11125 SW 119TH AVENUE #wj
11125 SW 119TH AVENUE --
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection — —
Date Requested Time A.M. P.M.
Address
Owner _
—
Lot #
Builder
The following Building Code deficiencies are required to be corrected*
Presented to pproved
Inspector / ❑ bltepproved
Date
CALL FOR REINSPECTION
YES Ll NO
i
INSPECTION NOTICE
�G
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phoney 639-4175
cga�-346
Type of Inspection
Date Requested __ 7 — Time A.M. P.M.
Address ���r�s 1 _ Permit #"& ' ))
Owner ___ Lot *150 P-
Builder
The following Building Code deficiencies are required to be corrected:
Presenters In _._ -- -- �PrOYed
Inipeclot _ _ [] Disapproved
Date r Z --
CALL FOR REINSPECTION
0 YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 ; f
Tigard, Oregon 97223 /
Phone: 639-4175
4-11
Type of Inspection -- Z-A '1-6=
,
Date Requested_.___ -3 7,-2 3 ._lG Time A.M. P.M.
Address ZZ/o;L 5 Permit #. L
Owner "_ Lot #
Builder
The following Building Code defici cies are required to be corrected:
Presented to Approved
Inspector .fir'% n Disapproved
Date
CALL FOR REINSPECTION
YES C NO
v
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CITY®F TIGARD I � BUILDING PERMIT
PERMIT 4t. . . . . . . : BUpq0_00--/(_i
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. P.O.Box 21397,Tigard,Oregon 97223 I P R 111. PERMIT #. : BUP90..-oo79
DATE ISSUED: 03/23/90
SITE* ADDRESS. . . .- 11125 E)W :1191+1 r_1V PARCEL: IS134CA—OV507
SUBDIVISION. . . . . PONOROM() N(J. 2 ZONING: R-4. 5
BLOCK. . . . . . . .. . . .* LCYT. . . . . -. 113
REISSUE: FLOOR AREAS---------------- EXTERIOR WALL CONSTRUCTION—
CLASS OF WORK. 2W@* FOdd FIRST. . . . :50 sf N: S: E: W
TYPE OF' USE. . . :;,,)r SECOND. . . : sf t-,ROTECT
TYPE OF CONS1 . :5N THIRD. . . . :00 sf N.. S.- E: W.-
OCCUPANCY GRVI. :Ml TOTAL—..... 50 sf ROOF CONST: FIRE RET'?:
OCCUPANCY L.DAD. BASEMENT. : sf AREA SEP. RATED:
STOR. P HT. : -f t GrqRAG1:,.. . . " Sf OCCU SEP. RATED-.
BSMT?: MEZZ'?-. REOD SETBACKS—-—-------- REQUIRED—._..."._.___...._
LOOR LOAD. . . . u Psf LEFT: ft RGHT: ft FIR SPKLc SMOK DE*T*. . -.
DWELLING UNITS: FRNT: ft RI:.--A R ft; F_TR ALRM- FINDICP ACC:
BEDRMS: BATHS: IMP SURFACE:: PRC) CORR: PARKING:
VALUE. $:,5e-,( :`SPO
Reni.v(+.s
Owner: FL:ES
ANDY FABIAN tY 1:)e arnaLtilt by (Jata vecpt
11125 SW 119TH AVE PAYM $ 15. 75 JLH 03/22/90 10'7976
,TIGARD OF., '.372213 F I RM T $ 15. 00
("'hone #: 620--2342 5PCT $ 0. 75
OWNER/CONTRACTOR
— ..........
F.Iharie 14:
Re4 #. . : OWNER $ 1.5. 75 'TOTAL
REOUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Final Ins peri tiorl
Tigard Municipal Code, State of Ore. Sperialty Codes and all other
Applicable laws. All work will be done in accordance with ............... ........
approved plans. This permit will expire if work is net started ..............
within 18@ days of issuance, or if work is suspended for sore
thAv 18P days. .........
.................
Pp-rnii.t Lee 5'i q llatLl re
...... ..............................................
I s s tt e d B y
Call f lis Pee t i c)n 6 3 94175
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—C1 1Y OF TWARD
CnY0FDGAW PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT / PLAN CHECK N /—q
17125 S.W.HA Mvd-P.O.Box 23397,Ti9sg%t 0mgm 9722:1..(503)63%4175 PERMIT N _&
DPTE ISSUED
v_
JOB ADORESS: , ,5 !�� //_J Z�41 TAX MAP/LOT /JI 3C/C 51 7
SUB: _ _ LOT: I-AND USE: _
VALUATION:
OWNER SPECIAL NOTES
NAME: _ ,•� N .. ;, f' l;�. _.— REISSUE OF:
ADDRESS: ,,, 1 .s�L�l l��>� ,{/� LAST REISSUE:
FLOOD PLAIN/
SENSIIIVE LAND: _
PHONE: —
APPROVALS REQUIRED
CONTRACFO_R PLANNING:
NAME: (J'Z�J7 Z�iZ ENGINEERING:
ADDRESS: _ _ FIRE DEPT _
OTHER:
PHONE: _ _ ITEMS REQUIRED
BUILDERS BOARD 0: EXP DATE: LIST/SUBCONTRACTORS:
BUS TAX: _
ARCH/ENGINEER CALCULATIONS:
NAME: _ TRUSS DETAILS: _
ADDRESS: OTHER:
PHONI_: — - ----^-
COMMLNTS:
SUBCONTRACTORS: PLUMB: MECH:
PERMIT H ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees i.5 , (�
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10--230 01 State Building Tax (5X) 2
Buiilding
Plumbing
Mech _
10 433 00 Plans Check Fee _
Building
Plumbing __—
Meeh
30-202 00 Sewer Connection
30-444 00 Sewer Inspection _
51-448 00 Streest System Dev ('barge (SDC)
57-449 00 Pares System Dev Charge (PDC)
31--450 00 Storm Drainage Syst Dev Chrg (SSDC)
10-730 06 Tiry _ _
TOTAL 1 - Z 7
-•� REC N
APPI.ICANZT�SIGNATURE
Received By: _ Date Received:
cn/3581P/18P
F Permit No:
Address: 11L2�S�117J_
Issued by:_ _ Date: _
'• r
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit app icants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
4 1. W�M I own, reside in, or will reside in the completed structure.
2. A. = My general contractor Is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Hoard.
OR
B. O' I will be my own general contractor.
If I hire subcontractors, I will hire only subcuritractors registered with the
Construction Contractors Board. If 14,-inge 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 imrnediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above Information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibllities on the
reverse side of this form.
gnat e-Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244) 10/24M
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
TN
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT c,ONSTRUCTiON RESPONSIBILITIES
NOTE: This information Notfce to Property Owners About Construction
Responsibilities was developed by the Construction Contractors Board in
accordance with ORS `701.055(5), passed by the 1980 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substantial Improvement
to an exicAing 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 follo: ing:
Oregon's Withholding Tax Law. As an employer, you must withhold income taxes from employee wages
at a mee— rnpl16yees arN paid. You will be liable for the tax payments riven if you don't actually withhold
the tax from your ernployees. For more information, call the Oregon Department of Revenue at 378,M90.
Unem lu n-Ient Insurance Tax: As an employer, you are required to pay a tax for unemployment insurant,e
purp:tses on the wage- s T57employees. For more information, call the Oregon Employment Division DHR
at 37841224.
Workers' Com ensation Insurance. As an employer, you am subject to the Oregon Workers' Compensa-
i on aw, arl mU-910--b an wo ers compensation Insurance for your employees. If you fall 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 3737434.
U.S. Internal Revenue Service: As an employer, you must withhold federal Incorne tax frorn employees'
wages.YOU Will e IlaRe or ie tax payment even if you didn't actually withhold the tax. For more Informa•
tion, call the Internal Revenue Service at 221.39130.
O)HER RESPONSIBILITIES AND AREAS OF CONCERN:
CodeComplliaiwe: Ae the permit holder for this proje( t, you are responsible for resolving any failure
to meet code rhquiretnents that may be brought to your attention through Inspections.
Liability and Property Damage Insurance, Contact your Insurance agent to gee If you have adequato
Insurance coverag—eTor acC r ents an omisslons such as falling toolR,paint overspray,water damage
from pipe punctures, fire, or work that must !,v til-done.
Time to Supervise Employees: Make -guts yuu have sufficient time to supervise your employees.
Expertise. lkgake sure you have the expertise to act as your i)wn general contractor, to roordlnate
the work of rough-In and finish trades, and to notify brrllding officials at the appropriate times so
they can perform the required Inspections.
It you have additional questions, write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
0244) 10124169 Phone 503-3711.4821
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II
CIT`i' OF TIOARD RECEIPT OF PAYMENT FCC NO: CIU jrj'797&
CHECk. AMOUNT s 15. 10,51
NAME: GOLUA FA81AN CASH AMOUNT .00
ADDRESS: 11125 SW 119TH AVE P'AYMEN'T DATE 0 '22—9
TIGARD. OR 9-7.22-5 61-00- NO/APDRI
PURPOSE OF F'A'YMENT AMOUNT PAID PUPPOfiE OF PAYMENT AMOUNT PAW
iI
TOTAL AMOUNT PAID
WEULNIMM
CITY'OFT11FARD ' NICAL
COMMUNITY DEVELOPMENT DEPARTMENT � M
RT
13125SWfW0tvd P.O.Bac23397,Tgant0mgaKW=(503)6394175 PERMIT . . . . : MEC90-0049
MES0-0049 — ----
DATE ISSUED: 03/09/90
SITE ADDRESS. . . : 11125 SW 119TH AV PARCEL: 1S134CA-00507
SUBDIVISION. . . . : PANORAMA NO.2 'ZONING: R-4.5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :18
--------------------------------------------------------------------------------
LLASS OF WORK. . :ALT FLOOR FURN. . . . : EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . :
OCCUPANCY GRP. . :R3 VENTS W/O APPL: VENT SYSTEMS:
STORI_ES. . . . . . . . : BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL TYPES----------.--- 0-3 HP. . . . :1 DOMES. INCIN:
:/ELF'/ / / 3-15 HP. . . . : COMML. INCIN:
MAX INPUT: BTU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS?— : 30-50 HP. . . . : WOODSTOVES. . :
GAS PRESSURE. . . . 50+ HP. . . . : CLO DRYERS. . :
NO. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. :
FURN < 100K BTU:1 <= 10000 cfm: GAS OUTLETS. :
FURN >=100K BTU: > 10000 cfm:
Remarks: New heating system -- electric furnace, heat pump, duct work
Owner: ----------------------------------- ---------------- FEES --- -----------
ANDY FABIAN type amount by date recpt
11125 SW 119TH AVE PRMT $ 22.00
5PCT $ 1..10
TIGARD OR 97223 PAYM $ 23.10 .ILH 03/09/90
Phone N:
Contractor: ------ ----------------------
SPECIALTY FABRICATION
9394 SW TIGARD ST
TIGARD OR 97223
Phone #: 5036205643 $ 23.10 TOTAL
Reg N. . : 48313
------- REQUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All 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 days. �— --—
Permittee Signature: -
Issued BY!
Call for inspection - 639-4175
CITY OF TIGARDReceipt#
MECHANICAL PERMIT
13125 SW HALL BLVD. Permit kale C 46-6e��y
P_ O. BOX 23397s 1 )O. -o-7
23397 :5q C_ � oescriplion
T IGARD, Olt 9 7 2?_3 I O.-o- Table 3A Mechanical Code — CITY PRICE AMT
(503)639-417.5 1) Permit Fee -0- -0- 10.00
Name,of 0Nvetopment
2) Supplemental Permit 3.00
Job Arwress 1 Furnace to 100,000 BTU 6.00 -
Address I� 2 5 S�✓ /rfp� '+ YE I ) incl.ducts 8 vents
Tax Lot Map No. ) Furnace 100,000 BTU t
2 incl.ducts&vents 7.50
Lot Block Subdivision —
Name(or name or business) 3 Floor Furnace 6.00
kio�. JQ§ ,,1 6j,�� 2 ) incl.vent - _-
Mailing Address / Phone 4) Suspended heater,wall heater 6.00
Owner .L S S //� or floc mounted heater
City/State Zip 5) Vent not incl.in 3.00
'7 1.AVL-,O 02 9 7 y Z, 3 appliance permit -
Name(or name of business) 6) Repairof heating,refrig., 6.00
cooling,absorption unit
Mailing Address Phone 7) Boiler or comp to 3 HP 6.00
Occupant absorp.unit to 100,000 BTU CO
OtyrStale Zip 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU
Name y) Boiler or comp 15-30 HP 15.00
SAL G/ e'7 Z f}7iYG , ?S //V e, absorp.unit 1/2-1 million
Mailing Address Phone - 10) Boiler or comp to 30-50 HP 2250
absorp.unit 1-1.75 million
Gontractor Boiler or comp to 50 HP
City/State Zip 11) 31.50
absorp.unit 1,750,000 BTU
Slate Registration No. City Bus.Tax No. 12) Alr handling unit to 4.50
10,000 CFM _
Air handling unit
I hereby acknowledge that I have read this application that the inlormation given is 13) 10,000 CFM + 7.50
correct,that I am the owner or authorized agent of the owner,that plans submitted are in --—
axnphince with State laws,that I am registered with th9 State Builders'Board,that the 14) Non portable 4.50
number given Is correct.(II exempt from State registration please give reason below). evaporate Cooler
15) Vent tan connected 3.00
to a single duct
— —— - -- Ventilation system not
16) 4.5U
included in appliance permit
17) Rby 4.50
mechanical
anicalnkat exhau
Signature(owner or agent) Date t 8) Domestic type 7.50
Describe work ❑ addition ❑ alterations repair ❑ incinerator
to be done residential '4 non-residential ❑ 19) Commercial or industrial 30.00
Existing use of _type incinerator
building or properly —. 20) Other i.e.,woodstove,water 4.50
Proposed use o1 heater,solar,clothes dryers,etc.
building or property_ — 21) Gas piping one to lour outlets 2,00
Type of fuel- oil ❑ natural gas ❑ LPG ❑ electric L)
22) More than 4-per outlet
NOTICE
SUB-TOTALTHIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 57.SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 1 IME AFTER
WORK IS COMMENCED. TOTAL
Special l'onditton:
Date issued by—-- _
I
1
i
CITY OF T I GARD RECEIPT OF F'AYMLNT REG NO:
CHEa AMOUNT 2". 10
HAME..: SPECIALTY HEATING & FAE+ CASH AMOUNT .00
r+1)Df'E9448 SW TIGARD ST PAYMENT UiTE= a 0`-09--':LO
TIGAP.D. CIR aryxi.` 90U, NO/ADDRI I'
t 11 5 N 119TH AVE
PURPOSE OF PAYMENT AMOUNT PAIS) P'URP'OSE OF FA'�MENT AMOUNT FFiIU
I
MECHANICAL- PERM 190-004G) 30 STATE BUILD N-:RMIT TAX c7-` ) 1 JL)
I�
_ _
TOTAL. AMIJEJtJ T P pa l E? _ '. 10
1
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 964 DATECc
PERMIT 1S GIVEN TO
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT 1,1I1S PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
I'LETIsD.
-' cam...
PERMIT FEE PAID ;..... ........ ..............TIGARD SANITARY DISTRICT
By
CONNI.-CTION INSPECTED jND APPROVED
I)A'
8upeelntenden--- t --
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Address///-24-- Permit No.___Q��.
Name of Occupant___ _ a Permit charge _
------ ._ ----. .-_-- —_- Connection fee
-- -
-------------- -- aid by--
- Date connected L�'7_
Type of Building Inspection fee
Service Rate Paid by _ Date
Contractor Assessment_ Paid
Size of connection
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 952 DATE _ - --- - ------
PERMIT IS GIVEN TO
OF ---- - --..
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT I ---
THIS PERMIT MUST BE POSTED ON THE DE4CRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
"'�
PERMIT FEE PAID $..... .....ru v...........TIGARD SANITARY DISTRICT
BY
CONNUMION IN5PECTED AND APPROVED
-- - Date --�—Superintendent _