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CITY OF TIGARD BUILDING INSPECTION NOTICE �\
Inspection a (Rec-O-Phone): 619-4175 Business Phone: 639 1�171
Inspectici : ��Q'��\
r Footing Susp. Ceiling Sprink. Rough-in Appr/ wl�
Foundation Plbg. Underslab Mech. Rcugh-in Fireplace
Post/Bei_., Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. pan. Sewer Gas Line ;Bldg
Plbg. Underfloor Zain DrZnc
Framing -PIL-mb.
Alarm Water Insulation -Mech.
Underilr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: �c/ r Lel Time: AM M
Address:,
Builder: q— Pernift #: 51
THE FOLLOWING CORRECTIOIJS ARE REQUIRED-
Inspector: Date:L015 ��-//
PROVED _DISAPPROVED _APPROVED SUBJECT TOO ABOVE
__Call For Reinsp.
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CITY OF TIGARD
@4-
OREGON
June 1., 1995
RE: BUXrXING PERMIT # 3 -'6q 3
Iaspect ion(s) have been conducted on this project. Howe.-ver, we
have no record of any sub,3equent or final inspections within the
past 180 days .
Please nate that permits become void if there has not been an
inspection p%r.formed for over 180 days. In thrAt ease, the Building
Divisiou may require a new application and fees to continue work.
A notice of non-compliance against the property may also be
recorded by the City. `
Please advise the Building Division, IN WRITING, within 15 days of
this letter, the status of this project . You iiay request
additional time to complete the project.
Respond IN WRITING to: Building Division, 13125 SW Hall Blvd. ,
Tigard OR 9%223 . be sure to include the following information:
1 . Building Permit # .
2 . Address of property.
j . Your name.
4 . Your phone number 8 :00 a.m. - 4 :00 p.m.
If you are ready to schedule your next inspection, please call our
24-hour Inspection Recorder at 639-4175 .
log in\ARdd._in+pections
13125 S%M Hall Blvd., TlWrd, OR 97223 (503) 639-4171 TDD (503) 684-2772 -
A\
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S" Hall Blvd.Tigard,Oregon 47223.0199 (503)639-4171
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�rIV(r13W,SWfl,nand PO.NCK/RLCT #CI 1r,(� OF 1 ARD PERMIT /
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COMMUNY DEVELOPMENT DEPARTMENT T' ( 3Om-gm �
)tt3"171
GATE ISSUED .
JOB ADDRESS: SW S FD�� CT �_ TAX MAP/LD1
SUB: LOT: ---. LAND USE: --VALUATION:—
OWNER SPECIAL NOTES
NAME: IWIC l01-7 �-.�I_/JK I — REISSUE OF: — — -- -
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
PHONE; �Z�. ��._— 1,v� Y=��'Z_— SENSITIVE LAND:
CONTRACTOR APPROVALS
NAME- - SEL _^_—__--- — PLANNING:
ADDRESS: —_ ENGINEERING- _
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: _ EXP DATE: ._
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: �— LIST/SUBCONTRACTORS:
MECH: BUS TAX: _--_
- — I
AR171YINGINCER CALCULATIONS: _
NAME: _ — TRUSS OE-TAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
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APPLICANT SIG 16RE
Received By: _ — Date Received:
PERMIT # ACCT # DESCRIPTION AMOUN1 AMOUNT PD. BAL. DUE
' ;' 3► y�-03 10-432 00 Building Permit Fees
- 10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permi': fees
u,.,•.�,,:.j 10-230 01 State Building Tax (5%) 3,1�
Building
Plumbing _
Mechanical
� 3
10-433 00 Plans Check Fee
Building
Plumbing
Mechanical
10-230 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 Fees
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) _ ^
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 Z�- -;!D20
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Permit NO:
Address: S6074-
z issued by:- Date: •
_.FUR OFFICE USE ONLY
STATEMENT: �
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIF31LITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants 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 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 boxes 1 and 2 and either box 3A or 38:
I own, reside in, or will reside in ine completed structure.
2. C 1 i understand that I must register as a construction contractor if the sti ucture is sold
or offered for sale before or upon completion.
3. AJ --l 1 My general contractor ic
Contractor registration number
I wi' instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
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I will be my own general contractor.
!f 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 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.
Signature of 45ermit Applicant Date
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CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY rO APPLICANT P
1 ,.fit
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction Responsibilities l
was developed by the Construction Contractors Board in accordance with URS 701.055(5),
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passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a naw 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 RESPONSIBILITIES: .
It you hire persons riot registered with the Construction Contractors Board to do labor in constructing or assisting Iy
in the construction or improvement of a residential structs. 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 even J 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
purposes on the wages of all employees. For more information, call the Oregon Employment Divisicn DHR
at 378-3224.
Workers C_om_p_ensatOn Insura_nc;e: As an employer, you are subje_-t 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 mor information, call the Workers' Compensation Division DIF at 373-7434,
U.S. Internal Revenue Service As an employer, you must withhold fFderal mcc. 1ployees' wages "
You will be liable for the tax payr en if you didn't actually withhold the tax ror trio ' Information. call
the Internal Revenue Service
OTHER RESPONSIBILITIES Al'"' AREA i OF CONCERN.
Code_Compliance: As ror this project. you are responsible for re.,olving any ' 'ure to meet
rode requirements to your attention through inspections.
L'ability and Property t,, ,„ Contact your insurance agent to see if you have aurquate insurance
coverage for accidew ,ach a fa!!!rig tools, paint overspray, water damage from pipe punc-
tures, fire, or work the me.
Time to Supervise E+nplcyee, ►4a'.m sure you have sufficient time to supervisr, your employees.
Expertise: Make sure you have th expertise to act as your own general contractor, to coordinate the work
of rough-in and fini,;h trades, and to notify ,wilding officia'^ 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
0244) 10/24/89