Permit MASTER PERMIT
a OF TIGARD PERMIT !#....... CL____YIST96 � E
DATE ISSUED: 09/1 3/96
` COMMUNITY DEVELOPMENT DEPARTMENT 4 ( 4 474 )
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 ® PARCEL: 1 S1 3 UG - ..3 60
SITE ADDRESS— : 11480 SW 92ND AVE
SUBDIVISION....: DOGWOOD RIDGE 44*7 a ZONING: R -4. 5
BLOCK........... LOT— ..........:9
Remarks: Alter ceiling of kitchen and provide access to 2nd floor bedroom
PATH I
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: Y
TYPE OF USE... :SF FLOOR LOAD • 40 SECOND...: 264 sf FRONT • 0 PARKING SPACES: 0
TYPE OF CONST. :5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT • 0
OCCUPANCY GRP.:R3 BORN: 1 BATH: 1 TOTAL : 264 sf VALUE..$: 15000 REAR • 0
--------- - - - - -- - - -- PLUMBING
SINKS • 0 WATER CLOSETS.: 1 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0
LAVATORIES • 1 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB /SHOWERS...: 1 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
------ - - - - -- MECHANICAL - - - --
FUEL TYPES FURN ( ..: 0 BOIL /CMP ( 3HP: 0 VENT FANS • 1 CLOTHES DRYERS: 0
/GAS/ / / FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0
MAX IMP.: 0 BTU FLOOR FURNACES: 0 VENTS • 2 W00DSTOVES • 0 GAS OUTLETS...: 0
------- - - - - -- ELECTRICAL —
-
-- RESIDENTIAL UNIT -- ---SERVICE/FEEDER---- - -TEMP SRVC /FEEDERS -- --BRANCH CIRCUITS - -- -- MISCELLANEOUS - - -- — ADD'L INSPECTIONS- -
1000 SF OR LESS: 0 0 - 200 asp..: 0 0 - 200 asp..: 0 W /SVC OR FDR..: 1 PUMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 app..: 0 201 - 400 amp..: 0 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 0 401 - 600 app..: 0 401 - 600 asp..: 0 EA ADDL BR CIR: 0 SIGNAL /PANEL...: 0 IN PLANT • 0
MANE HM /SVC /FDR: 0 601 - 1000 asp.: 0 601 +asps -1000 v: 0 MINOR LABEL -10: 0
1000+ asp /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 # SYSTEMS: 0
Owner: Contract or: - - - - - -- TOTAL FEES: $ 324.46
TERRY SMITH OWNER
11480 SW 92ND AVE
TIGARD OR 97223
Phone #: 684 -1460 Phone #:
Reg #..: OWNER
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
PLM /Underfloor Erasing Insp Plumb Final
Mechanical Insp Insulation Insp Building Final
Plumb Top Out Gyp Board Insp Erosion Control
Electrical Serv.i Electrical Final
Electrical Rough Mechanical Final / / /
Permittee Signature: Issued By:
Call for nspection — 639 -417`,
'
_.. , IRV
Plan Check a Ch c
ITY O`t= I`IGARD Residential Building Permit Application Rec'd By 1 M et
13126 SW HALL BLVD. New Construction Additions or Alterations Date Rec'd 4 - 2_t - IC,
TIGARD, OR 97223 Single Family Detached or Attached Date to P.E. 1 -1 11 /p
(303) 639 -4171 Date to DST f -/Z -q
Permit #
Print or Type i� - "N �1/
Called/JK' NI I '_Gt/
Incomplete or illegible applications will not be accepted q_ II _ q4
y
Name of Subdivision Lot # Name
Job 1 0 L_t1 i `� 'Li,/� �"� -r\_°�" CIA-�1
• Architect Mailing Address
Address Site Address ,Q �p-t-I
�1 i A_'L ` 0 r.-1_,0 - 1 i' 2 : ` ) City /State Zip ` Phone
ame° , N T f' .-t i+Ch
Owner Mailing Addr _ Name
Engineer Mailing Address
City /State Zip Phone ` g
&Btt-- W1 O City /State Zip Phone
Name
General ,-, ,_- 0 -A` Describe work new 0 addition 0 alteration\ repair 0
Contractor Mailing Address to be done:
1 Additional Description of Work:
City /State Zip Phone £ C- aLJ W..j 10D P F 14 Tt- -k-rc 1
. trE . 'IV T-.tA
Oregon Const. Cont. Board Lic.# Exp. Date
•
Attach Copy of Project
Current 1 V aluation
COT Business Tax or Metro # Exp. Date �S" n
Licenses
Name NEW CONSTRUCTION ONLY:
Mechanical ; Sq.Ft. Hou ,q 5 f F Sq.Ft.Garage:
Sub- ' Mailing Address t
Contractor Corner Lot Yes No Flag Lot Yes No
City /State Zip Phone (check one) (check one)
Restricted Audio /Stereo Burglar
Oregon Const. Cont. Board Lic.# Exp. Date Energy System Alarm
Attach Copy of
Current COT Business Tax or Metro # Exp. Date Installation Garage Door HVAC
Licenses Opener Systems
Name (check all that Other:
Plumbing apply)
Sub Mailing Address Will the electrical subcontractor wire for all Yes No
restricted energy installations?
Contractor Has the Subdivision Plat recorded? N/A Yes No
City /State Zip Phone
- Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
Attach Copy of (Calculation Attached)
Current Plumbing Lic. # Exp. Date I hereby acknowledge that I have read this application, that the
Licenses information given is correct, that I am the owner or authorized agent of
COT Business Tax or Metro # Exp. Date the owner, and that plans submitted are in compliance with Oregon
State laws.
Name Signature of Owner /Agent Date
Electrical
Contact Person Name Phone
Sub- Mailing Address
Contractor FOR OFFICE USE ONLY:
City /State Zip Phone Plat 4 Map/TL #: . I-
Oregon Const. Cont. Board Lic.# Exp. Date - P2 , 064 R J )51 ')5 3 'o7 n
Attach Copy of Setks Zone: / Solar:
Current Electrical Lic. # Exp. Date , Q -1--/'( jp
Licenses N pk
COT Business Tax or Metro # Exp. Date Engineering Approval: P anning Approval: TIF:
'dsts\mstapp.doc Y V V I n �l ' ik L
Permit # Account Description Amount Amt. Pd. Bal. Due
121:k •Dy2LMST. Permit (BUILD) HO,; D /1 O. ,Z
Plumb. Permit (PLUMB) 7, o v .27 --
Mech. Permit (MECH) ,;,
ELC/ELR Permit (ELPRMT) // D, ' 1/ 0
State Tax (TAX) ) 3 10./3
Bldg:
110.5 + Plumb: / 3.
27° +
25• + I/ Mech: ( 2
400 +
10.13 + ELC /ELR: c2r�c/
309 -
40° + Plan Check
248 °73 1
_
MST: (BUPPLN) .� 7 /, p j �� . 7 7 3, f
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS) T/Q. , (1 4 0
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (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: y2 V. y(/ 7r.1.3 z y 13
i:\dsts\mstapp.doc
Rev. 7/96
Permit #: ?
OF O
c Maa 7,2,d, 0:4-b
2 Address:
Z 4 '1 ' yid � 7/,g,9'
Issued by: (�2 , ate:
1859
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, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
./0
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
} � before or upon completion.
ri 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
i
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change 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 Owners about Construction Responsibilities on the reverse side of this form.
(. `gnature •f permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
. „.
•
Ergovmatlion NoUce to Pcroperty OW0181TS.
Lot Construct ResponsiibMties
•
Nme: This infOrmation Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
if you are acting as your own contractor to construct a new 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.
•
M'SIIPLOV7f.n RESPCNIVffALMES:
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 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 if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
Unemployment insuirraice rczz: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. Fcr fncre information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Workers' compensaa^r, fr.s As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain work compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties arid wl771,e noble for all ciaim costs if one of your employees is injured on the job. For more informatiOn,
call the Workers Compensaiiol Division at the Department of Consumer and Business Services at 945-7888.
U.S.1nternal Revenue Sar.ri!.. As an employer, you must withhold federal income tax from employees' wages. You will be
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.
OTh RESPONSPOSMES AMID AREAS OF CONCERN:
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.
.•
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.
Time 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, OR97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
1 /94
\i
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas
�� Appr/Sdwlk Reins.
Other: / / 4
Date: v r g T / / � A.M. M. P.M. Entry:
Address: // 7 d Q .c..-0 ' 4/ 6-4,-<, •'' -_ _ -
Tenant: Ste: MST % 6 ~0 Y 2/2—z BUP:
Con /Own: 1-- 2 _ MEC:
1 _61 (4 6 PLM:
7 ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
/ - JrAr A - I ' MS - /
''. d../ ?'Ila /11, !_:...UP
" - • �'.. . - - i.. L Ar a / -t.cey ?r)
o r ,„4:5- r� � c ar .
2' c- ya / / OfL 4.997/. A/ ,o CA -lA.da y:
...CO & 4-S �`X ejep w 4 e`= . .1-S' C-. e /'s .t./ t,"
1 . Pp ? O/�o 1'0�3%� (5/ 2 \
f�G�F� 66,cr i.e. Cam. : L L. 1l Nt
■I
l� o / ?�
Inspector: ���:_ Date: /
_APPROVED ---- DISAPPROVED/CALL FO : REINS' CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
i
Other: .. AZ - D
Date: /d /g I l q 1. A.M. P. . Entry:
b ? � q
Address: � L L fd
Tenant: Ste: _ MST: `76 6 `i' 2
/� ,L BUP:
or-c) . T2Q V CO ,3 q-'4Yti 44 6 MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
42_,/ p p-=- 0 --4.41
r
nspector• L / — k _ Datel
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO
9
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in yp. B: -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: I A.M. P.M. Ent :
Address: T� ?"6 `7.- o/
Tenant: Ste: MST: 94 D V7.2._
BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector: Allir Date: /a /S L
LAPPROVED DISAPPROVED /CALL FOR REINSP. CF CO
Lr
•eg - -_- ' /L % -4 . .
CITY OF GARD BUILDING INSPEdTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top •u Insulation - Elect.
Post/Beam Struct. V ech. Roug - Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk ein
Other: /h! ° A.... 41. _
Date: / b , A. . M. Entry:
Address: ; II, m/ ` _
Tenant: Ste: MST:9/p U 4 2-
p BUP:
O
Con /Own: L LI I �6 U MEC:
- 3 - 2- - 3 - ('i T I (! PLM:
ELC:
THE FOLLOWIN CORRECTIONS ARE REQUIRED: ELR:
2f-
f ✓�
+ '�
In pector: Date ij►k
AP PROVED DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD , 17)ST
BUILDING DIVISION PERMIT #: % _ bB Lea
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ms �iiui
Inspection Requests (24 Hrs.): (503) 639-4175 A i • I �..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / / � a,•f / 4-(j--- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
P_ ROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
�s
Inspection Request Scheduled For: Da e: g- /C' o 7 Pour Time
Code # Inspdtion Description Confirm # Contact # Message ,
l` 9 a- y 9 S (f- 36 4/3
Corrections /Comments /Instructions:
/ (7 , ,---- ,, /
r
/ i
/
KPASS fl PARTIAL APPROVAL I I CANCEL NO ACCESS
❑ FAIL C i L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 f q07
Inspector: t` Date: I Phone #: (503) 718-
CITY OF TIGARD ,` 1 ins"
BUILDING DIVISION PERMIT #: 9' 6- oe? zfaa
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 'q_ i 5_1 (
Phone: (503) 639 -4171 44 0PEMI it
Inspection Requests (24 Hrs.): (503) 639 -4175 -_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ii T 81. /J (7 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: / 444 C r .
OWNER: L✓ � PHONE #:
CONTRACTOR: 41Q 44,44410 1:11#14,70 ` a � PHONE #:
Inspection Request Scheduled For: Date: 7.- 7 Pour Time:
Code # Inspection Description Confirm # Contact # Message
ia a9ct, 6.ciq,3/7 , c°`-/' 36 `�.�
Corrections/Comments/Instructions:
l ) o i la
1' ' Cat P-e-t / el- / / 5-e-- (a)
VI PM5 4
.qq 1 , /ft
IAA No >u� a 1q P
1
1 10 ti
PASS ❑ PARTIAL APPROVAL n CANCEL U NO ACCESS
FAIL I XCALL FOR INSPECTION H ADDITIONAL FEES ASSESSED
bl t Inspector: Date: 517 O 7 Phone #: (503) 718
5/18/00 Activities for Case #: MST96 -00422
4:53:12 PM EXPIRED
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA005 Application received 8/28/96 B RECD - BON 9/4/96
MSTA008 Permit Created 9/4/96 B PEND BON 9/4/96
MSTA010 Check for prcl. restrict. 8/28/96 BON 9/4/96
MSTA012 Plans routed to Plans Examiner 9/4/96 B PEND BON 9/4/96
MSTA026 Plans approved by Plans Exmr 9/12/96 RT PASS BT2 9/12/96
MSTA030 Reviewed plans routed to DSTS 9/12/96 RT PASS BT2 9/12/96
MSTA717 PLM /Underfloor BON 9/4/96
MSTA720 Mechanical Insp 9/12/96 MS NR MRS 10/1/96 tested thru meter
MSTA722 Plumb Top Out 10/3/96 MS PASS MRS 10/4/96
MSTA723 Electrical Service BON 9/4/96 .
MSTA724 Electrical Rough In 10/8/96 MJR PASS MJR 10/10/96
MSTA725 Framing Insp 10/2/96 RB FAIL RB 10/3/96 plumbing & electrical covers
req'd before framing.
MSTA745 Gyp Board lnsp 10/15/96 KS APP KBS 10/22/96
MSTA790 Electrical Final BON 9/4/96
MSTA795 Mechanical Final BON 9/4/96
MSTA797 Plumb Final BON 9/4/96
MSTA799 Building Final BON 9/4/96
MSTB708 Erosion Control BON 9/4/96 .
MSTA080 (F) Ready to issue 9/13/96 CJS PASS CJS 9/13/96
MSTA092 (F) Issue combination permit 9/13/96 JMH APPR J *H 9/13/96
MSTA720 Mechanical Insp 10/4/96 MS PASS MRS 10/4/96
MSTA735 Gas Line lnsp 10/4/96 MS • PASS MRS 10/9196
MSTA725 Framing Insp 10/11/96 KS A/N KBS 10/11/96 #-1- exterior deck not built at
this time
MSTA740 Insulation Insp 10/11/96 KS APP KBS 10/11/96 •
MSTA725 Framing Insp 10/9/96 KS • DIS KBS 10/22/96 #-1- see correction list
MSTA724 Electrical Rough In 10/3/96 HW DIS MJR 11/5/96 do not use #14 conductor for 20
amp circuit need diswasher
circuit smoke detectors needed
• ground metal boxes complete
• make up
MSTA770 Misc. Inspection 2/18/00 2/18/00 2 /18/00 JMT DONE No Hold JMT 2/18/00 research inspection request
MSTA153 Expired by limitation 5/8/00 HAP DONE No Hold AKJ 5/8/00
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