Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST1999 -00231
.� : DEVELOPMENT SERVICES A 4 ! DATE ISSUED: 7/15/99
,. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 �
SITE ADDRESS: 12195 SW 121ST AVE o PARCEL: 2S103BB -06500
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: Interior remodel of an existing single family dwelling.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT:
VALUE: $ 8,000.00
OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT UN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
>=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: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 335.64
NEIL KELLEY CO, INC This permit is subject to the regulations contained in the
KEERINS NPATR PATRICIA C Tigard Municipal Code, State of OR. Specialty Codes and
12195 SW 1 1 21S 97223 NEI 121ST
PORTLAND, N N ALBERTA
BERTA TA 97217 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 the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rea #: LIC 1663 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
PLM /Underfloor Low Voltage
Mechanical lnsp Electrical Final ORIGINAL
Plumb Top Out Mechanical Final
Electrical Service Plumb Final
Electrical Rough In Final inspection
Issued By : lr„...._ Permittee Signature : / -
‘----
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
.
7
CITY OF TIGARD Residential Building Permit Application Plan Che J . / - 7 / ;
13125 SW HALL BLVD. Alteration - Interior Remodel Only Recd By :�I
Date Recd , - i M
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E.. -R
V 503 - 639 -4171 Date to DST - 30 - ra
F 503 - 684 -7297 'T'i Permit # r if 7!' R3/
Print or Type Called
Incomplete or illegible applications will not be accepted
Name of Project 7 k T C__t@ E' szoLt \16S- Name
Job 1L� c�l.traS
Address Site Address t 2 t 5' 5..Z. (2_/ ' T Architect Mailing Address
l (. Dal-0 F, 51).2 City /State Zip Phone
•
Name e
7) WV c LIP■ / C, l„ �. mi k4,ce. ,Llitil ; Name
Owner Mailing Address
i 2 _ . 1 1 . - 5 5. a..,._) . I ? t ----
City /State Zip Phone Engineer Mailing Address
l -c `�-'n , cQ. °C1.-/- City /State Zip Phone
General Name
8, /A/6
Contractor why L k r 1,k Li k S 1 CK,,let�1 S Describe work New 0 Addition 0 Alteration/0 Repair 0
Mailing Address to be done:
Prior to permit s, 4 I, (. , rxt t? A Additional Description of Work: i� RAMOM issuance, a copy City /State Zip Phone J
of all licenses "pelZ\-- L D,mz ci2, p'I' 1 1 7 A, ini, - 744o 1_
are required if Oregon Const. oont. Board Exp. Date PROJECT . c_c
expired in COT Lic.# t (0 lc 3 / -9_ sa . VALUATION $ (3 r' c `
database
Mechanical Name --- NEW CONSTRUCTION ONLY:
Sub- Sq. Ft. House: Sq. Ft. Garage
Contractor Mailing A dress
Prior to permit Indicate the restricted energy installation by the electrical
issuance, a copy City /State Zip Phone subcontractor in the following areas
of all licenses Restricted Audio /Stereo
are required if Or on Const. Cont. Bo d Exp. Date Energy System Alarms •
expired in COT ic.# Installations Vacuum Irrigation
database System System
Plumbing Name (check atl - that Other:
Sub - ( t1 C -`c s L, j (.. 0 t- CL3M1-1_ apply) .
Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO
. (check one) (check one)
(4 2 6 G 5 c-t) , UL( t, c . l.E1) ci\ni . Has the Subdivision Plat recorded? N/A YES NO
Prior to permit City /State Zip /loot Phone
issuance, a copy il AV F=Z�e `CQ._ (0 C/ 2 - 73 a� Solar Compliance
of all licenses are Oregon Const. Cont. 'Board Exp. Date (Calculation Attached)
required if Lic.# ear acknowledge that I have read this a
expired in COT 2 q (� y q ' ZE, -97 I hearby application, that the
database Plumbing Lic. # Exp. Date information given is correct, that I am the owner or authorized agent
of the owner, and that plans submitted are in compliance with
Z (c - l&2? (., .3 O `®0 Oregon State laws
Name Signature of O /Agee Date
Electrical ,2E_<lrs i ~l L'nIr ce- .4,A
S Mailing Address Contact Person Name Phone #
'r l 1 - 0 - `z.,.. � p.N 35
Contractor _ c, e, 2. t_ C_ l -,, c c,,,i S� FOR OFFICE USE ONLY:
City /State Zip Phone Plat #: MapJTL #:
Prior to permit T !) 26 _ s l0 ��O
�
issuance, a copy ?�� („eL,l \ cnC2 . 2. - (c Y67 Q
of all licenses are Oregon Const. Cont. Boa 33 rd Exp. Date Setb�iCks_ Zone: 7 T o Sola(: //
required if Lic.# get %j3 /���1L, Ate/
expired in COT ` L — Engineering Approval: Planning Approval: TIF:
database Electrical Lic. # Exp. Date _
b3R"
I:SFREM2.DOC (DST) 8/11/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST ITT - CoZst
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
G BUP
Date Requested '/ 2 / AM k PM BLD
Location 1 Z1 q S / z ! St-At I Suite MEC
Contact Person 0` I Ph 61 '7 2 - 7 :? 3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
<IIMMEIW
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
1•1- PART FAIL
ECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA �� ("2 ApproachlSidewalk Date v( Other Inspector Ext3
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
5/10/00 Activities for Case #: MST1999 -00231 EXPIRED
1:10:59 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA007 Application received 6/18/99 BON RECD No Hold GEO 6/25/99
MSTA008 Permit Created 6/25/99 GEO DONE No Hold GEO 6/25/99
MSTA012 Plans routed to Plans Examiner 6/25/99 GEO SENT No Hold GEO 6/25/99
MSTA026 Plans approved by Pln Examiner 6/30/99 BT2 DONE No Hold BT2 6/30/99
MSTA030 Reviewed plans routed to DSTS 6/30/99 BT2 DONE No Hold BT2 6/30/99
MSTA717 PLM /Underfloor 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA720 Mechanical Insp 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA722 Plumb Top Out 6/30/99 6/30/99 7/19/99 MS FAIL No Hold AKJ 7/19/99 need to test shower
req as. on plm
MSTA723 Electrical Service 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA724 Electrical Rough In 6/30/99 6/30/99 7/20/99 BRP PASS No Hold AKJ 7/21/99
MSTA728 Low Voltage 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA790 Electrical Final 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA797 Plumb Final 6/30/99 6/30/99 8/12/99 MS PASS No Hold AKJ 8/12/99
MSTA795 Mechanical Final 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA798 Final inspection 6/30/99 6/30/99 No Hold BT2 6/30/99
MSTA032 DST Post - Review Completed 7/13/99 BON DONE No Hold BON 7/13/99
MSTA080 (F) Ready to issue 7/13/99 BON DONE No Hold BON 7/13/99
MSTA092 (F) Issue combination permit 7/15/99 BON DONE No Hold BON 7/15/99
MSTA725 Framing Insp 7/20/99 7/20/99 7/20/99 RB FAIL No Hold AKJ 7/25/99 mech and elec insp not
complete,
framing contingent to
completion of elec Insp
MSTA722 Plumb Top Out 7/20/99 7/20/99 7/20/99 RB PASS No Hold AKJ 7/20/99
MSTA945 Request inspection research 3/28/00 JMT DONE No Hold JMT 3/28/00
MSTA153 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00
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