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INSPECTION NOTICE
city of Tigard Building Departt
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec -Phone): 639-4175 Business Phone: 639-4171
inspections--
Footing
nspection:__—Footing Plbg. Under ab Mach. Rough-in Appr/Sdwlk I
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -plumb.
Plbg. Underfloor Water Line Gyp. 8d. -Mech.
Date Requested:_ �', ^���/ [/- Time: —_)AM /,G PM
61
Address:_ 7 /` �l �`- Permit /:Z1�
Builder:- c- 7Z�1_j�C �L61'tJ --
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspec`.or: ` �.
APPROVED DISAPPROVED APPROVED SUMECT TO ABOVE I
—Call For Reinsp.
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CIT'! ®F TIG:A RD WYOFTWARD
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COMMUNITY DEVELOPMENT DEPARTMENT aewor+
13125 BW FWI Blvd. P.O.Bax 23:197,Ti"W,OmWm 97223(503)63"176
— --- -- - .—_
PLUMBING PERMIT
PERMIT #. . . . . . .
63-9-4171 .DATE ISSUED: 06/18/�2
SITE ADDRESS. . . : 12790 SW MAR T C CT 1='AR(CEL: 05000A X -•414'10016'
SUBD I V 191 ON. . . . : ZONING-
BLOCK. . . . . . . . . .
C1NINGcBLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . . a'
-----------------------------------------------------------------------------
(CLASS OF WORK— :ADD CIPRBAGE PI':aPOSOLS. . : MOBILE. HOME SPACES).
TYPE OF USE. . . . :SF WASH114G MACH. . . . . . . : BACKFLOW PREVNTRS. . : 1
OC'CUP'ANCY CRF'. . :R3 FLOOR DRA ING. . . . . . c TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . : WATER HEATERS. . . . . . : CATCH BASINS. . . . . . . :
F'1X'TIJRE_a-_._.____.__ L.OUNf"RY TRAYS. . . . . . : cF` RPIN DRAINS. . . . . :
SiNKS. . . . . . . . . . : URINALS. . . . . . . . . . . . : GREASE, TRAPS. . . . . . . .
LAVATORIES. . . . . c OTHER FIXTURES. . . . . :
SEWER LINE (ft) . . . . :
WATER CLOSET'S-- 14ATER LINE (ft ) .
DIBHWASHFRS. . . . : RAIN DROIN (ft) . . . . :
Remarks : S3PRTNKLER SYSTEM
Owner: ___.____. _._._._.__________.___..______._______ _____._.____._________. FEES
FRANK TEMPI_..(TnN •type Amo$_tnt by date recd
1_,790 9W MARIE CT F.RMT E 15. 00 JLH 06/18/9:? —
5f CT 4, 1Z. 'l a JL_H 06/18/92' —
I"IGAIRD 0R 9722`
Phone #:
Contractor :
OWNE R
Phone #: $ 15. 7'5 TOTAL
Rey #. . : 004100
REQUIRED INSPECTIONS
This pereit is issaed subiect to the regulations contained in the Torr—aut: l.ns p
Tigard Municipal Code, State of Ore. Specialty Codes and all other F=inal Inspection
applicable laws. All wcrl will be done in accordance with
approved plans. This pereit will expire if rwor4 is not started
r.ithin 180 days of issuance, or if work is suspended for Bore
than180 days. __._._.._.._.___. ...�_...__., _._..,..__...
J-'p}• m i c t e e S i g nA t�i 'e • `-•l c Q��' _....•...._..._.__......_._.... __�__..._.._-_...._... '
15%Ltfeci By: .
Ca.lI for inspection 639-4175
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Permit No:
Address:
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Issued by: /1— Date: 2-
\' —_—FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.05b(4) , requires residential construction permit
applicants who are riot 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 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 e pplicable blanks, and initial boxes 1 and 2, and either box 3A or 36:
1. 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.li 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. I will be my own general contracior.
If I hire subcontractors, I will hire only subcontractoi s registered with the Construc-
tion Contractors Bc.ard. If I change 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 immediately notify the office issuing this building perroit 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.
S nature of Per It Applic,, Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COP,' TO APPLICANT
1 '
Y
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Noiice to Property Owners About Cor^truction Responsibilities
was developed by the Construction Contractors Board in accordar., a with ORS 701.055(5),
passed by the 1986 Oregon Legislature.
6
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 RESPON IVILIT
S IES:
r
If you hire persons not renistered 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
the time employees are paid. You will be liable for the tax payments Sven if you don't actually withhold the
tax from 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
F,.r
purposes on the wages of all employees, For more information, call the Oregon Employment Division DHR
t at 378-3224.
Vorkers' 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, call the Workers' Compensation Division DIF at 373-7434.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.
' You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 221-3960,
P'
E, OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
erode Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
ode requirements that may be brought to your attention through inspections.
Liability and Property Damage Insurance: Contact your insurance agent to see 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.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work
t.F of rou h-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
02441 10/24/89
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CITY OF 'T 1 GORT) RECEIPT Or PAYMENT RECX I PT NO. a 92. - 'S6.9Qr
CHECK AMOUNT a 11. (50 a
NOME s TEMPL_ETON, FRANK CASH AMOUNT a 15. 75
ODDRE SS a 12"790 SW MARIE' CT PAYMENT DATE: a 06/16/9,? �
SUBDIVISIONTIGARD, OP 97223—
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PURPOSE k`F P"'YME:N'T AMOUNT" POI D PURPOSE OF PAYMENT AMOUNT PA I D
PEjMi IW',)' --ERM__,.___... _ _.. ....1:;. 00 ST. +BUILD ..PER 0. 755 {
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143PRINKI..F.R SYSI-EM I-''FRMI-r
L U I AL.. PMOLIN'f F"n i D - _ - > 13. 75
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