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CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171
CERTIFICATE OF
OCCUPANCY
PERMIT #. . . . . . . : MS"f96-u �
DATE l`.'SUED 11
F'ARCEI. : c:O114E1A-. 1C7OO
SITE ADDRESS. . . : 09750 SW DUR14AM RD
CiUHUI V ISION. . . . : IrILP?C+-001 t ZON1N6:R--4. °i
SLUCK. . . . . . . . . . I LOT. . . . . . . . . . . . . t00O ! itipiSDICTIONITIG
CLASS OF WORK. :NEW
TYPE or ME. . . I SF
TYPE OF CONSTRI5N
UCCUPANr:,Y GRP. z R3
OCCUPANCY LOAD I i
m a<r k s : PATH 1 CtW00 BLOCK Hp115E:
l Tat D KOL BU
+7j,0 CW DURHIAM RD
(BARD OR 97P23
Phone Ile '68-7208
unt r act or; _.•. ........__._._.._._.__....._.__.____,._..._ .
CNAN1 pE.C•r APPROVAL FROM OWNER
11orla± M:
Oq #. . 1 000131
'iris C:er-tifieiate gr•arits accuparncy of the above- r-eferanced bktilrJing (it portion
hereof and confir^ms that thR building has teen inspected for i_uwpliAnce witf
girt ritate of Or-egori S eciatlty Cc>rles for the qr p, 0c.11: rpancy, and k.rge under
;ric:h tI e refer er-mit was � nn�_red.
U DING INS Crl7R BUT DING OE'FICIAL
PCI,'r 11\1 CONSP I U!OU;7, PLAC'F
J
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phonn: 639-4171
Date Requested: p /? A.M. '� P.M. MST: 9,6 ct.2 a y
Location:_ 9 2 zrcAJ �4r)/L /-tog e-n BUP:
Tenant: — Suite: Bldg: NEC: _
Contractor: Phone- PLM:
(honer: 4� / 111 /�Q / Phone: ELC:
T -> 121 ELR: _
_ SIT:
BLDG(con't) CHANIC SITE
Site Post/Beam Post/Beam Post/Reum Cover 'ce Sewer/Storm
Footing Roof UndFl/S18b Rough-In Ceiling Water Line
Slab Framing Top Out Gas bine Rough-In UG Sprinkler
Foundation Insulation Sewer flood/Duct Reconnect Vault
Bsmt lamp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr I]cat Pump Low Volt _
Approved
Appr/Sdwlk Not A roved Not Approved PINAL
roved �FNALro
ved Not Approved
NAL FINAL
0 Cell for reinspection O Reinspection fee of S__.!__—required before next inst+cction O Unable to inspect
Inspector: _ .. late: ���_ Page of
RMIT
CITYOF TIGARD MLRMI'R #.. . . . . . .. 11ST96-0L:94
COMMUNITY DEVELOPMENT DEPARTMENT 1)f-s I E: ISSUED: 07/05/96
1;125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171
-JA : 2S 114 13 F)-16 7�so
F ALTRI=SS. . . s 0'3 7cil�l !3W DURA(-TM RD
UL-ADI VISION. . . ., : ML.P95-001 1 ZONING. R-4. 5
. . . . . . . . . . . L O T'. . . . . . . . . . . . . s c'
Remsvks: PATH 1 CONFORM BLOCK HOUSE
---------------------------------------------------------------- BUILDING -------------------------------------------------
--------------
REISSUE: STORIES.......: 1 FLOOR AREAS---------- BASEMENT...: 968 if REQUIRED SETBACKS---- REOUIRED-------------
CLASS OF WORK.:NEW HEIGHT........; 22 FIRST,...: 1632 sf GARAGE.....: 516 sf LEFT..........: 6 SMOKE DETECTRS: Y
TyuE OF USE...:SF FLUOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 20 PARKING SPACES: 1
TYPE OF CONFIT.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT....,....: 5
OCCUPANCY GRP_R3 BDRM: s BATH: 3 TOTAL------: 1632 sf VALUE..[: 129643 REAR......,...: 30
--------------------•------------------------------------------- PLUMBING -----------------------------------------------------------•----
SINKS.........- 1 WATER CLOSETS.: 3 WASHING MACH.,: 1 LPJNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....- 3 DISHWASHERS...: 1 FLOOR DRAINS..: C SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 0
T(.3/SHOWERS...: 2 GARBAGE DISP,.; 1 WATER HEATERS.: 1 WATER LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS..: 0
OTHER FIXTURES: a
--------------------------------•------------------------------- MECHANICAL ------------------------------------_.------------------------
FUEL TYPES----------- FURN ( 100K ..: 0 BOIL/CMP % 3HP, o VENT FANS...... 4 CLOTHES DRYERS: 1
/GAS/ / / FURN )=1001( ..: 1 INIIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...; I
--------------------------------------------------------------- ELECTRICAL -------------------------------------------------------------
--RESIDENTIAL UNIT— ----SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCFI CIRCUITS--- ----MISCELLANEOUS---- --PDD'L INSPECTIONS--
1000 SF OR LESS: 1 0 - ,00 Rep..: 0 0 - 200 Rep..: 0 W/SVL OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 5009~.; 5 201 - 400 amp..: 0 201 - 400 o•c..: a Ist W/0 SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR.....,: 0
i.IMITED ENERGY.: 0 401 - 600 amp..: 0 401 - h00 amp..s 0 EA ADDL HR CIR: 0 SIGNAL/PANEL,..: 0 IN PLANT..,,..: q
MANE HM/SVC/FDR: 0 601 - 1000 Rep.: 0 60l+amps-1000 v: 0 hINOR LABEL -10. 0
1000+ amp/volt.: 0 ----------------------------------- PLAN REVIEW SECTION ----------------- -------------...
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 630 V NOMINAL: rLS AREA/SPC OCC:
---•-•------------------------------------- -------- ELECTRICAL - RESTRICTED ENERGY ---------------------—--------------------------____
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL---------------------------------------------------------------------------
AUDIO I STEREO.: VACUUM SYSTEM..- AUDIO 6 STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..i OTH: :: X BOILER.........; MVAC...........: LANDSCAPE/IRR16: PROTECTIVE 51GNL:
GARAGE OPENER..- CLOCK..........: INSTRUMENTATION: MEDICAL......., : OTHR:
HVAC...........: DATA/TELE COMM.: NURSE LALIS....: TOTAL M SYSTEMS: a
Owner: ----------------------------------Contractor: ----------- ---- ------------ ',?TAL FEC•S:t 4412.70
KEITH KOLBU OAR
0972@ SW DURHAM RD
TIGARD OR 97223
Phone t: 968-7208 Phone 0:
Reg N..: 13125
This oervit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
appisr,able laws. A11 work will be done in accordance with approved plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspended for, more than 180 nays.
-------------------------------------•-------------- -- REQUIRED INSPECTIONS ---------------------------------Y.�..------------------
Footing Insp F'LM/Underfloor Framing Insp Gyp Board Insp Electrical Final
Foundation Insp Mechanical Insc� Shear Wall Insp Rain drain Insp Mechanical Final
Post/Beam Struct Plumb Top Out Low Voltage Water line Insp Plumb Final _
4,ost/Beam Meehan Electrical Servs bas Line Insp Water Service In Building F;r.al
Crawl [train Electrical Rough psis 1 tion ' s Appr/SdwJk Insp Eresion Control
F er m> ttee '�1ignati_tre : _A Ef-{ IssQed 13
Y �
Ca 11 for inspection - 639-4175
SEWER CONNEL [ ION
PM IT
l�� OF TlG�R® PE RERMIT #. . . . . . . : SWR96-0278
COMMUNITY DEVELOPMENT DEPARTMENT DATE IS SUED: 01/03/96
13125 SW Hall Blvd.Tigard.Oregon 97223*8199 (503)639-411711
PARCEL: .7S114BA-16700
1-31 I'L ADDRESS. 09750 W DURHAM RL)
SURD I VI S A ON. NLP95-001 1 ZONING. R--4. 5
BLOCK. . . . . . . . LOT. . . . . . . . . . . . .
TENANT NAME. . . . . 9
USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
CLASI,*:, OF W(JRK. . . :NEW DWELL I NG UN 11 S. . : I
TYP'E (IF USE. . . . . :SF NO. OF BUILDINGS: I
INSTA'-1- TYPE. . . . :BUSWR IMPERV 0 of
Remarks : PATH I CONFORM BLOCK HOUSE
Owner. FEES
1%-1 1 H KOLBU type aincli.int by date recpt
09720 SW DURHAM RD PRMT $ 2200. 00 JSD 06/el/96 96-280874
I N1,P $ 35. 00 JSD 06/r, 1/96 ')G+ 4
11CARD OR 97223
'hone #. 968-7208
Contractor-
CONTRACTOR NOT ON FILE
Phone #z 70TAL
REQUIRED INSPECTIONS
This Applicant agrees to cos;,ly with all the rales and regulations Sewer Inspection
of t1e Unifineq zwage Arv,ncy. The pervit expires 180 days froo
the Odie Issued, Tr- otal asount pard will be forfeitrd if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurevent
given, the installer shill prospect 3 feet in all directions fro@
the distance given. 14,F not so located, the installer sriall purchase
a "Tap and Side Sewer Pervit and the Agency will install a lateral.
r m i t t e r (5 i q n a t Lt r,e
' " Y I-,(I/
1• 1,k e d 13 1
Call f cr r inspection 639-417`;
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171G
�it,
Jobsite Address: 77V Slyy{�Yr� I�fiC '"
1��.� ,,� Office Use Oni
Subdivision: t t.�'J Lot#19
--�-
1 64
7 Contact Date / l�,' I /f Initials
Valuation: .7 Result
T
New Construction Only: (Square Footage)
��
/ 414-1 "`'"'^r Permit #�jkLc=LZ.�
House. ,� ? _ Garage: —_ Reissue of
Map & TL# ;/
Corner Lot? Y one
0-�
Flag Lot? Y
Plat
Owner:
Approvals Required <d�V
Address: - �17ZQ ✓1,�.� �tt-C�v� �c - � IjNr1 ?
O Planning Setbacks Solar
U��CC Engineering C !4 S ., pis– •7a ? vizi yam,
Phone: ( 503be -1200 —_�_ Other
Contractor: r-.,)IvI Ir I,' V)I �+_t V
Items Re uired
i ( };l -, i i Subcontractors
Address: _
Truss Details
Other _
--- Notes G r_ U -5 0/��
Phone:
Contractor's License
(attach copy of current Oregon license)
Contact Name:
Contact Phone:
Subcontractors: Architect/Engineer:
Plumbing: _ :%WOC � ,_^--^-- Address
Mechan cal. ----- -----.._._---- ------
(attach copy of current OR Contractor's License,
y Phone:
JOB DESCRIPTION:
Applicant Signature Applicant Phone number
Received by: _._ Date Received: 1
»iogn.rn....00
Permit # Account Description Amount AML Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mach. Permit (MECH)
ax Mw)
Mw) ���„=��,` y
Bldg:
Plumb:
Mech: a 2
Plan Check (PLANCK) !+ L'
Bldg:
Plumb.
Mech:
Sewer Connection (SWUSA)
Seiner Inspection (SWINSP)
Parks Dev Charge (PKSDC) _ �—
Residential TIF (TIF-R)
r
Mass Transit TIF (TIF-MT) _ Z{/ /2_,
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional T;F (TIF-IS)
Office TIF (TIF-0)
Water Quality (n;QUAL)
Water Quantity IWQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN) f. 1 5r.;
TOTALS:
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Permit#•
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Address:
Issued by: — _ Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construct:nn permit appli-
cants who are not registered with the Construction Contractors Boa-d to sign the
following statement before a building permit can be issued. This statement 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
qn 1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the struciure is sold or offered for sale
before or upon completion.
LJ 3A. My general contractor is
LJ (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 I change my mind and hire a general contractor, l 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 th t eih ve lnforrrptW i cg4'rect and that I ha ve read and do understand the Informat'ion
Notice io Proper h t C s n Responsibilities on the reverse side of this form.
(Signature of permit applicant) _ (Date)
(White colyr to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction ResponsibilWas
Note: This lgformation Notice to Property Owners about Construction Responsibilities
vva.s devel,)ped h%•the C"onstruction C'ontrctc tars Board in accordance with ORS 701.0550).
If you are acting & your Mit Cantractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board Ir do tabor 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 fallowing:
Oregon's withholding tax law: As an empinver,you must withhold income taxes from employee wages at tht,time employees
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 (h-egon Dept. of Revenue at 945-8091.
Unemployment insurance tax: As an employer,you are required to pay a tax for unemployrnent insurance purposes on the
wages of all employees. For more information,call the Oregon Iimployinent Division at the Department of Human.Revources
at 375-1524.
Workers'compensation insurance: As an employer,you are,subject to the Oregon Workers'Compensation Law, ir,ci roust
obtain workers'cotnj)vn,,,nion insurance for your employees. If you fail to obtain workers'compensation insurance,you'may
he subject to penal(U-m)d will he liable for all claim costs if one of your employees is injured on the job. For more informgtion,
call the Workers'Cot Division at the Department of Consumer and Business Services at 945-7889.
U.S. internal Revenue Service: As an employer,you must withhold federal income twt from employees'wages. You wil I he
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:
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 properly damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such m,fading tools. print overspray, water damage from pipe punctures, fire,or work that must he
r<-dune.
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 awn general contractor,to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times eo they can perform the regtliird inspections,
If you have additional questions, write or call the Construction Contractors Board WO Box 14140,Salem,OR 97309-5052,
503/178-462'). The Board is located:t 700 Summer St. NH Suite 300,in Salem.
prop-own.pm 4
1/94
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Plumbing Signature Form
Permit # . . . . MST96-0294
Date Issued. : 07/05/96
Parcel . . . . . . : 2S114BA-16700
Site Address: 09750 SW DURHAM RD
Subdivision. : MLP95-0011
Block . . . . . . . . f ( ,? - 2
Zon.ing. . . . . . : R-4 . 5
Remarks :
PATH I CONFORM BLOCK HOUSE
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual frorn your company sign
below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FCRM
WHIFF? PLUMBING CONTRACTOR:
KEITH KOLBU OWNEr
09720 SW DURHAM RD
TIGARD OR 97223
Phone # : 968-7208 Phone # :
Reg # . .
X
Signature of Authorized Plumber
Please return this completed form to the address &Jove.
ATTN: Building Dept.
If you have any questions, please call 639 41 71 , ext. #310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Forin
Permit # . . . . : MST96-0294
Date Issued. : 07/05/96
Parcel . . . . . . : 2S114BA-16700
Site Address : 09750 SW DURHAM RD
Subdivision. : "T,P95-0011
Block . . . . . . . : : 2
Zoning. . . . . . . R-4 .5
Remarks :
PATH I CONFORM BLOCK HOUSE
Your company has been indicated as the electrical contractor for the permit indicated above. In
order for the electrical permit to be valid, the signature of the supervising electrician
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be authorized until
this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
>WNER: ELECTRICAL CONTRACTOR:
KEITH KOLBU OWNER
09720 SW DURHAM RD
TIGARD OR 97223
shone # : 968-7208 Phone #:
Reg # �)
Signature o ul upery s g Electrician
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-417 1 , ext. #310