Permit CITY OF TIGARD MASTER PERMIT
��i DEVELOPMENT SERVICES PERMIT # : MST97 —OE?O0
�'. L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/04/97
tilt) PARCEL: 2S111AD -14800
SITE ADDRESS...:14783 SW 91ST AVE
SUBDIVISION •MALLARD LAKES ZONING: R -4.5
BLOCK LOT :14 JURISDICTION: TIG
Remarks: Interior remodel: vaulted ceiling in dining room to a flat ceiling and adding room above PATH I
room above
—_ ---- - --- --- BUILDING —_ -- _____ —_ _ _
REISSUE: STORIES • 0 FLOOR AREAS— - BASEMENT...: 0 sf REQUIRED SETBACKS ---- REQUIRED -- -
CLASS OF WORK.:ADD HEIGHT • 0 FIRST • 0 sf GARAGE 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 130 sf FRONT : 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT • 0
OCCUPANCY GRP.:R3 BORN: 0 BATH: 0 TOTAL------: 130 sf VALUE..$: 11 %% REAR • 0
-- ----- - -- PLUMBING --- - - - - -- -
SINKS • 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0
LAVATORIES : 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
---- -- - — MECHANICAL -- -
FUEL TYPES----- ---- -- FURN ( 100K ..: 0 BOIL /CMP ( 3HP: 0 VENT FANS : 0 CLOTHES DRYERS: 0
GAS FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 1 WOODSTOVES • 0 GAS OUTLETS...: 0
- - - ---- -- ELECTRICAL ----- -- -
- RESIDENTIAL UNIT— --- SERVICE /FEEDER ---- —TEMP SRVC /FEEDERS— — BRANCH CIRCUITS— - -- MISCELLANEOUS - -- - -ADD'L INSPECTIONS -
1'j% SF OR LESS: 0 0 - 200 amp..: 0 0 - 2% amp..: 0 W /SVC OR FDR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 amp..: 0 .201 - 4% amp..: 0 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL /PANEL...: 0 IN PLANT : 0
MANF HM /SVC /FDR: 0 601 - 1'1 amp.: 0 601 +amps- 1m v: 0 MINOR LABEL -10: 0
1000+ amp /volt.: 0 • - -- ---- -- PLAN REVIEW SECTION — - —
Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR> =225 A.: ) 600 V NOMINAL: CLS AREA /SPC OCC:
--------------- — ELECTRICAL - RESTRICTED ENERGY ------ - - -- -
A. SF RESIDENTIAL ---------- _ --- ---- ----- ---- B. COMMERCIAL - ---- --------------------- _ ____ _______ — ________ _
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM • INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: •• BOILER HVAC LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK • INSTRUMENTATION: MEDICAL OTHR: ••
HVAC • DATA /TELE COMM.: NURSE CALLS TOTAL V SYSTEMS: 0
Owner: ---- - ----- --- Contractor: -- --- - -- — TOTAL FEES:$ 216.31
MARK FUSICK HORIZON RESTORATIONS
14783 SW 91ST 16176 SW 72ND AVE
TIGARD OR 97224 TIGARD OR 97224
Phone NN: 684 -5362 Phone B: 620 -2215
Reg B.'.:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspended for more than 180 days.
— -- REQUIRED INSPECTIONS ----- —
Mechanical Insp Gyp Board Insp
Electrical Servi Electrical Final
Electrical Rough Mechanical Final
Framing Insp Building Fina
Insulation Insp _
�,'''� 1. erm ittee Signature: ,, �� � Issued' By: Al
F' .� /,
Lail tor inspection — bSJ -41 1n
Plan Check : 0
. :t'TY OF TIGARD Residential Building Permit Application Reed By 1.
' 3125 SW H m IL BLVD. New Construction Additions or Alterations Date Reed/ 5 r
r1 OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. 5 aof
'/ 503-6394171 Date to DST 5` 02 17 - ql 7
503- 684 -7297 Permit #/ ( 't7- Oa 0(?
Print or Type Called e*O3 9 - /moo
Incomplete or illegible applications will not be accepted . -�,../ 4 e-
• Name of Protect � Name /� � _,,C . � - ,
( ' Job F7ls�G, 'E -,g., - ft�� )
Address S ite Add ss Architect Mailing Address
/ � 8'3 9 /.c �" h3o $�o a K ter'
Na e City /State Zip Phone
g �elSrGl >�tm 97007 y� /9o,S"-
Owner Mailing A ress Name
ii-ve pi tat p ne Engineer Mailing Address . acz
" Name a ,� City /State . Zip . I Phone
General /TO// v� /e f livQ,w � jbAJ Describe work New 0 Addition 0 Alteration 0 Repair 0
Contractor Mailing Address to be done:
7 / 621.0 ,(r - ' /o) Additional Description of Work:
Ci /State Zip Phone / , �/ /�
Pox G 7aa y 6ZD rzZfS �.� dry - a/J V / X
t. Cont. Board Lic.# Exp. Date � ��� Tf) l� /Y1
Oregon Co
:attach Copy of 6De/ 4 -7.e / " - Cze654 l ' r` -- -
Current COT Business ax or Metro # Exp. Date PROJECT
Licenses Name /0 93 7— tt VALUATION $ /4 00 U.._ ,.
'lechanical 1-(1 (OL NEW CONSTRUCTION ONLY:
Sub- Mailing Address / I Sq. Ft. House: /3 U Sq. Ft. Garage
c ontractor l � id/ . / Corner Lot YES NO - Flag Lot YES I NO
lifillinialiVAIIII one) (check one 1/ • lath Co Oregon Const Cont. Board T:p Date Restricted Audio /Stereo one)
Burglar
Copy of Energy System Alarm
Current COT Business Tax or Metro I ti* 1.- ' . ate Installation Garage Door HVAC
Licenses
Name Opener Systems
Plumbing a pe all that Other.
Sub - Mailing Address Will the electrical subcontractor wire for all YES NO
Contractor restricted energy installations?
Cry/State Zip Phone Has the Subdivision Plat recorded? I N/A YES NO
Oregon Const. Cont. Board Litt Exp. Date ✓
%ttach Copy of Reissue of MST#: Solar Compliance
Current Plumbing Lac # Exp. (Calculation Attached)
Date
Licenses I heart acknowledge that I have read this application, that the
COT Business Tax or Metro # Exp. Date info• atio given is Corr- - , that I am the owner or authorized
a .. ent of e ow , that plans submitted are in compliance
Name Ore• ••n St -ys.
electrical Rp�S� C/7 FZ 7 'c ' /;�I 1 _, • ,: , o to iurat
Sub- Mailing Aooress oT.*' u rson Ma l tone
ontractor A).6 E CKL/ l,��tc� (0173
City/ate Zip I ° one - ., FOR OFFICE USE ONLY:
LSD
C7� - 8 7 - x/ 6 _ Plat #: f Ma Oregon Const. Cant Board Litt -+ ,. p. • : • l
Attach Copy of
Current Eleanca _
6 1 017 � � Setbacks: Zone: Solar.
Licenses G .. / C I Drto_lo� ' -y Engineering Approval: p
usiness Tax or M tro u r t; � g 9 PProval: fanning Approval: TIF:
t t 00 p. Da -----
� iasfapp.doc (dst) 1197
Permit # Account Description Amount Amt. Pd. Bal. Clue
7/7 ou MST. Permit (BUILD) $6.
Plumb. Permit (PLUMB)
Mech. Permit _ (MECH) a 3
ELC/ELR Permit ( ELPRMT)
State Tax (TAX) 233 V 7 '33
Bldg: d/, V .
- Plumb: -- _.. - - .
Mech: (c z rl -
ELC /ELR: / , 7 V _.
Plan Check
. • . ._- •
MST: (BUPPLN) 2co,
Plumb: • (PLMPLN)
Mech: - - (MECPLN) _ Q� ( TeTr
CDC Review - - • __ (LANDUS) •
Sewer Connection (SWUSA) .-
Reimbursement District ( )
-- Sewer Inspection . (SWINSP)-
Parks Dev Charge (PKSDC)
Residential TIF • (TIF -R)
Mass Transit TIE (TIF -MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS: �� 3 1 / ,,, i /6
is pp.doc (dst) ire? ,'
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: - 7 - )-1- 6 1 7 A.M. P.M. MST: _IL-1D21)0 ,
Location: 1 y 3 5u0 (� 1 1 4t BUP:
Tenant: Suite: Bldg: MEC:
Contractor: i, / IS — iIlhl —*AP 1 „LI(/ 1 .. 11 . • _ 1,0 — 1. PLM:
Owner: I I Phone: ELC:
ELR:
• SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam . Post/Beam n Cover /Service Sewer /Storm
Footing Roof UndF1/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bunt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spk1r /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved , ,t. , , _ :. Approved Approved
Appr /Sdwlk Not Approved Not Approved 1 o e I 'roved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
•
•
O Call for re' t; 0 Reinspection fee of $ required before n- inspection 0 Unable to inspect
Inspector: 4 i0 Date: r C Page of
6/6/00 Activities for Case #: MST97 -00200
3:23:04 PM 0
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA005 Application received 5/19/97 JDA PASS JDA 5/23/97
MSTA008 Permit Created 5/23/97 JDA PASS JDA 5/23/97
MSTA012 Plans routed to Plans Examiner • 5/23/97 JDA PASS JDA 5/23/97
MSTA026 Plans approved by Pln Examiner 5/27/97 RT PASS BT2 5/27/97
MSTA030 Reviewed plans routed to DSTS 5/27/97 RT PASS BT2 5/27/97
MSTA032 DST Post - Review Completed 6/3/97 JSD PASS JD 6/3/97
MSTA720 Mechanical Insp JDA 5/23/97
MSTA723 Electrical Service JDA 5/23/97
MSTA724 Electrical Rough In 6/12/97 TLP PASS J *H 6/16/97
MSTA725 Framing Insp 6/12/97 TLP PASS J *H 6/16/97
MSTA740 Insulation Insp
JDA 5/23/97
MSTA745 Gyp Board Insp 6/16/97 TLP PASS J *H 6/18/97 DRYWALL NAILING OK
MSTA790 Electrical Final JDA 5/23/97
MSTA795 Mechanical Final 7/21/97 ' RLP PASS J *H 8/19/97
MSTA799 Building Final
JDA 5/23/97
MSTA080 (F) Ready to issue 6/3/97 JSD PASS JD 6/3/97 Need MEC identified. jsd
MSTA092 (F) Issue combination permit 6/4/97 JDA PASS DST 6/4/97
MSTA770 Misc. Inspection 2/17/00 2/17/00 2/17/00 JMT DONE No Hold . JMT 2/17/00 research inspection request
MSTA153 Expired by limitation 6/5/00 HAP DONE No Hold AKJ 6/5/00
•
•
•
Page 1 of 1 .
1