9555 SW LEWIS LANE 9555 SW LEWIS LANE
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INSPECTION NOTICE J
City of Tigard Building Department `
P.O. Box 23397
Tigaid, Oregon 97223
Phone: 639-4175
Type of InspectionDate Requf)sted Requested 3 Time A.M. P.M.
Address _. - � ��1`� — .-- mit Z
Owner _ Lot # _
Builder ---
-— -The following Building Code deficiencies are required to be coirected:
Pr6eented to — *--- -- — ( A� pprored
Inspe;.tor — ^' ❑ Disapproved
Date _L ----- —
CALL FOR REINSPECTION
❑ YES f-�] NO
C17Y OF 71FARD
1LIPE ITO
COMMUNITY DEVELOPMEKPXxEPAR-fMENT RD • • • • 1,ST90-0022
13125 SW Hall Bbd. P.O.Boa 23397,Tigard Or n er2M (603)839 4175 RIN.. PE T il(. MST90-002 2
6.19 17_1 D _UE_ _: 01/22/90__
SITE ADDRFOS. . . : 9555 SW LEWIS LN PARCEL: 1S135CD-205 _ l
SUBDT1?1,'Tn!:. . . . ._ ZONING:
BLOCK. . . . . . . . . . . .,Z. . . . . . . . . . .
--------------------------------- BUILDING
REISSUE: DWF1,LING UNITS:O BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :AI.T BlDRMS:O BATHS:O GARAGE. . . . . . . . . . :640 of
TYPE OF USE. . . :SF F!:,OOR AREAS----------- REQUIRE:1 SETBACKS----------
TYPE OF CONST. :5N FIRST. . . :0 sf LEFT. . :O ft. RIGHT. :O ft
OCCUPANCY GRP. :M1 SECOND. . . :0 sf FRONT. :O ft T'EAR. . :O ft
STORIES. . . . . . . :5 THIRD. . . . :0 sf REQUIRED-•-----• -------------
HEIGHT. . . . . . . . :17 ft TOTAL------:0 sf £MOKE DETECTORS. :
F',OOR LOAD. . . . :25 psf PA-iFING SPACES. . :0
Remarks: Garage addition
------•---------------------------- PLUMBING ------------
SINKS. . . . . . . . . . :0 FLOOR DRI,INS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :0 WATER HEATER'-'- . . :0 TRAPS. . . . . . . . . . . . . . :0
TL'B/sHOWERS. . . . :0 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :O SEWER LINE (ft) . :0 GREASE TRI.PS. . . . . . . :0
DISHWAS.fERS. . . . :0 WATER LINE (ft) . -0 OTHER FIXTURES. . . . . :0
ARBAGE DISP. . . :0 RA.LN DRAIN (ft . :0
WASHING MACH. . . ;0 SF RAIN nRAINS. . :O
--------------- MECHANICAL ------- ------ ---------- •----- FEES --------------
FUEL TYPES----------- VNIT HTRS. . :O type amount by date recpt
VENTS . . . . . .0 PRMT $ 56.50
AX INPUT.0 BTU VEND FT"':S. . :O PLCK $ 36.73
FURN < 100K . . :0 HOODS. . . . . . :0 5PCT $ 2.83
FURN >-100K . . :0 WO0DSTO�jFS. :0 PAYM $ 96.06 JLH 01/22/90
FLOOR FT)RN. . . . .0 CLI) DRYERS. :0
BOIL/CMP < 3HP:0 OTHER UNITS:O
GAS OUTLETS:O
Fner: -----------•------------------------
HASTING
555 SW LEWIS LN
IGARD OR 97223
Phone #: 294-6582
Contractor: -------------------------------
'ONTRACTOR NOT ON FILE
Phone 1:
Regly. . . ----------------------------------------
$ 96.06 TOTAL
his permit is isBuEd subject to the regulations contained in the ------- REQUIRED INSPEC
igard Municipal Cole, State of Ore. Specialty Codas and all Wither. Foot/found Insp Gyp B
%pplicable laws. All work will be done in Accor.lance with approved Post/BAam Inep Rain
lane. This permit will expire if work is not started within 180 Plm/undalab Insp Water
aye of issuance, or if k iq s aended for more than 180 days. Mechanical Insp Appr/
cT- Framing Insp Final Inspection
ermittee Signature:,` -� ', c * Cireplace Insp
--� Gas Line Inep
asued By: Insulation Insp
Call for inspection - 639-4175
Nmiuw_�
Permit No: _
Address:
Issued b Date: —_--_--
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note grin Law, CHS 701.055'4), requires residential building permit applicants
who -iot regislared with the Construction Contractors Board to sign the
follovn„g statemeot before the building permit can be issued. Licensed Architect
and Engineer api)licants, 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 banks, and initial box 1 and either box 2A or 2B:
1. otL 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. - I 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 Jo 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 he
reverse side of this form.
W_
Signature of errni4 pllcant Daae
CONSTRUCTION CONTRACTORS BOARD
0244,] 10/24M9
WHITE COPY TO ISSUING AGENCY PERMIT FILE
MNK COPY TO APPLICANT
e.
� o s
INFORMATION NOTICE TO PROPERTY SWNERS
At#CUT CONSTRUCTION RESPONSIBILITIES _I
Iv OTE: This tnturmatlbn Noting, ►o Property Owners About Construction
Responsibilities was developed i;y the Construction Contract."rs 13aard in
accordance with ORS 701.055(5), pass()d by the 1989 Oregon Legislature.
nnt
a substantial imp
If y
vu are � .^ as our own contractor to conFtruc�&bew home of being aware of make
he following resporlslbll t es
to an existI� rctLre, you can preve�il many problems Y
and areas %A cera!
EMPLOYER RESPONSIBILITIES:
if you hire persons not registered with the Cont tnfc i ersld ntEa�structure, ou wlll,do �nrin Most Instances,
or assisting in the construction or lmproYeR1Pr
be ruled to be an "employer" and the people you hire will be "employees". As the r�m�aloYer, YO" mu
comply with the following:
rl 1 ee wagon
Oregon's Wit�ding Tax i You will bepiAs ai ablle�for the tgx payments eoki ve it you dome Wes n't to l `t�nU! 1
a�tFie tl►ne ampiaye� s ars l)a
the tax from your employ ees. For more information, call the Orec;on Department of Revenue at :zT8-:3390•
ent
ancO
Unem Iv rnent Insurance�Tax: As an emFor ,more information, Call theyOregoa tax n Employment Division DivisionrDHR
�iurposes or �vvages oTaTernployPes
at 378.3224
Workers• Curr�lsatron Insurance: As `nsatlurpiltna Iranc lot yoou are bre)mployeF'ct to the Oltgyou fon al�eohtaiinoworkerq
t un w, am must a to rr workers comps
you may be subject to perlaltfes and will be liable for all claim costs if one c,
compensation insurance, y Y
our employees is injured on the Jab. For more information, call the Workers' t^,ompransation Division DI
at 3737434•
U.S. Internal Revenue rervlce: As an emplaye�, Yf you dktn'ti ahctulallfederal
ehhold the tex.. For more informa•
wages�c-u w 1 ) I a a car ibe tax payment ev l r Y
tion, call the Internal Revenue Service at 221-39150.
OTHER RESPONSSIBILITIES AND AREAS OF CONCERN:
Code Cwt►► Iiianue. As the pdrrnit 11.01der for thls project, you are rosponsible for resolving any fallurn
to meet ceder .quirements that may be brought to your attention through Inspectlo s.
avH adenuatA
ou
LiabilitYand I?'ropert Damn�e Insurance,rnissir.�n"1 qi Bct ch as failing ton paint oversur insurance, igent to see it prary,water damage
"urance coveraar or arch=ants
r om pipe puncta•es, fire, or :Mork that must be redone.
"Itne to Su ervisb Employees. Make sure you have suffl;:ient time to supervise your employees.
racAtor, to
te
,�.Kyertise: Make sure you have the expertise coQratlfy building e, as your afflg.iaisrat thetapproprir�te tlmesa�o
the w�o—Tr c'of tough-in and finish trades,
they can perforin the required Inspections.
if you have additional nuestlona, write to: 700 Ski me�'St`�NF., Sulto 3ntractors rd
Salem, OR 97310-0151
Phone 503;G784821
0244) 1012+4189
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F-Qr-' f-C)LLISUCTION
PERMIT NO. SITE ADDRES3
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Address-_ �_ � s P�L,�—'j(A of. Permit No.,
Name of Occupant ,� �, 1' 2 >-tom' Permit charg
- Paid by--- _ ---- --
--------_- _ _ __-- Date connected
Type of Building_ Sd — --- Inspection foe __-- _ --- ---_ ___---
Service Rate 2 _- _ _ Paid by --___ Date____
Contractor Assessment------- .."Paid
r
Size of connection.
- 1
CITY OF TIGA'
RD
'�J PLAN CHECK APPLICATION
X C"YOFT..iARD PLAN CHECK H --__
COMMUk 1ITY DEVELOPMENT DEPARTMENT PERMIT N
II �j
I31755.W."AN13t. v.n.eoir �.Tq�ar,�,,,,� �+.(swleav�»s C�1 \\ DATE ISSUED
t� -i AX MAP/LOT / 5 /- S C O J O S
JOB ADDRESS: LS SSS S W Q ��5 �n' ---------
SUB: LOT: LAUD USE:
VALUATION: —
SPECIAL NOTES
OWNER -- -"
TD, .S r•�a _ __ REa'SSVE OF:
NAME: -_
ADDRESS: LAST REISSUE:
__ T�/�• C�Z �L�7 2 L f LO4)D PLAIN/
SENSITIVE LAND:
PHONE v� s6L -
APPROVALS RE(1�UIRE0
CONTRACTOR PLANNING:
NAME. _ ENGINEERING:
FIRE DEPT _
ADDRESS: OTHER: -
PHONE'
�`-'-- --- ITEMS RE VIREO
LIS USUBCONTRACTORS:
ARCH/ENGIKLR BUS TAX:
NAME: _ _._� __-- _ CALCULATIONS.
ADDRESS: TRUSS DETAILS:
PmRKING PLAN: -^ _
— LANDSCAPE PLAN:
PHONE: OTHER:
COMMENTS: 6 14o 6
PERMIT H ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
1•/j f )-uult 10-432 00 Building Permit Fees
✓ o -)�0
10--431 00 Plumbing Permit fees
_ 10-431 01 Mechanical Permit Fees -
10-230 01 State Building lax (5%) _* "� s
Building -
Plumbing ----__--
Meeh
10-433 00 Plans Check fee '� �4'•13
Building
Plumbing
Mech _ _----
_ 30-202 00 Sewer Connection
30-444 00 Sewer Inspection _---
51-448 00 Street System Dew Charge (SOC) _ -
52-449 00 Parks System Dew Charye (PDC) -
31-450 00 Storm Drainage Syst Dev Chrg (SSUC) —
10-230 09 TRFD ---- ---��
10-230 06 Washington County Fire #1 (95X) _
10-220 00 Amart/Wedgewood
TOl Al
REC N _
APPI_ICF1N1
Received By: A _ Date Received:
cn/3587P/1AP