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Permit __ ._ „ ~/ � CITY � �� TIGARD �m�� PERMIT #. . . . . . . : MST95-017 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 03/14/95 13125 SW Hall Blvd. Tigard, Oregon 97223°819e (503) 639-4171 PARCEL: 1S134DB-03900 SITE ADDRESS...: 11185 SW 109TH AVE �� ,,, �=u��N-0��N�y . SUBDIVISION....: CARNAHANS ADDITION ZONING: R-4.5 BLOCK ......~...: LOT.............:1 --- ------ ----- BUILDING — ---- REISSUE: DWELLING UNITS:1 BASEMENT........:0 sf CLASS OF WORK.:ADD BEDRMS:1 BATHS:2 GARAGE ..... .....:0 sf TYPE OF USE...:SF FLOOR AREAS --- REQUIRED SETBACKS----- TYPE OF CONST. x5N FIRST.... :0 sf LEFT.. :0 ft RIGHT. :0 ft OCCUPANCY GRP. :R3 SECOND... :500 sf FRONT. :0 ft REAR.. :0 ft STURlES.......:2 FINBSMENT:0 sf REQUIRED ----- — HEIGHT........:24 ft TOTAL------:500 sf SMOKE DETECTORS.:Y FLOOR LOAD....:40 psf VALUE.....$: 32330 PARKING SPACES..:0 Remarks: ADDING SECOND FLOOR ABOVE GARAGE � ---------- ---- PLUMBING --- — — — ---- SINKS..........:09 FLOOR DRAINS....:0 BACKFLOW PREVNTRS..:0 EAVATORIES.....:2 WATER HEATERS...:0 TRAPS..............:0 TUB/SHOWERS....:2 LAUNDRY TRAYS...:0 CATCH BASINS.......:0 'WATER CLQSETS..:l SEWER LINE (ft>.:0 GREASE TRAPS. ..... .:0 DISHWASHERS....:0 WATER LINE (ft).:0 OTHER FIXTURES.....:0 GARBAGE DISP...:0 RAIN DRAIN (ft>.:0 WASHING MACH...:0 SF RAIN DRAINS..:1 --------------- MECHANICAL -- — — FEES FUEL TYPES— ----- UNIT HTRS..:0 type amount by date recpt /GAS/ / / VENTS .....:3 BPRT $ 206.50 KS 03/14/95 — MAX INPUT:0 BTU VENT FAN8..:1 BPLC $ 134.23 KS 03/01/95 95-262336 rUHN < 100K ..:0 HOODS...^..:0 B5PC $ 10.33 K8 03/14/95 — FURN >=100K ..:0 WOODSTOVES.:0 MPRT $ 25.00 KS 03/14/95 — FLOOR FURN ^0 CLO DRYERS.: 0 M5PC $ 1.25 KS 03/14/95 — 8OIL/CMP < 3HP:0 OTHER UNITS:0 PPRT $ 45.00 KS 03/14/95 — GAS OUTLETS :0 P5PC $ 2.25 KS 03/14/95 — Owner: ------ KElTH JERGESEN 1.1185 SW 109TH AVE TIGARD OR 97223 Phone #: 620-8111 Contractor: — ------- OWNER Phone #: Reg #..: -- --- — -- ----- $ 424.56 TOTAL • This peroit is issued subject to the reyulations contained in the REQUI RED INSPECTIONS ------- Tigard Municipal Code, State of Ore. Specialty Codes and all other Footing Insp Gyp Board Insp applicable laws. All work will be done in accordance with approved Foundation Insp Rain drain Insp plans. This percit will expire if work is not started within 180 Post/Beam Struct Mechanical Final days of issuance, or if work is suspend fo` gore th. 180 days. PLM/Underfloor Plumb Final • �~ L� Mechanical Insp Building Final Permittee S /� � Plumb Top Out Erosion Control Framing Insp __ Issued By: __ ____ Insulation insp ___ -- 'Call for inspection — 639-4175 ' ' ' ~ Residential Building Permit Application City of Tigard , 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639 -4171 Jobs Address 1 + 1 — �y - !-p�pp A ` ff ` ce- �''s e:Onl ketilAa AAL.�lfQ Lot # Su P� 3 3 t �. '::Planck%Rec: #: • . ... . bdivision: Valuation: l > , U )U U ;::Permit: #::tfl $ �`_ 5 - Q iv Corner Lot? Y N � : Flag Lot? Y 0 9 _ - 6wner: '� i J / , ::aA ro�als;Re"uce < ` " ? ` `�`' pp q i i Address: �(.� l .. 11 S a g .. Engineering._. <:: ... O Phone / 1 --1(90- Contracto r: c..L- ><. [ferns' Re q uire > >< <' < > ``<< �< > Address: .Su i :;: z<. > s`` . >: T uss`Deta s. Phone: O he t Contractor's License # (attach copy of current Oregon license) D �- -3 - c'c. a,A ,J ( Contact Name & Phone: , p Subcontractors: Architect/Engineer: Plumbing: c C7-C/C - Address: • Mechanical: �G (attach copy of current OR Contractor's License) Phone: JOB DESCRIPTION: A f rt.), \ _ A___________ CoZe- i Applicant Signature Q Pho c number Received by: '''K Date Received: ( )q15- Permit # Account Description Amount Amt. Pd. Bal. Due )/-q5 - 0 %7 Bldg. Permit (BUILD) aa6. 5 0 - 0 9 • Plumb. Permit (PLUMB) j , Mech. Permit (MECH) , -C, v v / „Z j a u State Tax (TAX) /3 /3 . Bldg: / 0,3 3 / Plumb: .2 . Z) / Mech: / , Plan Check (PLANCK) /3(i (i, a3 /M. 23 Bldg: / 3el• z 3 Plumb: Mech: Sewer Connection (SWUSA) Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Residential TIF (TIF -R) Mass Transit TIF (TIF -MT) Commercial TIF (TIF -C) Industrial TIF (TIF -I) institutional Tit= (Tit= -IS) Office TIF (TIF -O) Water Quality (WQUAL) Water Quantity (WQUANT) Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) TOTALS: . �(� l r 2 33 iC(\ DEPARTMENT OF LAND USE & TRANSPORTATION - WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 4,`' 155 NORTH FIRST, HILLSBORO, OR 97124 COUNTY, INSPECTION REQUESTS: 503 /640- 3561/693 -4415 XXXXXXXXX - -> 640 -3470 OREGON Page : 1 of 1 Date : 05/10/95 • Time . 14:02 Permit Type Residential Electrical Permit • Permit # 0506'/313 Permit Status : PENDING Applied : 05/04/95 Situs Address : 11185 SW 109TH AV TI Issued : Permit Title : SFR - 4 CIRCUITS Completed : Permit Descr. To Expire . Project Title : SFR - 4 CIRCUITS Project # : P0049703 Project Descr. : * EROSION * • Parcel Number • : 251'1'1 - Land Use District . Valuation 0 Legal Descr. • • Owner : INSPECTION - TIGARD Construction : OTH Applicant Name : JERGENSEN, KEITH Classification. : 900 Applicant Addr.: 11185 SW 109TH AV Occupancy TIGARD, OR 97223 Validated by : PH Applicant Phone: 620 -8111 Inspector Area : Fee description Units Fee /Unit Ext fee Data. ist Branch. W /out Feeder [Enter #] 1 35.00 35.00 Addl . BrarLGL! W /out Feeder [Enter #], 3 5.00 15.00 Subtotal Electrical Fees: 50.00 State Surcharge of 5% • 2.50 Total Electrical Fees: 52.50 * * Fees Required * ** * ** Fees Collected & Credits * ** Method Check # Receipt No. Date Payment CK 5858 05/10/95 52.50 TOTAL THIS DATE * * * * * * * ** 52.50 Fees: 52.50 • Adjustments: .00 Total Credits: .00 Total Fees: 52.50 Total Payments: 52.50 • Balance Due: .00 NOTICE: This permit becomes null and void if the work or construction for which it is Issued is not commenced within 180 days. Once construction has started, the permit becomes null and void if construction is interrupted for a period of 180 days. I certify that the information by the applicant and his agent or agents in support of this permit is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance upon false and misleading information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use Of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the Building Department is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are,satisfied and approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all inspection requirements. APPLICANT'S SIGNATURE t Al Ili WASHINGTON COUNTY ELECTRICAL PERMIT Department of Land Use & Transportation Electrical Inspection Section Ele le North First Avenue, ion 2 APPLICATION 411 155 Hillsboro, Oregon 97124 Information: (503) 640 -3470 Fax: (503) 693 -4412 PLEASE PRINT Permit , ? S Please complete all sections, `1 through `5. Number �5�� -� Date �� 1. Location of installation 4. Complete Fee Schedule below Address 1 1 I St c S. i , 1 0 C1- Number of inspections per permit allowed Building City t 1(d{�(Z 1� Suite No. _ -� Service included: Items Cost(ea.) Sum Tenant Name A. Residential - per unit (if commercial) 1000 sq. ft. or less $110.00 1 t 6 0 4 Each additional 500 sq. ft Map No. Tax Lot or portion thereof $25.00 Thomas Map Book: Page: Section: Each Energy $25.00 1 p 9 Each h Manuf'd Home or Modular Directions Dwelling Service or Feeder $68.00 2 Commercial n Residential In Services or Feeders Installation, alterations or relocation 200 amps or less $60.00 2 2a. Contractor installation only; 201 amps to 400 amps $80.00 2 Electrical Contractor 401 amps to 600 amps $120.00 2 601 amps to 1000 amps $180.00 2 Address Over 1000 amps or volts $340.00 2 City State ZIP • Reconnect only $50.00 2 Date Job Number Property Owner C. Temporary Services or Feeders • Contractor's License No. Installation, alteration or relocation Contractor's Board Reg. No. 200 amps or less • $50.00 2 201 amps to 400 amps $75.00 2 401 Signature of Supr. Elec'n Over a 600 s amps o a 1000 volts see "B" above $100.00 2 License No. Phone No. D. Branch Circuits b. For owner installations; New, alteration or extension per panel 4.1-cu c`. _ � ,) 6,2.0-T I \ \ a) The fee for branch circuits with • Print Owner's Name Phone No. purchase of service or feeder fee. - 1m- Each branch circuit $5.00 2 Address �` ip b) The fee for branch circuits without j. -f L.4 223 purchase of service or feeder fee. City State First branch circuit / $35.00 3.S 2 Each add'nl branch circuit �Z. $5.00 ) S • CO 2 The installation is being made on property I own E. Miscellaneous (Service or Feeder not included) which is not 'nte dedr ale, lease or rent. Each pump or irrigation circle $40.00 2 Owner's Signature ■ _ Each sign or outline lighting $40.00 2 . Signal circuit(s) or a limited energy panel, alteration 3. Plan Review section (if required) or extension $40.00 2 . Please check appropriate item and enter fee in section 5B. F. Each additional inspection over the allowable 4 or more residential units in one structure • in any of the above • Service and fee 800 amps or more Per inspection $35.00 p Per hour $55.00 System over 600 volts nominal In Plant $55.00 • Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees �. !S° Submit 2 sets of plans with application where any of the A. Enter total of above fees $ above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ - �7 S services. Subtotal $ This permit becomes null and void if the work authorized by the permit is B. Enter 25% of line A for not commenced within 180 days from date of issuance of such permit or Plan Review if required (Section 3) $ if the work authorized is suspended or abandoned at any time after work Subtotal $ is commenced for a period of 180 days. Electrical Permits are non- ❑ $ refundable and non - transferable. Trust Account For inspections call Balance Due $ . ` .TZ.. r 681 -3699 or 681 -3698 24 -hour recorder, one working day in advance of need BL28 • 3/95 05/30/2000 Activities for Case #: MST95 -00107 11:27:53 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA007 Application received 03/01/1995 KS PASS BLT 03/10/1995 MSTA010 Plan check deposit paid 03/01/1995 KS PASS BLT 03/10/1995 MSTA020 Plan check by 03/10/1995 03/10/1995 RT PASS BLT 03/10/1995 MSTA030 Check for prcl. restrict. 03/10/1995 03/01/1995 KS PASS BLT 03/10/1995 MSTA705 Footing Insp 03/24/1995 RB PASS RB 03/24/1995 MSTA706 Foundation Insp 03/24/1995 RB PASS RB 03/24/1995 PLACEMENT OF VENTS AT 3' TO CORNERS; ANCHOR BOLT PLACEMENT. MSTA710 Post/Beam Structural 03/28/1995 RB PASS RB 03/28/1995 no mech. MSTA717 PLM /Underfloor 11/13/1995 MS PASS MRS 11/14/1995 MSTA720 Mechanical Insp 11/13/1995 KS DIS KBS 01/08/1996 #-1- elevate water heater 18 inches above garage floor/ strap top bottom #-2- support gas piping at horizontal section ( water heater) #-3- provide soffits at garage to provide complete separation between garage and dwelling #-4- insulate exposed heat ducts at garage cavity and suoort #-5- wall around B vent at upper level #-6- provide protective collar B vent at attic #-7- secure exhaust ducts above roof sheathing and secure MSTA722 Plumb Top Out 10/06/1995 TLP FAIL MRS 11/14/1995 flat venting on everything wrong use of fittings san t on back all work under floor to be redone MSTA725 Framing Insp 11/15/1995 TLP PASS TLP 11/15/1995 MSTA740 Insulation Insp • 11/21/1995 TLP PASS TLP 11/21/1995 MSTA745 Gyp Board Insp 11/27/1995 TLP PASS TLP 11/27/1995 MSTA755 Rain drain Insp BLT 03/10/1995 MSTA795 Mechanical Final 10/24/1996 'KS DIS KBS 10/28/1996 #-1- need clarance at B vent garage ceiling also metal collar MSTA797 Plumb Final TLP 11/15/1995 Page 1 of 2 05/30/2000 Activities for Case #: MST95 -00107 11:27:53 AM • Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA799 Building Final 10/24/1996 KS DIS VLN 01/29/1999 #1 -1- need clearance at B vent garage also collar #-2- provide complete separation between garage and dwelling #-3- nail • gypsum adjacent to furnace and tape #-4- ceramic tile at jaccuzzi not installed at this time #-5- need electrical,plumbing,finaled #-6- property owner,will provide inspection card for mechanical inspection and approval prior to covering MSTB708 Erosion Control BLT 03/10/1995 MSTA092 (F) Issue combination permit 03/14/1995 KSA PASS KS 03/14/1995 MSTA724 Electrical Rough In 10/06/1995 MJR ECA MJR 10/06/1995 MSTA722 Plumb Top Out 11/14/1995 11/13/1995 MS PASS TLP 11/15/1995 ms pass MSTA799 Building Final VLN 01/29/1999 Inspection request to Hap W. 9/18/98. MSTA799 Building Final 07/21/1999 07/21/1999 07/21/1999 HAP No Hold DGW 07/21/1999 Addition does not need USA final approval not o /500 sq ft on ground floor MSTA770 Misc. Inspection 02/23/2000 02/23/2000 02/23/2000 JMT SENT No Hold JMT 02/23/2000 SECOND RESEARCH INSPECTION REQUEST MSTA153 Expired by limitation 04/11/2000 HAP DONE No Hold AKJ 04/11/2000 • • • Page 2 of 2 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11185 SW 109TH AVE, US Building/Res/Master Permit/NA 299 Final inspection PASS - No C of O MST95-00107 Chip Barnett Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11185 SW 109TH AVE, US Building/Res/Master Permit/NA 699 Mechanical ﬁnal PASS MST95-00107 Chip Barnett Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11185 SW 109TH AVE, US Building/Res/Master Permit/NA 399 Plumbing ﬁnal PASS MST95-00107 Chip Barnett Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11185 SW 109TH AVE, US Building/Res/Master Permit/NA 199 Electrical ﬁnal PASS MST95-00107 Chip Barnett Violation Summary: Inspector Contractor