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MAY 1 91997 �l IIIII � IIIIIII III ; IIi � I � llli ( 1111111 IIIII 1 ' 1111111 1111111 IIIIIIiiIIIII ' I I l lIlIIII1JI I II1 � 1I IIS II 111111 IIIIjIIlI11IIlI � li1111111111 INCH MADE IN CHINA I , I I I I I I I I I I I I I I IIIIIIIIIIIIIIIiIIIIiIIIiIIllililllll(lIIIIIlilll!!II!(IIIlI!!I!!II !!lI�I!lllllll�ilIIIIII! I i III ' I '4 " ' ' ' l i !I If III111111,IIIIIllloll�ll..IIIIIIIIII�IIIII���IIi�,IIS,III�IIIIII�II�IIIII���illlllliflllllllll I�IIII!lIII!!Il.IlIllll!!!Itli�iliillll�!!I!�!!I�lIII!!!II!!lIII! I ! ! I IIIIIIIIII IIIIIIII I16 X II� { 28811 8V" 24" 68" � 74" ,a 24" _ 12" �„ 24" _' 24'1 2411 _... 12" 24" fib" i IL 7rt t e � 24 2) BP-36 # if 2411 2) PP--36 , 1 i(P-3Q fi --20430 - _ I _. i s$ t I 24' l � i 4 � j - - - - - - -- ._ _ _ _ _ _ _ _ _ _ ! tB-2424SK - - FOO - - - - - - - - - - - - - -- - - -- - - --- - a U- 24RWan 2 40 1 '\4&4. 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Al , i ..1, '-,,, '� �i�s RI ...1 ., ,. e .K,11 INSPECTION NOTIC.'E City of Tigard Building Depa►iaent 13125 SM Hall Blvd. Tigard, orogon 97223 Inspection Line (Rec-O-Phone): b39-4175 Businean Phone: 639-4171 Inspection:____— -- --- Footing Plbg. Underslab ich. Ro,.gh-in / Appr-/Sdwlk Found. Plbg. Top Out 6ae�Line X \�FINALe Poet/seam Struct. San. Sewer Framing -Bldg. ' Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. �Mech. x Date Requested: L� G U -1 Time: _ AM —PM Addrene I `ts�-S— . Permit 1:_`�`7 - ©/a� Builder:-- — -- THE Fo.LOWING CORRECTIONS ARE REQUIRED: i i Inspectors / APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE __.--.._.Call For Reirnp. r . F • INSPECTION NOTICE City of Tigard Building Department 13125 SN Ball. Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41'rl p inspection:_� Y, Footing Plbg. Underelah Mach. Rough-in Appr/Sdwlk , 1#A Found. Plbg. Top Out Gas Line FINAL- Post/Beam Struct. San. Sewer Framing -Eldg. Poet/Beam Mach. Rain Train Insulation -Plumb. Plbg. Underfloor Water Line G vp. Bd. -Mach. 9 ■ Date Requested: _�—�/9- �.---Time: AM PM � t Address: �iV�• Permitt�1:_/ 7— O�Oj_ THE FOLLOWING CORRECTIONS ARE REQUIRED: ! ! ftio Inspector: —x1rjtVrnate:; ri rE; ,, APPFAMDDIBAP OVED APPROVED SUBJECT TO ABOVE �• V Call For Reinsp. ,'�„�9,s'Mf4t?nJNM YAV� g�1,��A• ',r1p�+A1MM{!j�{`'°x��' ylh'�b N. 'l,�hh:... t 11ECHAN I CHL_ CI1Y OF TIGARD FERMI r F L FTM I f #, . . . . . . ME'C;94-0 102 r COMMUNITY DEVELOPMENT DBRARTMENT DATE I SS JF!? --04/18/94' ' 13125 SW Hall Blvd.Tigard,Orapon 97223.6199 (503)539-4171 Q ' PARCEL: O'310 3BA--001 43 SITE: ADDF2ES,:). . . . 11B2.5 SW LYNN ST xs 1 SUBDIVISION. . , . LERON WE I CHT'S IVC]. ZONING: R--4. ,s; BLOCK. LOT. . . . . . . . . . . . . :33 _–.------___._..______..___._.______.__..__.___._______–___ CLASS OF WORK. . :ADD FLOOR FURN. . . . : EVAP COOLERS: � T'YPL_ OF USE. . . . :SF UNI 'l HEATERS. . : VENT FANS. . . OCCUPANCY GRF,. . :R3 VENT'S W/O AF 'L: VENT SYSTEMS: STORIES. . . . . . . • : 1 BOILERS/COMPRESSORS HOODS. . . . . . . FUEL TYPES-–--–_.._ _. 0-3 HP. . . . : DOMES. I NC I N: a :/GAS/ / / 3–.5 HP. . . . : COMML. INCIN: 1..., 9T!J 15-30 WP. . . . : REPAIR UNITS: MAX INPUT: FIRE DAMPERS''. . . 30--50 HP. . . . , WOODS Vt GAS PRESSURE. . . : 50+ HP. . . . : CLO D4 NO. OF UN I'TS____._._..___._..-- AIR HANDLING LJN I TS OTHER UN. FURN l 100K BTU: <= 10000 c f m : GAS OUTLETS. : 1 ;a4 FURN > =100K PTU: ) 10000 cfm : Remarks- GAS INSF RT Owner-: FEES COLANTINO type amoi.lnt by elate r-eupt 11825 SW LYNN PRMT $ 25. 00 JG 04/16/94 •– 5F'C;T $ 1• 2 J ,7G 04,118/94 – ' 'T'IGAl1D OR `3722'3 I Phone #: i DEAN STODDARD 90' 7 MT. BAKER AVE VANCOUVER WA 96660 Phone #: 7,37-9949 4 26. 25 TOTAL_ Reg #. . : $2299 p REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the i as Line 1nsF Tigard Municipal Code, State of Ore. Specialty Codes and all other Wo od st o v e I n s ca __. _....__... __.. applicable laws. All work will oe done in accordance with r incl Inspect on _,.. _ _—___-- approved plans, This permit will expire if work is not started i within 188 days of issuance, ar if work is suspended for more than 180 days. F ermittee Signati-ire ' T S S I..r e(.1 B y ' Call for, inspection - 639-4175 I An, .Y 11YltlnNA'4W.:YM•FMp"+bOtM11NY+F•u.,,.. uwF....WM'!TYIRq'"1FF.vwrun+r,rrrMwwx�r: r I City of Tigard MECHANICAL PERMIT P anck/Rec. # 13125 sw Nall Blvd. APPLICATION Permit # w Tigard, OR 97223 i (503) 639-417` ••»� ��• � esaipuon --- - � Table 3A Mechanical Code QTY PRICE AM' Job 1) Permit Fee -0 •0 1000 Address �• ----_ �--- 2) Supplemental Permit 3.00 « - Furnace to I r. CI/I 1C) 1) incl. ducts&vents 6.00 a «• Furnace 100,000 BI U + owner �`, =�CC� tib(/;(1 �� 2) incl. ducts&vents ___ 7.50 — r• urnanrA — 3) incl. vent 6.00 - i«, -9—uspencledeater,wall eater i 4) or Woor mounted he, ter —_ 6.00 ��- -Veit nmT—otc.-Tin— Occupant 5) appliarY-�e permit 3,00 Zip epair 0 e.arng, rn---te ,q— _ 6) cooling,absorption unit 6.00 i er or comp, heat pump,air con 7 -1- 7) to 3 HP;absorp unit to 100K BTU 6.00 r f •v ` of e�or comp,Feat pump,air conte ' "t Iti 8) 3-15 HP;absorp unit to 500K BTU 11.00 Contractor a —Boiler or con p,heal pump,air conc�� V )1 L ��J t l( � 9) 1E .,U HP;absorp unit 5.1 mil BTU 15.00 - s"T�w — i e-BoTr or comp, epi 5t Pump,au con 10) 3050 HP,absorp unit 1-1.75 mil BTU _�?50 ere yac ow ge a a ie readlfrs app ice ion, a e —Boiler or comp,heat pump,air con. information given is correct,that I am the owner or authorized agent >50 HP;absorp unit 1.75 mil BT U 37.50 of the owner,that plans submitted are in compliance with State Air han ing RI t to laws, that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 4.50 that the number given is correct (If ex,ampt from State registration, Air an rng urns-- please give reason below.) 13) 10,000 CTM + 7.50 -- on porta e 14) evaporate cooler 4.50 —` - Vent Ian connected 15) to a single duct 3.00 __Ve_ndfabon system not 16) included in appliance permit •4.50 Hood seryy 17) mechanical exhaust 4.50 seen wo new addiffion U aIi[5 aLon�_ repair ornmercia or incusT sten l to be done residential O non-residential Q 18) type incinerator30.00 Existing use of Utlier i.e.,wood stove,we inif^ns. I,;,'i building or property_ 19) heater,solar, clothes dryers,,.etc. 4.50 Proposed use of 20) Gas piping ore to four outlets / 2.00 building or property--__ _ — — - - --- Type of fuel -oil Q natural as LPG 21) More than 4-per outlet 9 O O electric O Minimum Fee$25.00 SUBTOTAL PERMITS BECOME. VOID IF WORK OR CONSTRUCTION - AUTHORIZED IS NOT COMMEND FD WITHIN 180 DAYS,CR 5%SURCHAF 3E IF CONSTRUCTION OR WORK I" SUSPENDED OR - -- ABANDONED FOR A PERIOD OF ;A0 JAYS AT ANY TIME AFTER WORK IS COMMENCED PLAN REVIEW 25%OF SUBTOTAL. i - --. — - TOTAL- ------ -- ( Special Conditions - Y Date issued _ by _ k.>aeatnur � .ortftarnn.F R �r k.. IY:C'f Y I:lF' '1 I:C3AF<I) .... hEC;1�: :CF�''f' f;1F: r��'fa'YMF::N1' F�F:'r,:;F: ]f•'''1 Nil. a`>?.t�_ i:';�i].:3;58 CHECK AMOUNT a I-(:,»�'0 AME.", a �1'ilC)I)taFli) I) ("Asli AMOUNT 0.00 F.(lhl PAYMr'N'T I)ATF" w 134/:1 S/94 UIJRESS a 51.18I)TV I SDIN y llF<f�CI43F 0F' PAYMENT �IMf:)IJN7' GSATI) F'lll',Pr. SE. OP, V,Ay11F.141AMOUN1 P( CI) f.C;F1ANr.r,A1. r-, , 25.00 IST» I,I,IT,f.1) FUER r 1 �lJ13P , 13W LYNN ST a, Irurow. AMOUNT PAID r lip i I INSPECTION NOTICE City of Tigard Building Department 131,25 SW Hall Blvd.. Tigard, Oregon 97223 V Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: E' Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk �•, Found. Plbg. Top Out Gae Line FINAL: Poet/Beam Struct. San. Sewer Framing -Bldg. - Poet/Beam Hoch. Rain Drain Insulation -Plumb. � Plbg. Underfloor Water Line Gyp. Bd. -Hoch. Date Requested: ` J' �L Time: /- AM �PH • Address: l �11✓� ST Pemit lf `'13`VZ� Builder:_ �` _ 103 THE FOLLOWING CORRECfIOtSS ARE RE RED: I Irl Inspectors `ice---- -- --_-Dates I APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE G /(� ____Call For Reinep. e MEME tl� N�• .'d41' � 1 ! III 1 �a .4 r � " A INSPECTION NOTICE City of Tigard Building Dapartm-,yit ) 13125 Bit Ball Blvd. Tigard, Oregon 97223 Inepection Line (Rec-O-phone): 639-4175 Busineas Phone: 639-4171 inspection: Footin � 1 q Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Cae Line �' FINAL: Poet/Bear Struct. San. 5e:rer ` Framing -Bldg. Mech. Rain Drain Ins"-AtionI -Plumb. Plbq. Underfloor Water Line Gyp. Bd. -Meeh. Date Requested:__ � 1 _..� j Time: --q AM — QpM Address: 1 ��J�J �A V�� 7-)- Permit j `1 UZ_l Builder; ----��-- ._._7 — S \ T)o-z, ■ THE FOLLOWING CORRECTIONS ARE REQUIRED: CSS le Inepect_or: _�/^�_ bate: APPEOJED DISAPPROVED Y_ APPROVED SUBJECT TO ABOVE Call For Reinep. V } � j- 1 INSPepartment EC'fI0- N NOTICF. city of tiger. Bn ids, Oregon 97223 13125 SW Ball Blvd- 9 Inspsction Line (Ree--O-Phone): 639-4175 Business Phone: 639-4171 Inspections -- Plbg• Underelab Hach. Hough-in Appr/Sdwlk Footing Cae Lin FINAL: Found. Plbg. Top out ((((�����_---- San. Sewer Framing -Al-dg. � pnet/Deem gtrtsct. Rain Drain Ineulati: -Plumb. Poet/Beam Mech. plbq. Underfloor water Lina Gyp. Bd. -Mech. PH �lJ `r �+� \ lJ "1 _T c Date Requeetedsl� i me AH rmi?t_ C�� IS ZS �_ `!� �� _ Permit !s Address: Builder: lv 7'r'1 THE FOLLOWING CORRECTIONS ARE Rg(ZUTAF.D: il 4 /-���< ' j ,.r----�•'-"-' Dater, �L� Inspector:�L/ --- /------ — )/ DISAPPROVED APPROVED SURJFCT To ABOVE APPROVED _ �- /`7 Call For Reinep. 1. imccTION NOTA City of Tigard Building Departs—t 13125 SR Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-o-Phone)s 639-4175 Business Phone: 639-4171 Inspections --- Tooting Plbg. Underslab Hach. Rough.-in Appr/Sdwlk Found. Plbg. Top Out /La• Lins FINALS I Post/Beam Struct. San. Sewer ll Framing -Bldg. l Post/Beam Hoch. Rain Drain Insulation -plumb. Plbg. Underfloor Water Line Gyp. Rd. Nech. Date Requested: �U�� �� _Times AM PM ■ Addresss 92 Permit # F-1— t � Builders THE FOLLOWING CORRECTIONS ARE REQUIRED: ..ii" 44' Inspectors //_ — — Dates_ � -�'7 __APPROVED l.�' DISAPPROVED APPROVED SUBJECT TC) ABOVE Call Par Reinoip. -44 CITY OF TIGARD I COMMUNITY DEVELOPMENT DEPARTMENT 13125 8W Holl Blvd.Tigard,Onpon 97223.3109 (503)639.4171 1 i t . � 'r i i � t1l.)i'•I l.i b y .J a t a r~ Y 6w i t i i a 1, if1 �t r i,. r I I 1e� r ..i I Y Of "1'1 h0RD kt 1:1: i F,1 l Il l'htYMl.N f HIs.1.':H l f''f NI►. i ; � NAME a C;1"11...f—rlN0, 14 I T`a U",-ill Ahil.RMI �. �d 1 Se'ti G;w L YN ',f f2C.F::.'{ f'1tYMf:.N1 GFa I f ) Vii 1 t.l/�:� OF POYMC`NT AMC11.IN1 PAID D OF lafaYMF:N{ KaMcrilNl {'E1 � MECHANICAL PL MI.C;9:3- W-:'91 25. 00 C3'T. JAJ I C_1) lmT'A I1')"TN{.. AMOUNT FSAI1) _ _) 1:•. :.' i_. F I"'"r�N d• � � ",�Y` ;��?'���' ��w ,h r � to ,j� ✓,� ,�` ��a .��. .7 .i 0 T►'1PECTION NOTICE_. / f city of Tigard Building Department 1:3125 Sit Hall Blvd. Tiqard, Oregon 97223 Inspection Line (Fac-o-Phone): 639-•.175 Business Phone: 539-4171 Inspect ion:" 1 Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Pound. Plbg. Top Out Gas Line FINAL: Poet/Beam Struct. San. Sewer Fr^ming -Bldg. I Poet/Beam Moch. Rain Drain Insulation -Plumb. Plbg. Underfloor hater Line Gyp. Bd. -Rech. Date Regtieated: Time: AM M - � � ► 1 Addrene: � _ Permit Builder: tt��/A .3* i— THIS FOLLOWING CORRECTIONS ARE REQUIRED: 't Inspector: / �W Dates APPROVED DISAPPROVED APPROVED SUBJRCT To ABOVE Call For Reinsp. i .LNSPECTION It!LICE City of Tigard Building Department 13125 Sw Rall Blvd_ Tigard, orok an 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gae Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. . Post/Beam Mach. Rain Drain Insulation -Plumb./ Plbg. Underfloor Water Line Gyp. Bd. -Mech.G �� r Date Requested: L/ Time: Address-11C' Z Permit rr Builder: % � � ev—/2 0 3 _, ,'` ■ THE FOLLOWING CORREMIONS ARE REQUIRED: r 1 N. i I Inspector: / Date: _`APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE --Call For Neinap. INBPECTION NOTICE City Of Tigard Building Departaent 13125 811 Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-4171 Y Inspection: Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk • Found. Plbg. Top Out Gag Line FINAL: POet/Beam Struct. San. Sewer Framing --Bldg. Post/Beam Mech. Rain Drain ir. aulation -Plumb. t Plbg. Underfloor Water Line Gyp. Bd. -Nech. Date Requested: Time: —� v AM PN Address 4: Permit �fy Builder: THE FOLLOWING ODRRBCOWN6 ARE REQUIRED: F � j Inspectors APPROVED DISAPPROVRD APPROVELi SUBJECT TO ABOVE call For Reinsp. n '4 _ 4 F INSPECTION NOTICE City of Tigard Building vaparteeint 13125 M Ball Bled. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171 inspections — Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINALs `P t/B•am�1 San. Sewer tram nq -Bldg. Poet/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mach. . Date Requested: i �^ `� Time: ____M PH Addresses L) �� / �� _ Permit 1a R J )Lam) Com. • Builder: �" =i' ' �-'iv .L.r• r�r �S i �O THE FOLLOWING CORRECTIONS ARE REQUIRED: i I I q Inspectors — Dates _ / APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE i Call For Reinsp. i ♦ �J INSPECTION NOTICF ` City of Tigard Building riepartm nt 13125 SW Ball Blvd. TigaM_, Oregon 97223 Inspection Line (Rec-O-Phone): 639-0175 Business Phones 639-4171 Inspection: 6 Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: 1 Post/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Mach. Rain Drain Insulation -Plumb. Plbg. Underfloor Watar Lina Gyp. Bd. -Mach. Date Requested: '7_� �L_ Time�`vL ��L _ PM Address: f Permit �: „'[f Z''2'.0 _ 4 Builder: TRE FOLLOWING CORRECTIONS ARE REQUIRED: i (Z)�-�2�.__ /_'G�, is [�. ��C�l •� Cl•,,..� ♦i v — ILA A � ♦��fi fe�U Ll�r! Lei nd ZL Inspector:_ _ !Z APPROVEDy DISAPPROVED APPROVED SUBJECT TO ABOVEle" `--W Call For Reinsp. l iai INSPECTION NOTICE City of Tigard Building Department , 13125 SK Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-C-Phone): 639-4175 Business Phones 639-4171 Inspection: i-.Footing\ Plbg. Underalab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct. man. Bever Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Nater Line Gyp. Bd. -Mech. _ / 1 Date Requested. /C57) ' - Timer AM PM Address: S Permit I: Builder: / B THE FOLLOWING CG i CTIONS ARE REQUIRED: �n I i Inspector:_�� Dates��Z _--APPROVED DISAPPROVED v APPROVED SUBJECT TC ABOVE Call For Reinsp. r i Jig 4� i tit;: ly4 BUILDING GERMITs C17YCWTI fAr RD *OF f-ff?P11T #. . . . . . .COMMUNITY DEVELOPMENT DEPARTMENT 13126 SW wi Blvd.P.O.Box x33,Tipp,Oregon s►1 (eD3)>W4475 i iDATE ISSUED- 12/17/91 :5 i1" 'S 1 O3BA--OO 143SITG ADD2F` 1 18SL 'UU _ .' SUBDIVSIGN. . . . : LERON HE=IGFi"►�� IdQ. ZONING: R-4. "v r BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : i a RE ISSUE: FLOOR Gal l E:R I OR WALL CONSTRUCTION CL ASS OF WORK. :ADD F I RST. . . . :288 s f N E: W: TYPE OF USE. . . :SF SECOND. . . : sf FIROIEC T i]FI KINGS?--••_._.._._.___-_... TYPE OF CONST. :5N TH I RD. . . . : s f N: 5: E:: Wo OCCUPANCY GRP,. : R,-.-, TOT41L - - --- —: BB s f ROOF- CONST: FIRE RET? : OLA"UF'ANCY LOAD: BASEMENT. sf AREA SEF'. RATED: STOR. : 1. HT. : 15 i't GARAGE. . . : Sf OC;CU SEID. RATED: PSM'f? : ME Z Z? : REOD SETBACKS-------- REQUIRED------------------- FLOOR LOAD, , . . :��. i Us f LEFT:42 ft RGHT: ft 1=I R SPKL: SMOK MT. . : {.- B UWE_LLING UNITS: 1 FRN'f: ft REARs21 Ft FIR ALRM: HNDICP ACC: E31_DR1�15: BATHE: I1+IF' SURFACE: PRO f.'ORR. PARKING VHLUE.. f : 13248 t Remarks : addition c:fifl sq/ft new addition Owner,, _.___._._.____._._-___._..._.._..__.__________._._.__._ ________________ FEES —_—__----__--.... HARr_AN REETZ type amol_rnt by date recpt 1' J825 SW LYNN F'RMT $ 104. 50 JLH 12/17/91 -- PL.CK $ 67. 93 JLH 12/17/91 — TIGARD OR 972:23 aPCT $ 5. 23 JLH 12/17/91 — P'lione #: 639-9703 Contractor: OWNER Frhone #: $ 177. 66 TOTAL i pert #. , -_... — REQUIRED I NSF'ECT I ONS -----.------ j This pereit is issued subject to the regulations contained in the Foot/fol-aid Insp ��• __- ______ Tigard Municipal Code, State of Ore. Specialty Codes and all other Post/Beam Insp applicable laws. All work will be done in accordance with Framinq Insp approved plans. This permit will expire if work is not s'.arted Inwulation Insp within 188 days of issuance, or if work is sa5oended for sore Gyp Board Insp than 18N days. Rain drain Insp Final Inspection :4 e r,m i t t e e S i q n,a t l.r r e s _ �_. ..._..._--.---_ 1s5'_red By : Call for inspection — 639-4!75 i i s i I k Permit No: Address: — Y Issued by:__._— Date: `,,�'' '' • .FOR OFFICE USE ONLY -- STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CnNSTRUCTION RESPONSIBILITIES 1 Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants ■ who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be Issued. 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 box 1 and either box 2A or 2B: -- I i i 1. �G] I own, reside in, or will reside in the completed structure. 2, A. = My general contractor is �.—`— Contractor registration number I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR B. ® 1 will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction 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. ignature of Pe mi pIIcant Date CONSTRUCTION CONTRACTORS BOARD 0244) 1190 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT r, f .,n •e � it 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), 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 9xisting structure, you can prevent many problems by being aware of the following responsibilities Y and areas of concern. EMPLOYER RESPONSIBILITIES: ■ If you hire persons riot registered with the Construction Contractors Board to do lab=s in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled tn he 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 r•om emotoyee wages at tfi4Tif6e employees are paid. You will 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. Unernj?2yment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages-s oTaiffempinvees. For more information, call the Oregon Employment Division DHR at 3783224. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensa- tion l_ww, andmust obtain workers' compensation insurance for your employees. If you fail if) 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 37374:34. U.S. Internal Revenue Service: As an employer, YOU must withhold federal income tax from employees' wagei.Y6u will be liable ar the tax payment even if you didn't actually withhold the tax. For more informa- tion, call the Internal Revenue Service at 221.3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Comvllance: As the permit holder for this project, you are responsible for resolving any failure to greet_coda requirements that may be brought to your attention through Inspections. Ltabllily andPropertDa__rn__�age Insurance: Contact your insurance agent to see if you have adequate Insurance coverage for accidents and omissions such as falling tools, paint ovempray, water damage from pipe punctures, fire, or work that must be redone. Time to Supervise EmployeF:s: Make sure you have sufficient tirne to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate II e work of rough-in and finish trades, and to notify bui,ding officials at the appropriate times so they can perform the required inspections. If you have additional questions, write to: Construction Contractors Board J 700 Summer St. NE, Suite 300 Salem, OR 97310.0151 Phone 503.378.4621 0244J 10124189 j n linx(. ,K, �+e�;....�ri■:,aw�s,:.r..y.i;H4.._. ,....... ..............wa�e,A'1tWlM'��Ik .,... ......n..rrrea+mrwwMMi4ifilAN� sKse ..,.... 6 i E , FYI h � R . V 1 1}, CITY OF' T I CaARD - RECEIPT OF l.'AY'MENT REC;E IPV IJC). :91 CHECK AMOUNT z 1.'77. 66 C;AISH gMC]I.JNT z 0. 00 � NAMES REETZ, HARLAN prvy'MC'NT DPTL,'.-; 1'c'/ ADDRESS- 11525 SW » SUBDIVISIUhl +� T IGARD, OR 97223-- i r r-'URPOSE OF' PAYMENT AMOUNT PAID PURPOSE: OF PAYMENT AMOUNT PAID 50t''l_.AN CHECK FE 67. 93 ST. BUILD PER.. 5. 23 I �I I t I I r0TAl_. r-)M(R.INT V Ira I.u _ _ _ _, 17-7. 66 ; 11 C11YOFT11FARD PLAN CHECK APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECKPERMIT t>>t?SRWFI�Md PA�?501.11orJ.0'po^�2f(f001i>p�1�6 .+ DATE ISSUED q� JOB ADDRESS- iL��2�51`✓ y�/1 S�' �.e -- TAX MKFAOT�.�y/t - . — LOT: LAND USE.SUB1 VALUATION: " SETBACKS: FRONT: REAk: _ LEFT:._ RIGHT: ---_ WOVK CLASS: _a44�,_ HEIGHT: TOTAL AREA: USE TYPE: s- F- _ FLOOR MAD: ,y L, IST: CoINSTR TYPE: rl NUT TYPE: 2ND: B OCCUP GROUP: � L DWELI./UNITS: T— 3RD: _ OCCUP LOAD: - NO BEDROOMS*. BASEMENT: NO STORIES: �_ NO BATHS: GARAGE: IMP SURFACE: APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED PLANNI1,JG: REISSUE OF: LIST/SUBCONTRACTORS: ENS: _ LAST•RFSSSUE: BUS TAX: FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS: w OTRER: SEN LND.: TRUSS DETAILS: PARKLNG PLAN: LANDSCAPE PLAN: PLAN CHECK BY: OTHFP: PERMITP DESCRIPTION AMOUxrI AMOUNT PD. BAL. DUE r 10-432 00 Building Permit Fees , SO 10-431 00 Plumbing Permit Fees ` 10-431 O1 Mechanical Permit Fees 10-230 01 State Building Tax (5X) Building Plumbing Mech 10-433 00 Plans Check tee ,1� Building G. i'.% ' Plumbing Mech _ _ 30--202 00 Sewer Connection _— ---- - - 30-444 00 5rwer Inspection _— SI-448 00 Street System Dev Charge (SOC) _ _ -- 1 52-449 00 Parks System Dev Charge (PDC) -- 31-450 00 Storm Drainage Syst Dev Chrg (:SOC) --- 10-230 09 TRFO �---- --- - 10-230 OG Washington County Fire n1 — "' 10-220 00 Amari/Wedgewood -- To rAL REC n ---- -- - APPLICANT SIGNATURE - Received By: --- — --- ---- ... --- ---- Oat, Received: - ------ ---_— cn/3507P/18P y o. ft i i„ kr1 ��� 1, , .,. t�• f 5 � 1 1V RrZv Trw; I J r �,4,; 4 1 �Sry. 1 ,yt,tQ Ot Yw�.M�h^r; 1glMAiiMJVMInKMHffWw.ow..+rn www.�w....... ... ._.... .......«..www ��i�; • Address Permit No o / f' r Permit charge� �; Owner ��. ` ;�- c%.�.- Connection fee4 Paid by� Type of building'' _ Date connected - Service rate Inspection fee Contractor Paid by Date Size of connection ” Assessment.____ —Paid_ f i •I i f. eJ�1 1 4� � i i a t Yf 0 !•;, r �, i 9 ! yl ! t lI F f nye u rte 1,, • r {t+,dli Z �tFj� i � r r � } f ti t f t t• i • t P p+t.� �,5 iSS� � ��y i�Kl�, r'ya��� l .;�� � ;� •' f.: i+ y f I Amid PERMIT TO CONNECT Tigard Sanitary District PERMIT N? 1354 DATE PERMIT IS GIVEN TO _i(� lL.� [l• I TO CONNECT A _y •, �1-- - �__--------_—__. TO THE SYSTEM OF TIGARD SANITARY DISTRICT 1 THIS PERMIT MUST BE POSTED JN THE DF!'CRIBED PREMISES UNTIL CON- NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM- PLETED. I ` PERMIT FEE PAID ;...,� 1 ..t... TIGARD SANITAR,Y�DISTRICT .. ......_By I CONNECTION INSPECTED AND APPROVED Date !— Y — Superintendcat� X f ,. t d�`` ✓./..7 J �5 F �' .'•`'r ��M��eP�J"4�s#i.r.'6�t���,�t�nwv��Y'k� :,.,i:fis. f