9340 SW HILL STREET-1 nw.gy.yp�v.r�'Aesea MlIAMNIIww
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NSPCC ION NOTICE 5...
City of Tigard Building Depart38ent.
13125 Sw Ball Blvd. Tigard. oragon 97223
Inspection Line (Rec-O-Phone): 639-4175 �'usiness MonM'-41
Ino tion:
looting plbg. Underolab Lech. Rough-in (/pLpDXLgdwlk
round. Plbg. Top Out ;as Line IN
Post/Beam 3truct. San. Sewer Framing .Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb. '
Plbg. Underfloor water Line Gy p. Bd. -Hoch.
Date Requested: --i �� t ' Time:
Addre 3s {� "�l l U I I Permi?T#:C�� f LJ
Builder:--
THE loLLow:NG CORRECTI04S ARE REQUIREDs
9
{ Inspector: -- — — _— _ Dat3:- 711,V1L,(//C'--
1 APPll"ED DISAPPROVED APPROVED S11RJE/J CT TO ABKPfE
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Call For Reinsp.
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Ask 's
WOM
- CITY OF TIGARD MASTER PERMIT
T I e
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MST94--021.7
13125 SW Hall Blvd.Tigard,Oregon M23sa1911 45031139417`1 DnTE ISSUED: 06/09/94.
1
PARCEL: :S102DB--01600 �
SITE ADDRESS. . . : 09340 SW HILL S1
SUBDIVISION. . . . : ZONING: R-4. 5
BLOCK. . . . . . . . . . . 10 L01.. . . . . . . . . . . . . . ■
.-.____-___.__.__._.____- .------------- SUiL-UINv
REISSUE: DWELLING UNITS:0 1AASEMEN'T. . . . . . . . :0 s f
CLASS OF WORK. :ADD BEeDRMS:O BATHS:O GARAGE. . . . . . . . . . :0 sf ■
TYPE CIF USE. . . :SF FLOOR AI�E(ac�____.__..._.. _.__.....__. REQUIRED SETBACKS-
TYPE
ETBACKS_......_._.__.__--.__.TYPE OF CONST. :5N FIRST. . . . :0 Sf LEFT. . :0 ft RIGHT. :0 ft
OCCUPHNCY GRP. :R:; SECOND. . . :0 S f FRONT. :O ft RE(4R. . :0 ft
STORIE=S. . . . . . . : 1 THIRD. . . . :0 -.3f REUUI RED__._---_ ___. _._______.•.. ■
HEIGHT. . . . . . . . : 0 ft I,0 T HI - -- _ :0 :a P SMOKE= D T'F C TORS. :
I LOOR LOAD.. . . . :0 os f VAL.UE. . . . . 1000 NARKING SPACES. . :0 i
Remarks : in�•tallir, _ bay window
r"LUMBING
j '.iINKS. . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :0
y LAVATORIES. . . . . ..0 WATER HEATERS. . . :V1 IRAPS. . . . . . . . . . . . . . .0
1'U8/SHUWEF2S. . . . :0 LAUNDRY TRAYS— :0 CATCH BASINS. . . . . . ,. :0
WADER GLOSETS. . :0 SEWER LINE (fft ) . :VI GREASE TRAPS. . . . . . . :pl
DISHWASHERS. . . :0 W(ITER LINE (ft ) . :Ill OTHER FIXTURES. . . . ., :Ill
GARBAGE DISP. . . -O RAIN DRAIN (ft) . :0
j WASHING IhA'',H. . . :0 SF RAIN DRAINS. . »0 ______. _________..__
MECHANICAL --- - -_-- -- FEES
FUE=L TYPES ___..__._____._ UNITHTRS. . :0 type amoi.Ant by date recpt
VENTS . . . . . :0 BPRT $ 25. 00 JF 0".409/94 -
MAX INPUT:O BTU VENT FANS. . :0 SPILC $ 1b. 25 BL"I Ob/07/94 94-c'.52956
F•URN ( 100K . . :0 HOODS. . . . . . :0 B5PC $ 1. 25 JF 06/09/94 -
TURN ) =100K . . -0 WOODSTOVES. ;Ill
FLOOR FURN. . . . :O CLO DRYERS. : 0
BOIL/CMF t 3HP:0 OTHER UNITS:0
GAS OUTl_E'TS.0
Owner; _____._______..___._._.---_._•._.___._._....._--_..___._._�
RONALD CARRIKER
9:34171 SW H I:.i. CT
T I GARD ON 97'2;23
Phone #: 664--8986
t:ontrac:tor: _______________._-_____________
OWNER
i
phone #:
$ 4ii. 50 TOTAL r`
This pereit is issued suh.ject to the regulations contained in the ---- --- REQUIRED INSPECTIONS ----- -
Tigard Municipal Code, State of Etre. Specialty Codes anc all other Framing I n s p
applicable laws. All work will be done to accordance with approved I i s u 1 at i o n I n s p
plans. This pereit will expire if work is not started within 180 uyp Soard Inst
days of issuance, or if work is suspen for noore an 8k Hsys. Bt_1 i 1 d i n g Final
ea r m l t t e e 5 i g n a t u r e:
J.Gsl_1ed By :
Lal. l for inspection - 639-4175
,.. a �4+'"iJ1F. iNW q:'Rxe"qtr 1
Residential Building Permit Application
City of Tigard
13125 SIN Hall Blvd.
Tigard, OR 97223 '�
(503) 639-4171 1
Jobsite Address: L {, c L 4,0
Subdivision: Lot # u Office Use Only '
Valuation: Planck/Rec #__-� --OL
Permit #1_j
Owner: _ k A /... , R Reissue of
Address: !.� y C/ Map& TL#, j 'r 2.. ( j –0
Phone: Approvals Required
Planning
Contractor: L F
--- Engineering �
Address:
— Other
' Phone: Items Required
— I
Contractor's License # Subcontractors
(attach copy of current Oregon lir nse) Truss Details
1 Contact name & phone: ,�!„�
-- Other(,.��� !
Subcontractors:
Plumbing: —_
Mechanical: _
(attach copy of current OR Contractor's License)
Architect/Englneer:—
Address:
Phone:
JOB DESCRIPTION:
Applicant Signature & Phone number --
Received by: Date Received:
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Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
i
State Tax (TAX) /z ,�! _ ' Z
Bldg: i 2
Plumb.
Mech:
Plan Check (PLANCK)
I
Plumb:
Mech: _
Sewer Connection (SWUSA) _
Sewer Inspec,�tion (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R) _
{ Mass Transit TIF (TIF-'MT)
Commercial TIF (TIF-C) _
Industrial TIF (TIF-'I)
Institutional TIF (TIF-IS)
Office TIF !TIF-O) _
Water Quality (WOUAL)
Water Quantity (WOUANT)
Firs District (FIRE)
T
Erosion Crdii Permit (ERPRMT)
Erosirni Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN) u_
TOTAL:::
� I
70
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Permit No:
� .
Address: �
rHn z Issued by:._ _ Date:
L___FOR OFFICE USE ONLY — —I
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicant,; 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 P -chitect and Engineer applicants, exempt from registration
under ORS 701.010(/), need riot 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 . C ,l --� I own, reside in, or will reside in the completed structure.
2. ( _ 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.I --__-_-1 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.( -_ 1 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 Roard
and I 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 ,ead and understand
thFr Information Notice to Property Owners about Construction Responsibilities on the
rpvArse side of this form.
L
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Signature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
s
0244113191
I WHITE COPY TO ISSUING AGENCY PERMIT FILE �
PINK COPY 70 APPLICANT
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
i.
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 structu,a, you can prevent many problems by being aware of the following responsibilities and areas
of concern. 4
EMPLOYER RESPONSIBILITIES: "
If you hire persons riot registerec'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
F thi time employees are.paid. You wit; be liable for the tax payments even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390.
Unempl�ment Insurance Tax: As an employer, you are requirod to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Orerjon Employment Division DHR
at 378-3224.
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, ,rill the Workers' Compensation Division DIF at 3!'3-7434.
U.S.-Internal liabRevenue__Service: As an employer, you must withhold federal income tax from employees' wages.
You will be le-To the-ax 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:
0.
Code Compliance: As the permit holder for this project, you are responsible for rrsolving any failure to meet
code requirements that may be brought to your attention through inspections
i
Liability and Property Damage Insurance Contact yt;ur insurance agent to 9f a if you have adequate insurance
coverage for accidents and omissions such 7s falling tools, paint oversprF y, water damage from pipe punc-
tures, fire, or work that must be re-done.
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to cocrdinate the work '
of rough-in and finish trades, and to notify building officieils at the appropriate times so they can perform
the required inspections.
If you have additional questions write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89
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