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CITY CF TIGARD PERMIT #.. . . . . . . MST'.
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 107/22/96
13125 SAN Hall Blvd.Tigard.Oiagon 97223.6199 (503)639.4171
Pt-4rL`EL: 1 S1 33DC..tZt>.:s00
. . i...: ,_ I.— - . . I I .3 SW f-FALC ON RISE DR
JbDIVISICIN. . . . : MOONING 1,111--. NO. 1 ZONING: R-7
.(JCK. . . . . . . .. . . 1_01.. . . . . . . . . . . . . :41
+arks( Interior remodel
------------------------------•-------------•------- ------ BUILDING ---------------------------------------------------- ------
ISSUE: STORIES....... : FLOOR AREAS----------- BA5EMENT,..: 0 sf REWIRED SETBACKS---- REDUIRED--•-••-----
-LASS OF LURK.:ALT HEIGHT........: 0 FIRS1....: 0 sf GARAGE...... 0 sf LEFT..........: 0 SMOKE DETECTRS: Y
I4,E OF USE... :SFA FLOOR LOAD..... 40 SECOND.... 0 sf FFONT........... 0 PARKING SPACES:
YPE OF CONST.:514 DWELLING UNITSt 1 FINBSMENT: 0 sf RIGHT.........; 0
"UPANCY GRP,:R3 BDRM; 2 BATH: 4 TOTAL----•--: 0 sf VALUE..1: 10000 REAR..........; 0
----.----.---------------------------------------------------- PLUMBING -----•--------------- -----------------------------•------------.
WS.I........ 0 WATER CLOSETS.: 2 WASHING MACH..: 0 LAUNDR'i TRAYS., W RAIN DRAIN ft: 0 TRAPS.........: 0
)HTOK6....: 2 DISUSHERS...: 0 FLOOR DRAINS_: 0 SEWER LINE ft: 2 SF RAIN DRAINS: 0 CATCH BASINS.. : 0
14/90WERS...: I GARBAGE DISP,.: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
_-----------------------------------••-------------------- MECHPAICAL ---------------------------------------------------------------
.kL TYPES---- ----- FURN ( INK ..: @ BOIL/CIS' ( 3HP: 0 VENT F,MS...... 2 CLOTHES DRYERS: 0
.:AS/ / / FURN )-100X. .. : 0 EMIT HEATERS..: 0 HOOi3.......... 0 OTHER UNITS...: 0
4 INP.: 0 BTU FLOOR FURNACES: 0 VENTS......... : 4 WOODSTOVES....: 0 GAS OUTLETS...: 0
--------------•----•-------------------- ---•----------------- ELECIRICAL ----•------------ - -- -------------------------- — -- -._..
RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-•- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS
x°40 SF OR LESS: 0 0 - "00 amp., : 0 0 - c00 amp,,: 0 WiSVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
ADD'L 500SF.: 0 201 - 400 alp..; 0 201 - 40N amp..: 0 1st W/O SVC/FDRi 1 SIGN/OUT LIN LT: 0 PER HOUR......: 0
.MITED ENERGY.: 0 401 600 am,-.. ; 0 401 600 amp,. , 0 EA ADDL BR CIR: 1 SIGNAL/PANEL...: 0 IN PLANT:..... : e
NF HM/SVC/FDR: 0 601 - 1000 amp. : 0 601+amps-1000 v: 0 MINOR LABEL -10: 0
NW4 apply It.: s ------- ---- ------ PLAN REVIEW SECTION ------------ --- ---.. -
Reconnect oily.: 0 )-4 RES UNITS..: SVC/FDR)=225 A.; ) b00 V NOMINk. CLS AREA/SPC OCC:
_-------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ------------------------------------------....--------
SFRESIDENTIAL---------------------------- B. COMMERCIAL-------—---------------------------------------------------------------------
.:10 A STERED.: VACUUM' S�;',TEM..: AUDIO L STEREO.: FIRE ALARM.....; INTERCOM/PAGING: OUTDOOR l-NOSC LT:
RGLAR ALARM.,: UTH; :: BOILER.......... HVAC...........; LANDSCAPE/IRRIG: PROIECTIVE SIGNL
,RAGE OPENER.,: LLDCN..........: INSTRUMENTATION: MEDICAL........; OTW-
,WC...........; DATA/TELE COMM.: NURSE PP.LLS.....I TOTAL. 0 SYSTEMS: 0
,ner: ------------------------_...-------------Contra,:tor: ------------------------------ TOTAL ',EES:$ 270,31
,'_ENTht aEICIARU OWNER
.145 SW FALCON RISE DRIVE
GARD OR 97223
-one 01 503-5e4-9119 Phone #:
Reg #.. :
is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codps and all othe
plicabie laws. All work Mill be done :n acc r,dance with approved plans. This perir;t will expire if work is not started within 180
iys of issuance, or if work ;s suspended for more than 180 days.
___..-----___---------- -- ------------------------ RE^UIRED INSPECTICN5 ... ------------------------------------------------- --- -
At/Beam Mechan Framing Insp Plumb Final
M/Underfloor Insu:ation Insp hild;ng Fina!
:umb Top Out Gyp Board Insp _-
ectrical Servi Electrical Final
lectrical Rough Mechv irai Final
e i nt i t t e c' '-I y n c ! <
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(. t I foi i n vct i oT-) t,219 417`,
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Resides i-aQ( d_ in-g-F'ermR Application
City of Tigard
13125 SW Hall Blvd.
Tigard, 4R 9722.'
(503) 639-4171 77//// r�
JobsiteAddress: .1J/"�� SW
Subdivision: !6l � T Lot# / _ ofsge Um C
valuation: 110, L7 _ ____-_ Contact Date ;F-L12&' Initials
Result 1y ,, ,:� 1 p'log
New Construction Only: (Square Footage)
Planck/Rec# �- �." �1
House. Garage: Permit# . _
Reissue of
Corner Lot? Y r;N; Flag Lot? Y N Map & TL#_j i?j. GDC_ U 12iO-E_
� Zone
r
Owner: Va f/t°n�r7 �e�UQ TZ i/ Plat# ---- -- --
Address __ App-roy-als Remuired
Planning Setbacks — Solar.
c1 G Engineering
Phone Ls,93 7 /f'i / - -- Other_ -- - --- ------..
Contractor: Items Fie -v Lrql
Address Subcontractors-----
Truss
ubcontractors —Truss Details
Other ---
Phone: X503) 51 7 - 7!(7 y9sps - _—. -- ------ --
Contractor's License#`(�1 AUI - -
(attach co of current Oregon license)
Contact Name --
Contact Phone.
Subcontractors: Architect/Engineer.
Plumbing. MrKtl-f Address
Mechanical:
(attach cop,y of current OR Contractor's Licen
W
Electrical: r YL-Q ti- one:
JOB DESCRIPTION. iu . (S-y3) SZ4 --
Applicant Sign. ;ire ���� 4c. ",. ant Phone number
Received by! _ Date Received _ 0�O _
ioq"^CI'S ra+wo
Permit a< Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) So
Plumb. Permit (PLUMB) .5,r,
Mech. Permit (MECH) U c«
State T&x- (TOW
Bldg:
Plumb: ,
Mech:
Plan Check (PLANCK) 3 33
Bldg:
Plumb.
Mech: _ �� l/
Sewer Connection (SWUSA),� _____�
Sewer Inspection (SWINSP)
Parks C7ev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-M
Commercial TIF (TIF-C)
Industrial TIF (Th%I) _
Ins:itutionaf TIF (TIF-IS)
Cffice TIF (TIF-C)
Water Quality (WQUAL)
Water Cuantity I',VQUANT)
F� Life Safety (FLS'
Erosion Cntrl Permit (ERPR,b1T)
Erosion PlarckjUSA (ERPLAN)
rasion PlanckiCOT (ERCSN)
T
0 rALS:
Permit
Address:
' (c,
Issued by: Oh-� Date: �
7-,7
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
folk-Ting statement b�jor•e a building permit can be issued. This statement i s required
fi-r 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 he filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
a1. 1 own, reside in,or will reside in the completed structure.
J 2. 1 understand that 1 must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
(� 3A. My general contractor is
L J (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.
V
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, I will contract with a contractor who is
registered with the CCB find will Imnledlatcly notify the office issuing this building permit of the
name of the contractor.
hereby certify that the above information is correct and that I have read and do understand the I nform-Mion
Notice to Proper - Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(While cop3,to issuing agencY permit file.
pink cop},to applicant)
I
1
information Notice to Property Owners
About CJnstrurtion Responsibilities
Note: 1 hik lnli,r'nration Notwe to Prnj,t•rltofi-ti rr+ allow Con.o-w lion Rvsj)on.\ihilille.+
Wilk(1eveloPed hr/be('orr\!n•uc tion l.'onlractor+ !(r'ord in(rcc•orlanc e sidle ORS 701.055)
Ifvou are acting a>}()ur(m if contractor to-inn tic n nc\\ Ifo ne or make a.,ttbstantial improvement to an existing structure,
you can pre+cnt Irlanti I,n(hlcnl',h� hcinrt a++art:((Cdl+ f„Iluu ing respun�ihilitics ancJ arras ufcvrn t rn.
EMPLOYER RESPGNS'.BlLIZIE� .
Il'yotl hire persons not rcgistcfe(I \\fill the conm uction Contractors Board to 6o labor in constructing ur assisting in the
construction or improvement of a re,,ldcraial stntcture.you\\•ill. in most instances,be ruled to be an employer and the people
you hire will be employees Ai;the employer.you nlu,t goof Iv\%fill the follo\virg:
Oregon's\%ithholdingtax law: Asanentplc,)•er,Nounitlst\vithhotdincumetlixestronlenlplo%,ccwagesatthctinte,rmployees
arc paid. l ( u++ill be)fall) f(,r tite tax payments even ifyoil don't actually withhold the tax from your employee~. For more
information•call the(hegon Dept of Revenue at 945-8091.
Uncntptoynitc, t insurance (s v \,,fn crnpl(,\cr, �(,u arc per- red to pay a tax lilt•unetllPloynlertt insurance purposes on the
wages(.,lillI(v nr; r+' nlfr,n,!s1Uon.cat,'heOret:r,n Lnlplo)ment Departmental378-352.1.
Workers'compensation iits urance: A,an cnlploN cr.\(,(1 arc:sub1cct tt,the Oregon Workers(_'ompensation Lim,and must
(lhtain+\orkerti ci>mprn ati;nl in':urance lite\(,ul cel{,I\\'ecs. If\ou fAiI t( ()htain workers'compensation insurance.you may
lie snhtectIf,pena11ic,and\+iIIhcliable f,(rifIIclaIll)c(VAS il'encOf\uureniPloyec,iSill inled(111the,jnh. f(,rfit(ire inl6rmation.
cal!the•W(,rkrrs'f'c,rttprn,utit,n f)ivi�it�n nt tllc!)epart►ncnt o!'Ct>rlsumer and F3usinesti`iervict.•,alt q as-78ft8.
U.S.Internal Revenue`,crvice: A--In cnlpl((\(•r.\tett fnu,t\+III h,,ld IcderaI income tax fvin emelt'\cc,'\\ages. You will be
fall)cf((rthetaxpa�n,cnlr\reit'\((udidn'tactnall+ \+ithh((ltlthctax l'urmoreinfbrinatitm,cu{IthElnternalRvvenueService
at 1-900-829-1040.
OTHER RESPONSIBILiTIES AND AREAS OF CONCERN:
Codecompliance. A,,thcpc•rn ith((I(lert((Ilhl,prol., 1.\. u;I cit:'i ; n,ihletilrrest,l\'in�.an� failuletunitrlcudercyuirenter.ts
that Ina\ he hrought 1(,\,,ur attention throwd,
I,iabiliIN and property dantalir insurnner: t (intact\our in,urancc agent to,ec it\ou ha\c,ldcyual 'ul,nrnncc co\erage lur
;IlI:IdC Il(',alld(,Ili)„It�ll�'•Illll I• i11f1�;ttlt(I,. pall))t(\/t'r,Pra1.++ate'rdalna�;l' )reel)) PipC plIflClllt'C'�, tlll' c;f \`•(irk thiel illll5t be
re-dyne.
fime to super-clse rmpinti t're: \l:Ihe•,Inc\ou ha+t sut•ficicnt)fine to ;Ilrer\ise\ottt•employee°s.
F'xpertise: R4ake .(111”\t(,I IIII+C IhC Cxpl`r11 C l(, Ill'❑,\t(lll't \\Il:'eIICI':11 ctlntrllelell',! �,((�rdmatl`the Noik t f(,IIc Il In lend 11n19h
oadeq.And to n(ttifv h(Iiidint!t,fliriak at rhe,Ilrpropriatc time';so thev can per•fonn the requires!inspections.
1I )1111 hd\'l'i11IC11tll(Ilal(iUl',IICHI' . ,\rite of (:111 ili',.'l ('I1.It UCllt n( i I1111ICtUIS 1t(;alll{I'1 1 1t (\ 1 11.i1i 1,I '_'ll; t11t y7 ijltr jt), ',
�ni'378-46711. the Board is Ideated al 7111) (;Illmiler Y til `iuilc 00) in `alenl
i
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Plumbing Signature Form
Permit # . . . . : MST96-0369
Date Issued. : 07/22/96
Parcel . . . . . . : 1S133DC-01300
Site Address : 13145 SW FALCON RISE DR
Subdivision. : MORNING HILL NO.1
Block. . . . . . . . Lot: . 41
Zoning. . . . . . . R-7
Remarks :
Interior remodel
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 from your company sign
below and return this Plumbing Signature Form prier to the start of work. !Lo plumbing inspections
will be authorized until this compIcted form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
WNER : PLUMBING CONTRACTOR:
VALENTIN SEICIARU OWNER
13145 SW FALCON RISE DRIVE
TIGARD OR 97223
Ph,)ne # : 503-524-9119 Phone # :
Reg # . . .
Signature of Authorized Pl,.tmber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171 , ext. #310
CITY OF TIGARD
13125 S W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit # . . . . . MST96-0369
Date Issues.. : 07/22/96
Parcel . . . . . : 1S133DC-01300
Site td&ress : 13145 SW FALCON RISE DR
Subdivision. : MORNING HILL NO.1
Block. . . . . . . . Lot : 41
Zoning. . . . . . . R-7
Remarks :
Interior remodel
Your company has been indicated as the electrical contractor for the permit indi^ated above. In
order for the aiec;trical permit to be valid, the signature of the supervising ciectrician
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
MNI R : ELECTRICAL CONTRACTOR:
VALENTIN SEICIARU OWNER
3.3145 SW FALCON RISE DRIVE
TIGARD OR 977.23
Plio ne 4 : 503-524-9119 Phone # :
Reg # . .
// C4CLf
Signature Supervising-Electric ian
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639 4171 , ext. #310