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INSpEGTzoN NOTICE � '
City or Tigard Building Departaent \\\777
13145 80 WT. Blvd. Tigard, oregon 97223
inspection Line (Ree-o-Phone)s 639-4175 Rusiness Phoue: 639-4171 q
1[Aspection: - — --'
Footing Plbg. Underslab Hach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Lino FINALS
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Post/Beam Struc.•t. San. Sewer Framing
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qt/Beam Poch. Rain Drain Insulation -Plumb.
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Plbg. UndealloarNater Line Gyp. Bd. b.� /-
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Date Requested: 1 - �_ TimesPH
Address: 1 A�1�Y V11 V1 'j�1_� Permit f S�
Builders -
THS 10Id.ONING CORRECTIONS AAE REQUIRED:
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Inspector
✓ APPROVED _r- DIBAPPROVRD U APPROVEO SUBJECT TO ABOVE
Call For Reinsp.
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Citi of Tigard Building Department ^�f'r�
3-3125 OW Ball Bl'-- 7.'!y.rd, Oregon 97223
Inspection Line (Rec-O-Phone), 6:;9-4175 Business Phones 639-4171 a
Inspection:_
Footing Plbg. Underslab Mach. Rough-in APP r/Sdwlk
Found. Plbg. To Out
Top Gas Line FINAL.c
Post/seem Struct. San. Sewer Framing -bldg.
Poet/Beam Moc,n. Rain Drain Insulation
-Plumb.
Plbg. Underfloor Nater Line �Oyp. Ed._ -Neth,
Date Requested: 411" -7 7. e, x
Times AM PM
Addresas Permit 5l �I1,
Builder: ( V\
THE FOLLOWING CORRECTIONS ARE REQUIRED, v� I
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Date: c�
APPro"D DISAPPROVED APPROVED SUBJRCT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE.
City of Tigard Building Department
13325 SW Fall Blvd. Tigard, Oregon 97223
Inbpection Line (Roc-O-)?hone)= 639-4175 Business Phone= 639-4171
Inspect is n= _
rooting Plbg. Underslab Koch. Rough-in Appr/Sdwlk al
round. Plbg. Top Out Gas Line FINAL=
Poet/Beam Struct. Sen. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain _ Insulatlo -Plumb.
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�4 Plbg. Underfloor Water Line Gyp. Rd. -Hoch.
Date Requested= Times �AM —PM
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Aadreses !! ���7 !! ","2
f.,. Builder=—+--- — -- -
THE FOLLOWING OORRECTIONS ARE REQUIRED=
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APPROVED DISAPPROVED APPROVED RUBJECT To ADM
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INSPECTION NOTICE n
City of Tigard Building Department.
13125 SM Hall Blvd_ Tigard, orugon 47223 �J
Inspection Line (Rec-O--phone): 6�-399^-4175 Business Phone: 639-4171
Inspection:_ V �,Q
Fouting Plbg. Underelab McOh. Rough-in Appr/sdwlk I
Pound. Plbg. Top out Gas Line FINALS e
Post/Beam Struct. San. Sewer FrslOinq -Bldg.
Pnet/Beam Mach, Rain Drain Insulation -Plucb.
Plbg. Underfloor Fate//r Line Gyp. Bd. -Hoch.
Date Requested: Q LI
_Times _Ix- _AM PM
Addrenes Il OtIG (1 �• i(J(y\�y�)y�i - h,�7�, Pe.mit # 033y
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Builderr, I`lt�t'C \ '��-C1)-71 7
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Dates:
APPROVED DISAPPROVED L A1PR01fRD SUR.7ECT TO ABOVE AM
Call For Reinep.
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INSPECTION NOTICE 1
City of Tigard Building Departsant G
13125 811 Ball Blvd. Tigard, Oregon 97223 6: I
Inspection Line (Roc-O-Phone), 639-4175 Business Phone: 639-4171
Inspection,
Footing Plbg. Onderslab Mech. Rough-in Appr/Sdwlk I
Found. Plbg. Top Out Gas Line FINAL, ,
t/Beam Struc San. Sower Framing -Bldg. l'
"at/Beam Hoch. Rain Drain ) Insulation -Plumb.
Plbg. Underfloor Nater Lina Oyp. Bd. -Hoch.
Dots Requested,_ [/
Times
PM
Address, � 43 ��, .
Builder,�_____,�
TBE FoLLOWINo OORRICTIONS ARE RILQQZRFD:
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Inspector:__ r` _ _ Date,
;_--APPROVED DISAPPROVED APPROVED SOBJECT TO AY MR g
Call For Nainap.
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INSPE4'fION NOTICE N� / ���` '�;
City of Tigard Building Dwpartm t (N
13125 SW Hall Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone:: 639-4171
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*ootLng Plbg. Urdaralab Hoch. Rough-in Appr/Sdwlk J
nd Plbg. Top Out Gas Line FINAL:
Post/seam Struct. San. Sewer Framing -Bldg.
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Post/Beam Mech. Rain Drain Insulation -Plumb. '
plbg. Underfloor Nater Line Gyp. Bd. -Hach.
Date Requested:, 4 —Time: 1111 PH
I�.L'� f;1/ f �!V Permit �`5 (_�5
Addressi_ ` -� h-
THE FOLLOWING CORRECTIONS ARE REQUIRLD:
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Inspector: Yy Dates / v
_APPROVED DISAPPROVED —� APPROVRD SUBJECT TO ABOVE
Call For Reinep.
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CITY CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SVI(Hall Blvd.Tigard,Oregon 97223.9199 (503)639-4171
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Permit No:
Address:
' z Issued by:- Date:
\!`�• • FOR OFFICE USE ONLY__--__
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION REZiPONSIBILITIES
Nate: Oregon Law, ORS 701.055(4) , rec7.,ires residential construction permit
applicants who are not regis,ered 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), need not submit this statement. This statement will be
filed with the permit.
Fill i'n+ the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1 . 1 own, reside in, or will reside in the completed structure.
2. ( 1 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
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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. 4��_l I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. Ir I change my mind and do hire a general contractor, I will
contr-3ct 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.
I hereby certify that the above Information Is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
_.7
S mature of Permit Anplican _ te t "�
CONSTRUCTION CONTRACTORS BOARD
0244J 8!91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
P114K COPY TO APPLICANT
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INFORMATION NOTICE TO PROPERTY OWNERS
P, 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),
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 RESPONSIBIi_'TIES:
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 emplG,yee wages at
the time employees are paid. You will be liable for the tax payments ever if you don't actually withhold the
tax prom your employees. For more 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 378-322x.
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'
i 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 373-7434.
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U.S. Internal Revenue ^ rvice: As an employer, you mast withhold federal income tax from employees' wages.
r You will-be liable for the tax payment even if you didn't actually withhold the tnx. For more information, call
the Internal Revenue Service at 221-3960.
OTHER F.FSPONSISILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet ;
code r Nquirements that may be brought 10 your attention through inspections.
Liability and Property Damage Insurance. Contact your insurance agent to gee 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.
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
Ex erose: 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.
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 10/24189
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' D125SWHsUMy& PLNCK/RECT #CITY TI RD PERMIT # 97s — U.,3-3
COMMUNITY DEVEst,OPMrNT DEPARTMENT Tiprd.Oregon 97221
(S01)63""1 DATE ISSUED
JOB ADDRESS: AAV�1I MBfptisiy_ � Ur TItX MAP/LOT _jC.p—U 73GU-
- ---- __ .
SUB: LOT: LAND USE:
VALUATION: /3 15'6-1
OWNER ( I/ SPECIAL NOTES
NAME: _ J 0 N (0k,ul B Mu I ked REISSUE OF: _
ADDRESS: _1L�Ei� `7�LU. Mtt�t 1 _ LAST REISSUE:
I ct� ��3 FLOOD PLAIN/ e
PHONE: 1-) 60 7 _ SENSITIVE LAND:
CONTRACTOR APPIOVAI_S REQUIRED
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NAME: — `70.�u PLANNING: (--�v:e K
ADDRESS: ENGINEERING: ^
FIRE DEPT:
PHONE: _ _ OTIILR: o --r/F
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: — LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE: 2 az!
COMMENTS:
/14 � t17h1 1 iut414
APP DANT SIGNATURE
Received fly: Date Received:
wa._,,.... .,._.,,.,.�.,. .. _�............. .,. _.,....._..n. . .,�,� _.._....
PERMIT k ACCT b DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
/n51 3 v3H 10-432 00 Building Permit fees Lo- Ski "� /oq. )?/
10-431 00 Plumbing Permit. Fees _ _ -
10-431 01 Mechanical Permit Fees CP �i' 2 ��
10-230 01 State Building Tax (5%)
Building _ 5, 2.3
Plumbing
Mechanical
10-433 00 Plans Check Fee
Building y
Plumbing
Mechanical
10-2.30 06 Fire
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 Fe--s
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)
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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)
TOTAL C%"C ,-1L
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CITY OF TICARD RECEIPT OF PAYMENT RECEIPT NO. -.93-241408
CHECK AMOUNT : 135. 98
II�IAIMF % MUL.KE"Y, JONATHAN CASH AMOUNT 0. 00
1ADDRESS a 1. 1868 SW MORNING HILL DR PAYMENT DATE 08/17/93
SUBDIVISION
TIGUARD 97223
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE: OF PAYMENT AMOUNT PAID
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BUILDING PERM 104. 50 MECHANICAL PE r� � � 25. 00
ST. BUILD PER 6. 48
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T13TAL, AMOUNT PAID - 1,35. 98
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CTTY CIF TIGARD RErC:E IP'I' OF E:'AYMEwNT RECt-IPT NO. :93 40"7: 1
r CHECK AMOUNT : 67. 9.3 '
NAME. MULKf Y, X)NATHAN CASH AMOUNT a 0. ovi
ADDr?FSS a 11668 SW MORNING HILL_ DR PAYMENT DATE a ME;./Oc". 9;3
SUBDIVIBION c
T'TE.3ARD, OR 9.72;m'3---
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j PURPnEsE (IF PPYME:N'C AMOUNT F,A T D PURPOSE" OF' f 1(IYME_N'P AMCIUilff PAID
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PLAN CHECK FE f,7. 93
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t'E)'TAL_ AMLIUIV T PAID - > F.,l. 93
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