROVED Z. PPROVED SUBJECT TO ABOVE
_Call For Reinap.
INSPECTION NOTICE
City of Tigard Building Departamt 1\'
pp.+ 13125 Bw Ball Blvd. Tigard, Oregon 97223
naR��'}rrY, Inape tiionn Line (Rec-o-Phone): 639-4(17,5 Business Phone: 639-4171
Inspectionf
footing Plbg. Underslab Match. Rough-in Appr/Sdwlk
7 p
bund. Plbg. Top Out Gas Line FINAL:
f Poet/Beam Struct. San. Bower f[ Cvi� -Bldg.
Poet/Beam Match. Rain Drain Insulation -plumb.
r
Plbg. Underfloor Water
rLin a Gyp. Bd. -Meeh.
Date Requested: !� -CI - l Time:
C
Address
t7SC� 1�. Permit i:M.�(
Builder:
THE FOLLOWINGCORRECTIONSARE REQUIRED: T �
62 0
/� /� 144` L � t•.....
' I
I
1
1
V% �`��' Date:
InRpaotor:77" _
y APPROVED DIBAPPROVRU APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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INSPECTION NOTICE •
City of. Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection fine (Rec-O-Phone): 639-4175 Buainoss Phone: 639-4171
Inspections_
F(v:)ting Plbg. Underelab Mech. Rough--in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Pont/Beam 5tzuct. San. Sewer Framing -Bldg.
Poo-./Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Undorfloor Water Line Gyp. Bd. -Mech.
Date Requesteds_ 3& -f Time: AM PM
Address:� Permit #0_5T 13-0,�J5 _
Builder;
THE FOLLOWING CORRECTIONS ARE REQUIRED:
__T Z f��- -- - - ------ ----------
G 2- 7,1 2•
Inspectors __yc^� _-- —" Date: -�4►�/ —
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE*
Call For Reinap.
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17:CITY OFTIFARDMASTER PiKRIY11T
My flA1RD IJER0111' #. . . . . . . . fvlU T9 13-0 Q0 3
COMMUNITY DEVELOPMENT DEPARTMENT one"
13126 SW W1 Bbd P.O.Bm MW,TipM,OmWs 97M(509)639-4175
Dr,'Tr. T1:-3SUE1J.- 03/it.o/93
PARCEL: 15134PA-0-2'2*!-,
SUBD I V 19 1 ON. . . . 4 ZONIN'i. R -3. 5
BLOCK. „ . . . . . . . . . L-07. . . . . . . . . . . . . ..
.UILDING
RE I SBUE r DWELLING UNITE,3*0 BP)S'E M L:-�N T. . . . . . . . .Q1 sf
CLASS OF WORK. :114EW BEDRIvIF-3:0 BO[HIS:0 61:4RAGk . . . . . . . . . . ..0 F
TYPE OF USE. ALS FLOOR RLUUIRED
TYPE OF CONSI'. s 5N 1, 1 RST. . . . :b 0 s f I-Ef"T. 1',-".r ft R I GHT. 49 ft
r1CGuPA1\1Uy bRP. M.1 i4.AUND. . . z VA s f F*Rfjl\4'1 . :59 f t REAR. . 15 f t;
G T 0 R I E S. . . . . I TH I RD. . . s 1?1-,-61LJ I HLL)----
)KE DETEL70RS.
HEIGHT'. . . . I C" f-t TO 5.-?0 f, Styli.-
FLOOR LOAD. . . . :40 pqf VALUE'. . . . . 91,61a PARK I NO PALES. . -0
Remmr,ks : 520 SO FT OCS BUILDING UNPI'TACIAEU
PLUMBING
S I 141AS. . . . . . . . . . .0 FLOOR DRAINS. . . :0 BACKV-1.0W PRE VH I'REs. 16
LAVATORIES. . . . ,. -11.1 WOTE.R HLAJERS. . . c 0 f ROP S. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . 1.-0 LAUNDRY TRAys. . . -o CATCH DASINS. . . . . . . :0
"
WATER CLOSE"f*S. . :0 SE WER LINE (ft ) . 0 6W..AGE
DISHWISHERS. . Q1 WATER LINF (ft ) . Wj OTHER FIXTURES. . . . . :V,
GARBOUE DISPI. 0 RHIN DRAIN (ft ) . :0
WASHING MACH. :0 BF RHIN DRAING. 0
VEN,Q') . . . . . :V1 M-1111" (30� 50 1W Q.13/ 15/93 -•b*l*(J VENT FANS. . :0*0 B P L C 5�:,. 33 JUA 02/1. 7'/93 93--23
F:UE'L T'YPL UN 17 ITT Rb V, type emclull t by date rec�pt
MAX INPUT'.111 674F
FURINI i 1.00KN La`_Pc k 4. @3 JH le)3/ 15/9,3
TURN . . ..0 WOODSTOVES. i VA
r7LOOR FURN. . . . -0 LLU DWYIERS. ;1 0
3HP,tib OTHLR UNITS-0
(3�1 U U 1"L E 1"S
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10650 ,:'7)W NORIA-4 DAKO-1A 51*
TIGARD OR 972-23
Phnne #-
OWN R
Phc)ne It.,
Reg 41. . - 0000ib
1 3C,. Cir. T'0 I A L
This permit is issued iub)ect to the replations contained in the REQUIRE'D 11\114-1-1,'TIONS
Tigard Munirnpal Code, State of Ore. Specialty Cooes and all ather Forit/tuund Instil
ar
applicable laws. All work will be done in accordance with approved Fr-sminq I n s p
plans. This perait will expire if work is not started within 180 B-,iilditiq Final
days of issuance, or if work is suscended for ore t'--n i8e days. ErObiMi L-m-Ar,ol.
Permittee
By ..
Gall 1`m- iyisippcut -Lon 639-4175,
I T
t�
1
Permit No:
Address:
N z Issued by: _ Date:
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), ri+:nd 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 . L 1 own, reside in, or will reside in the completed structure.
2. C 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before ur upon completion.
3. A.C._-_l 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.
1 hereby certify that the above Information is correct and that I have read and understand
the Information Notice to Property Owners about Constructic'n Responsibilities on the
reverse side of this form.
Sj&ature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
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 Contactors Board in accordance with QRS 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 riot 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 rnor,, 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 378-32.24.
i
r,
Workers' Compensation Insurance; As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain wcirkers' compensation insurance for your employees. If you fail to obtain workers'
1 compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your x
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:
j
Code Compliance_ As the permit holder for this project, you are responsible for resolving any failure to meet
i
code -re*quirements that may be brought to your attention through inspections.
I
Liability and Property Dtirnage 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.
'rime to Supervise Employees: Make sure vou 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.
0
If you have additional questions, write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
j Phone 503-378-4621
0244J 10/24/89
,
s
+'j�'1GAR �(('� , `[� 13115 SW HolDW& PLNCK/RECT N �� - V •
CITY OF 1 PERMIT /
COMMUNITY DEVELOPMENT DEPARTMENT '[1pc4��'1 I
(SO3)09417 DATE ISSUED
-� 1��) S c� S� (,� S T� TAX MAP/LOT /S 1,3(t p q -022 a0
JOB ADDRESS:
SUB: ----- 4.
LOT: LAND USE:
� l
VALUATION: � d i
WN R SPECIAL 0 S
REISSUE OF:
NAME: C� cN 0 z. I a //
S f LAST REISSUE: _
ADDRESS:
FLOOD PLAIN/
PHONE: SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME:
L� /� e Jr PLANNING:
_-- �—
ADDRESS: ENGINEERING: —. —
i
FIRE DEPT:
�c�� �' 73; OTHER:
PHONE:
CONTR. BOARD #: .__ EXP DATE:
ITEMS RE UIREO
i SUBCONTRACTORS: PLUMB: —_ J
LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH/ENGINEER CALCULATIONS:
1 NAME: -- __ — TRUSS DETAILS:
ADDRESS: OTHER: —
,
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SIGNATURE
Date Received:
Received By: - - - k
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PERMIT # ACCT 0 DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE"
/hs tio5s 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees ------
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)j
—3
Building
Plumbing
Mechanical
3
10-433 00 Plans Check Fee
SL
Building z '3
I
Plumbing
Mechanical j
10-230 06 Fire r �
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)
2,3
TOTAL_
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LIABILI M The City of Tigard, Oregon, or it'
em loyees, shall not be responsible fur �.
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