14965 SW LESLIE COURT-1 ur '� ���,' " i•�.•.",C�' �^..;�y,,,,��a�;' �.�' "''�Ri°� �Ur!n+p 1 tf� + .. ,iy��kl�gi��, ' 'Y,� � �.C. W.. r n �1 �
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CITY OF TIGA D BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171 ,
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Footing Rain Drain Cove,/Service FINA
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Foundation Water Line Ceiling 'Iamb.
Post/Beam Mach. Shear/Sheath Framing Q4 tech
PIbg.Und/Flr/Slab Plbg. Top Out Insulation Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg,
N `' 1 San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: ( / A. —P.M.._— En ry: ---
I" Address, _. '5 CP
Tenant: Ste:— MST:
-- _-
Con/( w �_ G u p J--t�Q-� _ MEC:
/ r ( 0Z PLM
ELC: _
fHE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
17
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Inspector: — -- Date 14
ROVED _DISAPPROVED/GALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line- 639.4175 Business Phone: 639.4171
41 Citi 1
Footing Rain Drain Cover/Service y µ
{
�� {; Foundation Water Line Ceiling lum U i
t ��
a i� , Post/Beam Mach, Shear/Sheath Framing i I
1Y �
Plbg.Und/Flr/Slab Plbg. Top Out Insulation Aid Post/Beam Strurt. Mech. Rough-in Gyp. Bd.
San. Sewer Gas Line Appr/Sdwlk Feins.
Other:
Date: _ A.M, P.M. Entry:
Address:
-a
Tenant: _ Ste: MST:
Con/Own: BUP: W1 PIF;
_. _ MEC:
PLM:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
vat"
Inspector: — Date: -- 4
APPROVED DISAPPROVED/CALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE
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Inspection Line Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace w
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mach. San. Sewer Gas Line -Bidg.
Plbg. Underfloor Rain Drain Framing -Plumb,
Alarm Water Line Insulation -Mech.
Undertlr. Insul. Shear Wall Gy,). Bd. -Elect. r'` f"�'F'.
Date Reque3ted: �7
�.�c:: Timo: AM PM
6 yh r r "♦rr'S'.
Address:`
Builder. - �.� �/ — s�c11_Permit #: S ��� j�) 4i 'S', , } ` }rr aril
THE FOLLOWING CORRECTIONS ARE REQUIRED: l+ '1 4 v�y' `r �f.•yf
rrr1 1.4,4Z�
PM
v�iti
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APPROVED _DISAPPROVED _APPROVED SUB ECT TO ABOVE
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CITY OF TIGARD BUILDII IG INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-1175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
FOL-ndation Plbg. Underslab �e_h. Roughs! Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: w
Post/Beam Mech. San. Sewer Gas Line > -Bldg.
Plbg. Underiloor Rain Drain Framing -Plumb. -
Alarm Water Line _ Insulattii`o'n -Meeh. TWFA I r.. , a
Underflr. Insul. Shear Wall Gyp. Bd. Elect.
Date Reouested: /If j �S� Timer AM PM r
Address
Builder: Permit #:�'Ty
THE FOLLOWING CGRRECTIONS ARE REQUIRED:
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Inspector: Dare: 2-4,? 5
PROVED ,DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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ELECTRICAL F,'CFIMIT'
CITY OF TIGARD DATE=tISSUEDi: 12/22./95 ,
..
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,O. jon 07223.8190 (503)830.4171 E-'ARCEE_: 2,1 I i AC-04200
14')65 'SW LGSi-li_: Cl
SURD I V I 5I ON. . . , . LAUNALYNDA PARK Z ON I N17.: R--4. 5
BLOCK. . . . . . I.._OT. . . . . . . . . . . . . : 10
P ro.ject Description: Install six br anch circuits.
-..--RESIDENTIAL UNIT--.-- ----TEMP SRVC/FEEDERS----•- -----MISCELLANEOUS------
1000
--•MISCELLANEOUS-----1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : In
EACH ADD' L 500SF. . . : 0 201 - 400.' amp. . ,. . . . . : 0 SIGPI/OUT LINE LTG. . : 0
E_IMITED ENERGY. . . . . : 0 401 •- 600 amp. . .. . . . . : 0SIGNAL/PANE=L. . . . ., . . �l
17�
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . a 0
-.-_-SERV I CE/FEEDER------ -_ _-)3RANC1( CIRCUITS——— --•--ADD' L INSPECTIONS——
0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . e 0 ■
201 - 400 <_imp. . . . . . : 0 1st W/O SRVC OR DR. : 1 PER HOUR. . . . . . . . . . . : 0
401 600 c-Imp. . . . . . : 0 EA ADDI L BRNCH CIRC: 5 I14 PLANT. . . . . . . . . . . a 0
601 - 100i amp. . . . . . 1;) r ;
-- PLAN REVIEW SECTION-
1000+ amp/volt. . . . . : 0 > =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . :
Reconnect only. . . . . : u4l SVC/FAR > = 225 AMPS. . : ClR-iSS AREA/SPEC OCC. :
Owner,: -._.__._.._.._...__._.._ .___.,__..___----------------------------------- - --- FEES ---
A & J ELECTRICtYpe ��mo�.rntby date --- -r^eLpt
PO Box 330 PRMT $ C:0. 00 CJS 12:/22/95 95-274213
5PCT $ 3. 00 CJS 12/22/95 95--2742:13
FOREST GROVE OR 97116-121330
Phone #: 503--359-5891
Contrfactor:
63. 00 TOTAL
REQUIRED INSPECTIONS
- -- ---
Ceiling Cover Eler_t' l Service171harp V : I
Wall Cover- Elect' 1 Final
Req #. . .
J
Thrs pereit is issued subject to the regulations contained in the
1 Tigard Mmicir•al Code. State of Ore. Soecialty Codes and all other Permittee Signature
' applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
' within 106 days of issuance, at- if work is suspended for more
G' than 180 days. 1 ssLted By -- -- _
.___--OWNER INS ALLATION ONLY.------,
e The installation is being made on prrperty I awn which is not intended for
sale, ---
sale, lease. or rent.
- OWNER' S SIGNATURE:
DATE a
.-____-___-_-__CONTRACTOR INSTALLATION
SIGNATURE OF SUPR. ELEC' N: IA,�C'R DATE:
I...I CENSE NO:
Call for inspection - 639-4175
L.......... r -
Community Dev,dopment ELECTRICAL PERMIT APPLICATION 1
13125 SW Halt Blvd,
Tigard, OR 97223 Permit # EL C
Date Issued /,� - r��- 9s
Phone (503) 639-4171
CITY OF TIGARDFAX (503) 684-7297
TDD No. (503) 684-2772 ■
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule below:
t�
Name of Development_. ___.—__.. +_n bar of Inspections per permit allowed
Address,z;��9,4� ZE-5�1�—L=1_----
Service included Items Cost(ea) Sum
Clty/State/ZI�+_,;.d 14a. Residential -per unit $11000
----- 4 Fo
1000 sq. ft. it less $110 00
Name (or name of business)r �?1�/-1 5 !^ F..ach additional 500 sq ft or $25.00
—
portion thereof —
Limited Energy $25 00 1
Commercial ❑ Residential �_� Each Manul'd Hume or Modular
Dwelling Service or Feeder `_ $6800
—_ 2
2a. Contractor installation only: 4b. Services or Feeders
/ Installation,allerrtion,or relocation 2
Electrical Contractor/y t. h.r Ile 1 ,e1�_._—�_ 200 amps or less $6000
'1 201 amps M 400 amps $8000 _ 2
Address S `"-- 1 401 amps l0 000 amps $120 00 2
City rt �_- ZIP 'l $leo 00
_—_ �7 00t amps to 1000 amps
Phone NO. �e Gam_'/_ Over 1000 amps or volts �_ $34000 _
Job NO Reconnect only $5000 _
contractor's license NO. / _�.�_ 4c. Temporary Services or Feeders
Contractor's Board Reg. No %s Is Installation,alteratlon,or relocation 2
��-- 200 amps or less
Signature of Supr. Elec'n ��72c,4 --- -- 2
201 amps to 400 amps $50.00 2
License No.��V Pnone Nc = 'q/ 401 amps to 900 amps
$�5 00
Over 800 amps to 1000 volts $100 Uo —
2b. For owner installations: see"b"above.
4d. Branch Circuits
Print Owner's NaII_ —____ New,alteration or extension per pane
Address _ a)the fee for branch circuits with
---- purchase of service or feeder fee. 2
City,_ _ State_—___. ZIP ___ Each branch circuit _ $500
Phone No. _ b)The fee lo-branch circuits without
purchase of service or feeder fee. 2
The installation is being made on property I own which is O 2
First branch circuli $3500 � �^
not intended fol sale, lease Or rent. Each additional blanch circuit $500 .uL�.LfL
Owner's Signature —____ 4e. Miscellaneous ),
(Service .1r feeder not included) 2
2
Each pump or Irrigation circle $40 00
3. Plan Review section (if required): Each sign or oulline lighting $4000 —
Signal circull(b)or a limited energy
Please check appropriate Item and ente, fee in section 5B. panel,alteratlon or extension $40 00
4 or more, residential units in one structure Minn,labels(10) $10000
_ Service and feeder 225 amps or more
4f. Each additional Inspection over
System over 600 volts nominal
Classified area or structure containing special occupancy the allowable In any of the above
Per inspection _ $75.00
as described in N.E C Chapter 5 Per hour _ $5500
In Plant - $51,00
Submit 2 sets of plans with application where any of the above
apply. Not -auired for temporary co+rstruction services. 5. Fees: ,n
5a. Enter total of above fees $ u• -
NOTICE 5% Surcharge (05 X total fees) $ ? 00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ a •�
5b. Enter 25% of line A for 6
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR If Plan Review if required (Sec 3) g
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS rr 11
COMMENCED Trust Account# _i
$ � r
Balance Due $ p/
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 1639-4171
Inspection:
Footing Susp. Ceiling c�Frink. Rough in Appr/Sdwlk
Fourn'ation Plbg. Underslab eeh. i uugh irP Fireplace ,
Post/Beam Struc,t. �P16g: op u Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg. r `
Plbg. Underfloor Rain Drain -Plumb. y'' '" •
Alarm `Nater Line e Insulation -MFrch.
Underflr. Insul. Shear Wall Gyp. Bd. -Eiect.
Date Requested: ��% ��/�5� Time: AM PM
1r� /�S /
Address: 5 Gci /G" C /
Builder: —_ _Permit #: �� S`"u� GAS
THF FOLLOWING CM'IECTIONS ARE REQUIRED:
e'C 77
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Inspo� -1�/ ``'�_ Date:
,z6PROV170 _DISAPPROVED _APPROVED SUBJECT TO ABOVE
—Call For Reinsp.
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CITY OF TIGARD BUILDING INSPECTION NOTICE •
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639 4171
'r
Inspection:
ry
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough ' Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough in FINAL:
Post/Beam Mech. San. Sewer Gas Line Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underilr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:_ Time: AM PM
Address:
Builder. J Permit #: r
THE FOLLOWING CORRECTIONS ARE REQUIRED:
t `
Inspector: _, Date:
�4PPROVED DISAPPROVED ,_APPROVED SUBJECT TO ABOVE
_Call For Reinsp. S `
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CIT'/ OF TIC'RD BUILDING INSPECTION NOTICE
Inspection Li,ie (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Ap I
Foundation Plbg, Underslab Mech. Rough-in Fireplace
r_l"V i/beam'" ;At. Plbg. Top Out Elec. Rough-in FINAL:
i"estf' -Ma �. San. Sewer Gas Line -Bldg.
g. lJnderl r Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Unden ,. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: /'(f 24) " — Time: AM PM
Address:_
Builde� U Permit
THE F&LLOWINGORRECTIONS ARE REQUIRED:
i
I - -
Inspector: _ Date: _
VED _DISAPPROVED �APPROVED SUBJECT TO ABOVE
__Call For Reinsp.
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CITY OF TIGARD BU{LD:NG INSPECTION NOTICE 1
Inspection Line (Rec-O-Phore): 639-4175 Business Phone: 639-4171 ►!
f
Inspection:
0o Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
�undatl� Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam S
truct. Plb . Top Out Elec. Rough-in
FINAL:
■
Post/Blom Mech. San. Sewer Gas Line -Bldg.
Plbg. Under loor Rain Drain Framing -Plumb. l
Alarm Water Line Insulation -Mach. �' �
Underflr. Insul, Shear Wall Gyp. Bd. Elect. !
Date Requested: /Z, z '15 T{mb.L�AM PM
10
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Address: s2�
Builder: Permit ia:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
y� A
M' y
Ali 7°lrlA t.
Inspector: . z Dato:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reir5p. s �►;M
.TV
CtTY OF TIGARD i 1_F'MITj#ER. . .. . .TMST950299 i.
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 09/05/95-
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171
PARCEI.-: -3111AC•-04:00
SITE ADDRESS. . . :,W LESLIE ( 1`
SUBDIVISION. . . . : LAUNALYNDA PARK ZONls4G: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .. 10
,
----------- BUILDING
BUILDING __________..___.______.________._..•__.___._...__..__
REISSUE: DWELL INO UNITS: 1 BASEMENT. . . . . . . . :0 s
CLASS OF WORK. :ADD BEDRMS:O BATHS: i GARAGE. . . . . . . . . . ..0 elf
TYPE OF USF. . . :SF FLOOR AREAS -_.___.____..._ REOU I RED
TYPE OF CONST. :SN FIRST. . . . :543 s f LEFT. . :5 ft RIGHT, s 5 ft
OCCUPANCY t.RFr. :R3 S[::COND. . . :0 sf FRONT. :O f-c REAR. . .- IS ft
STORIES. . . . . . . : 1 F I NB SMENT:0 s f REQUIRED-
HE iGHT. . . . . . . . : 18 f-t TOTAL-•-•__-----:543 s-F SMDI�E DETECTORS. : ■
FLOOR LOAD. . . . :40 psf VAL.UE. . . . ,. $ : 35110 PARKING SPACES. . :0
Remarks . ADDITION 543 SO FT PATI; I
PLUMBING
SINKS. . . . . . . . . . :0 FI..00R DRAINS. . . . :0 BACKFLOW PRE"ViITRS. . -.0
LAVATORIES. . . . . : 1 WATER HEATERS. . . .0 TRAPS. . . . . . . . . . . . . . .0
TUB/SHOWERS. . . . : 1 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . : i SEWER LINE (ft ) . :171 GREASE TRAPS. . . . . . . :0
DISHWASIAERS. . ,. . :0 WATER LINE: (ft ) . :0 OTHER FIXTURES. . . . . :0
GARBAGE: DTSP. . . :171 RAIN DRAIN (ft ) . :0
WASHING MACH. . . :0 SF RAIN DRAINS. . : 1
MECHANICAL - .__.-----_.._._•_______ ._.___. __._...._..._.____.-._ FEE,
UNIT HTRS. . :O types amoIant by date I-grpt
/GAS/ / / V%NTS . . . . . :3 BPRT $ 2210. 00 B 09/05/95 95--270173
MAX INPUT:O nTU VEP IT FAN,. . : 1 SPLC $ 1A.1. 00 JD 07/31/95 95--268691
FURN ( 100K . . :0 HOODS. . . . . . :0 B5PC $ 11. 0171 B 09/05/95 95-2741173
FURN ) =1001', . . ;Qr WOODSTOVET. :0 MPRT $ c7'6. 5121 R 219/05/95 95--270173
FLOOR FURN. . . . :0 CLO DRYE'RS. : 0 MPLC $ 6. 63 B 219/05*/95 95-270173
BOIL./CMP ( 3HP:121 OTHER UNITS:0 M5PC $ 1 . 33 B 09/05/95 95-•.07017:3
GAS OUTLE:Ts:O PPRT $ 57. 00 B 09/05/95 95-070173
I Owner: $ 0. 85) S 09/05/95 95--270173
JAMES LEWIS EROS $ 06. 00 B 09/05/95 95-070173
1
1.4905 SW LESS-IE CT E:RPC $ 8. 45 S 09/03/95 95-•07171173
R ERPC $ 6. 45 x: 09/015/95 95-270173
1
T I GARD OR 97224
Phone #: 638-466 : F
Contractor,:
i G;AS HEATING & APPLIANCE
1 SERVICE, INC.
3305 SE DIVISION ST.
PORTLAND OR 97LO2
l Phone 11:
iReg #. . : 030506 ___._____.-----•--._..___.._._.__.._._.._._.__._._.____.____ .__...
$ 511. 21 TOTAL
This perait is issued subject to the regulations -ontained it the ------- REQUIRED INaPE..CTIONS -----
Tigard Municipal Code, State cf Ore, Specialty Codes and all other Footing Insp Frarming Insp
applicable laws. All work will be done in accordance with approved Fa 1.lndat i on Insp I n s 11 l At i on Insp
plans. This peroit will expire if work is not started within 180 Post/Seam Str�.ict Gyp Board Insp
days of issuance, or if work is suspended f ere than Iays. Post/Peam Mechan Rain drain Insp
E Crawl Drain Mechanical Final
rermittee 5i. at'
: ,+ PLM/'.lnderf1oor- P1'..1ml:i 1'i.nal
Mechanical Insp Pl.tilding Final
I s 7 1.1 e d B y: ' _.� - `� _..__....__ pr 1 1-1 m h 'Tota O t.1 t Eras i o n C O T�t1--0 I
. Call for^ inspection 639--4175
�1, t
` Residential Building Permit Application
City of Tigard LN
13125 SW Hall Blvd. (�
Tigard, OR 97223
(503) 639-4171 �I}R(�►5 I��n .
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Jobsite Address: /7� '� GC C'_/
� OfflcA Use Only
Subdivision: e L.-Llra I Z it i,-, Lot #If
Contact Date / / Initials
Valuation: / ,' S;e7—j �) Result
New Construction Only: (Square Footage) Planck/Rec # �
--) ''/f)i Permit # 1-n 5t-rS -U Gl '
House: _ - _) _ Garage: _ Reissue of
v -
Map & 'I L I i illi
Corner Lot? Y N Flag Lot? Y N Zone
' Plat #
Owner: � 1% S 'Z`
' Approvals Requi: -J
I Address: l (r� .; / e
(".220 a ;K P;anning Setbacks !'�~ Solart"
Engineering
Other
Phone: �88c _ -- —
Contractor:
Items Required
'1d�-� Ul t)ht<i�
i
Subcontractors
Address: Truss Details _ y
Other
Phone: L � Notes
Contractor's License # "--
(attach copy of current Oregon license)
Contact Name:
Contact Phone:
d
Subcontractors: dc���= ' �J�y��' Arch itect/Engineer: _
Plumbing: %'! u���'`� z Iv A 1�1 Address:
Mechanical: (�o� 3_. 5'f� N-Ir q� _
(attach copy of current OR Contractor's License)
Phone: ( )
jOB DES RIP . N: �� i, /� z?.,telll
Applj t Signature Applicant Phone number
R�eived by: -2 Date Received:
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Permit# Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mach. Permit (MECN) o?�c.SU
!
State Tax (TAX)
Bldg:
Plumb: >
Mach: t-3 3
Plan Check (PLANCK) �% 3 � e
Bldg:
i
Plumb:
Mach: 4 G 3
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) _
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
1
iCommercial TIF (TIF-C)
i
Industrial TIF (TIF-1)
Institutional TIF (TIF-iS)
Office TIF (TIF-O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) _
Erosion Planck/USA (ERPLAN) (! ►~ �. �l
Erosion Planck/COT (EROSN)
TOTALS: ,.S/ L c/3, i m 2 l
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Permit#: `�`_, —yl
Address: i
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issued by: LI 10_ Date: I S ■
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Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701,055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can bE issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, e.rempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the propriate blanks and initial boxes I and 2, and either box 3A or 313:
1. I , reside in, or will reside in the completed structure.
2. i understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
U 3A. My general contractor is
U (Nar.ie) Contractor regis #
I will instruct my general contractor that all suthcontractors who work on the structure must be
registered with the Construction Contractors Board.
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OR
3B. I will be my own general contractor.
If I hire subcontractors, i will hire only subcontractors registered with the Construction Contractors
Board. If i charge my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and 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 do understand the Information
Notice to Property Ow about Construc n Responsibilities on the reverse side of this form.
(Signature of it applicant) (Date)
(White copy to issuing agency permit,ile, �
pink copy to applicant)
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Information Notice to Property Owners
i About Construction Responsibilities
Note; This Information Notice to Property Owners about Construction Responsibilities r
was developed by the Const fiction Contractors Board in accordance with DRS 701.055(5),
3�If you are acting as your own contractor to construct it new home or make a substantial improvement to an existing structure, t
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
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 riled 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 mast withhold income taxes from employee wages at the time 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
y' information,call the Oregon Dept.of Revenue at 945-8091.
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Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the r
wages of all employees. For more information,call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
1: 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,
,t call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenue Service: As an employer,you mint � ithhold federal income tax from employees'wages. You will be xt
liable for the tax payment even if you didn't actually withhold the tax. For more information,call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
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Code compliance: As the permit holder for this project,you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
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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 punctures,fire,or work that must be
re-done.
'nme 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 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 or call the Construction Contractors Board(PO box 14140.Salem,OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 3(K), in Salem.
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CITY OF TIGARD BUILDING INSPECTION NOTICE 1 /
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-417
Inspection: — —
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk ■
Foundation Plbg. Underslab Mech. Rough-in Fireplace
W ''ost/Boam Struct. Plbg. Top Out Elec, Rough-in FINAL:
Post/Ream Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
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Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: //Z _T mePLI—/ AM PM
Address:, �v 5—
Builder: Perr it #: 7 U Z I
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspect :_ Date:
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PPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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