Permit PERM4 CITY OF TIGARD
DEVELOPMENT SERVICES MASTER PERMIT
IT #: MST2003 -00473
_
DATE ISSUED: 10/3/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12010 SW 119TH AVE PARCEL: 1S134CD -02900
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT: 059 JURISDICTION: TIG
REMARKS: Master bath addition of 61 square feet.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 10 FIRST: 61 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 15,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 61 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 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: 1 0 - 200 amp: W /SVC OR FDR: 00 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL 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: LANOSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 557.78
BRIM HALL, DIANA C AND NEIL KELLY CO This permit is subject to the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes and
GEORGE H 804 N ALBERTA ST all other applicable laws. All work will be done in
12010 SW 119TH PORTLAND, OR 97217 accordance with approved plans. This permit will expire if
TIGARD, OR 97223 work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: 288 - 7461 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 001663 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp PLM /Underfloor Shear Wall Insp Plumb Final
Foundation Insp Plumb Top Out Exterior Sheathing Insr Final inspection
Post/Beam Structural Electrical Service Insulation Insp
Underfloor insulation Electrical Rough In Rain drain Insp
Crawl �ratri7B ateL Framing Insp _Electrical Final
. ( 4
Issu d By : . !u - / / Permittee Signature : a / v !
Call (503) ; 9 -4175 by 7:00 p.m. for an inspection needed the next business da
RECEIVED
9 ~
SEA 18 200 9—M-- 03 -P/14k/
Building Permit Application OFFICE USE ONLY //
CITY OF Application
D received: 5' i8 0 5 Permit no.; / /�jO,j.DO'/7
t p�! City of TigardB UlLOING DIVISION
Project/appl. no.: Ex.ire date:
City of Tigard Address: 13125 SW Hal 6, Tigard OR 97223 /
Phone: (503) 639-4 !) ' •ate issued: By .. Receipt no.: \
Fax: (503) 598 -1':0 Jt e-2 re"-t) l se file no�- Payment type:
dor ,.
Land use app oval: ...amm- _fi I Complex:
TYPE O PERMIT 1, \
1 & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi- family Ill - New construction ❑ Demolition
Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB_ SITE_INFORMATION • w
Job address: (2-010 SvJ I 19fk i -- Tiqfa , 02 °7? Z.3 Bldg. no.: Suite no.:
Lot: Sol I Block: I Subdivision: LEp__04 k c_ - 4-3 1 Tax map /tax lot/account no.:
Project name: be l/y 1..(L .
Description and location of work on premises /special conditions: V//L e . t T-!t YENYT)Unl
OWNER FOR SPECIAL INFORMATION, USE CHECKLIS
Name: HUNT t 1) 14/41 .FiCi M Hf1LL (Floodplain, septic capacity, solar, etc.)
Mailing address: 1Z016 S W 119t 1 & 2 family dwelling:
City: `rl State: OlZ ZIP: 97223 Valuation of work $ 15, 000
Phone: S o . ' $(o 2 G Fax: E -mail: No. of bedrooms/baths I
Owner's representative: Law) Total number of floors
O Phone: '- - f ; : ' 4,• Fax: E -mail: New dwelling area (sq. ft.) (n i Safi_
O APPLICANT Garage /carport area (sq. ft.) G
rp Name: LJ »4,D Anib 4 p » ( NEIL VELLI CD ,) Covered porch area (sq. ft.)
s Mailing address: '' N I A -rA s-r ` Deck area (sq. ft.)
City: State: (sq. ft.) Ex, / �^
ty � � . 02 ZIP �' L 1 h r CommerciaUindustrial /multi - family:
Phone: '2 e - # . F ax: , 7_ 3 t 4E -mail:
CONTRACTOR Valuation of work $
Business name: /J r ft.)
r Existing bldg. area ( ft.)
t
New bldg. area (sq. .)
Address: g04 N i ALP r,4 ST"
Number of stories
City: Pp TzA,Th I State:0/2_ I ZIP: 9 7, 17 Type of construction
Phone: � - cyto c I Fax: 22 7. i74 E -mail:
��� t Occupancy group(s): Existing:
CCB no.:
City/met o�Iic. no.: /0 e• ( -y -
�U V New:
Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the -P
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies: c. 9 `'
Contact person: Plan no.:
0
Phone: Fax: ' E - mail:
j ENGINEER OFFICE USE ONLY
Name: Contact person: Fees due upon application $ s
Address: Date received:
City: State: ZIP: Amount received - $
Phone: I Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. 1
\ ,
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with, w s cifled herein or not. Credit card number: / / N, ('t
" / Expires
Authorized signature: ', / /! ✓ Date _____//___A3 Name of cardholder as shown on credit card i Nk%,.
Print name: _%I $
- - Cardholder signature Amount
,_
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 - 4613 (6 /00/Cr ^
r
' g 111 • ,,, kik''
0$/1.5/2003 20:15 5036427755 ANCTIL PLUMBING PAGE 02
• 40( 1V/ long 1U/1 i:t4 r.A bu;$ Ztt 5574 [Nell Kelly North ... Anctl ®002/003
Ilumb gPe a l f lip r t•. (.St? ()NIA' V * D received 9 /ff E . .. tno.: I��r 3�b�
rat ,•_i y f Tigard Sewe • - it n0,: .. r wing ,trait no.:
CIO' o ,,,,, _ t ,d Address: 13125 SW Heil Blvd,SEPd, (�1
!'hone: (503) 639 - 4171 • ea ti.. no_: . date:
Pays: (503) 598 -1960 Date issued: I I Receipt no.:
CITY OF TIGARD . -. _�_._
• E
Land use approval: �RUlI DINC flfdl oN G" �do'� - Y'meet type:
l'i r I (i,' p t.:1011' r
XI & 2 family dwelling or accessory ❑Commercial/industrial o Multi- family • Tenant improvement
Cl New construction Addition /aiterai on/roplacetnent O Food service • Other: _
j ,1011 SII h. INUOIIN1A'114. I I k ,,54IIIalty;h:I toe +lot :vial inlurinali(ntuse( . i) i
lob eddressiJ a • 4 Deacri . 1 on IIMMIIMM T otal
Bldg. no.: Suite 7p : en. 11- IM . - , 1 dwe oul
Tax map/tax lot/accountno.� (Infinite loOQ.lbrttlelultltitt .. )
-�` — - •, SPR 1 bath
Lot: Block: Subdivision: SIR () bath - -.--__ -
Project name: .. ,ary , SFR (3) l ath _ _
City/county: -3-r _ ZIP: ) 7ti1) Each additional bath/kitchen .
Description and location of work on premises: Site udlltfeE
_ _ - Catch basin/area drain - Eat, date of corn .letionlins action: a ll s/teaeh line/trench drai -
I'll il>ieiNr; (i�N i'll ac' "lilt
Footin drain ( lira, ft j . .._._ ________
liminess dame: Msautactured Irmo utilities
A' 1 L- J ,' 11/ _ __ Manholes i M J
Address: - OO [o Rain drain connector
C' .: - : J ■a . Suave 4 z� 1-4 Sanity Hewer no. lin. f1.) 1 --
Phone: .j E-mail: Stamm - Sto sewer o, lin.. f!.)
-City/metro no.: i c 4 1 , - _ r e l . : X. i r �,, Wattzr service no. lira. ft-
City /metro 1k. no.: — �w 1 Fixture arNeon:
Contractor's , - tentative siinature: Air �/ -- Abao tion valve
� _ Deck floe reventer
se
Print name: . .■ rJ Date: Backwater valve •� � - ` - -- Mil
CONTA(1 )'i�'itS!N BasinailavatorY -'
Names 2) q r k'*F76 - .._ Clothes washer IMI
Address: ' N 1 ALPFP3- 21 Dlahwashcr
Cr : "'Q P ..1) j State: oR. ZIP:_ _ '17L.11 - ° D ecto : toutitaxn ti .. ..... - — -
- - -- ectorsJa
Phone: W' ..; 4'o ' Fait: %0 . : -mail: M _..
Expansion tank
II
' o w Nt it Fixture/sewer CO
l�farneSerin9_ �7 .a JJAntrt 1�LfM/t -- - ^ Floordralna/fI ainks/hub �
l� . • Ga., s di _ _ -
Mailing address: -- -
Huse bibb Ice seeker __
Phone: w 7 Fax: E-mail: _ Inters tor /cease tra `_
Owner installatton4eaidcniial tt>alttttxrance only: The actual installation . pa+ r made by Prime & p - o.
will be made by ma or the maintenance and repair my regular ) commercial) — -- " -
Y Y 13n Roof drain _._.t_�.....w._.,
employee on the property 1 own as per ORS Chapter 447. Sink a basin(), Iavtt(s)
Owner's si: nature:
Date: 3utn •
. I:Nt:I 'sk.t;R Tuba/shower /shower pan
Name: urina
Na Water �... �_-- -. -. --
I
States ZIP: Other:
Phone: ,,.,,..,,.,... Fax: - E -rnnll Total
Nat AI leu.ad� p)t tana wort t cards, punt eauimtedialon fix mete 100t+eNiaa. Notice This peaa:t applicatital Mini fee o $
0 vas lesszCard expires if a perrnit ;a 1101 obW nod Nan review ( k} $
Credit coed minter Li t within 180 days after it has been state 9archar (8 %) .... $
14.0.4 of cardholder a; 'holm on end, cod accepted as complete. TOTAL ....... ................ S
I
`- ----^ 7;ualekke 1iw _..._ Amount __, 445.016 (6/0021(6/00211M) OM)
, OCT - 03 -2003 09:45 P.01/01
��. Department of Consumer and Business Services
1 Building Codes Division
• Theodore R. Kulongoski, Governor 1535 Edgewater Street NW
PO Box 14470
Saiein OR 97309 -0404
(503) 378 -4133
FAX(503)378-2322
TTY (503)373 -1358
httpl/www.oregonbcd.org
+ - Entity /Address /License Screen - +
; LICENSE NUMBER: 3 -575C
ENTITY NAME: COHO ELECTRIC INC_. _
ADDRESS ONE: PO BOX 40
ADDRESS TWO: COUNTY: CLACKAMAS
CITY: WILSONVILLE STATE: OR ZIPCODE: 97070-
TELEPHONE: (503) 582 -9774 PRINT DATE: PRINT FLAG (Y /N): Y
SECTION CODE: EL ENTITY TYPE: DBA FIRST LICENSED: 09/30/03
LICENSE TYPE: C - ELECTRICAL CONTRACTOR
LICENSE STATUS: ACTIVE ISSUE DATE: 09/30/03 EXPIRATION DATE: 10/01/04
;VALIDATION DATE: 09/29/03 VALIDATION NO: 033001008 AMOUNT PAID: $125.00
ENDORSEMENTS: CERTIFICATION LEVEL:
EMPLOYERS: START: END:
RECIPROCAL LIC: CCB NO: 157169 SUPERVSR SIGN DATE:
; AB EXAM DATE: EXAM DATE: EXAM SCORE:
COMMENTS: SS =3483S
; CC HOURS TAKEN: 0 CC HOURS REQUIRED: 0 SENT TO PHOTO ID:
: CR HOURS TAKEN: 0 CR HOURS REQUIRED: 0 LAST RENEWAL SENT:
NSF CHECK RISK: MULTI EMPLOYER? LAST UPDATE: 09/30/03 - DAVI
• +
:Window :Enter :Sy ; ;SoftKevs; ;Collector
:Ed Off; ;Hardagjc ;October 3, 2003 :Level 1
CERTIFIED TRUE COPY OF
BUILDING CODES DIVISION
LICENSE
BY . // {�
DATE( / 3
TOTAL P.01
S
bip
CITY OF TIGARD - SITE PLAN REVIEW °
BUILDING PERMIT NO.: T � .rr -- I. _ 7 L J .3 r■...i
- PLANNING DIVISION: fZ 4 . (1) C d ;
R e c roved 0 Not Approved 1 2.0 N a
,,,.quired ..,efbacta: App. PP I� / �
Side: S Street Side: l 0 \ Z Rear: _
)s
Front. ?° Garage: a
�' I " N
Approved ❑ Not Approved r—� ��-+ g o
Visual Clearanc.e:N� ❑App' Pp I _
Maximum Building Height 3v feet 1 a
CWS Service Provider Letter Required: ❑Yes No � N 4I 5 z 0
z B� , g o
. a
: CG¢ ww� ❑ Received
Date: °I ' a3'v 3 _ _ _ _
ENGINE ING DEPARTMENT: ` G
- 1 , ,
EXISTING DRIVEWAY I �� �°
Actual Slope:_,% ''_'4 Approved ' ❑ Not Approved I y,,,
7ot
Site Pi n: 'Approved ❑ I I I ,A ii• By: A Date: \ iv
I s Drawn: 15 JUL 03 SP
I Revised: 16 SEP 03 SP
�i
Notes: I I
• 39.20+ • Revised:
C X I I Revised:
< N -� •
z EXISTIN SE j I I Revised:
G
S
1 Revised:
m
c I I
co I
;..,, — — FUTURE GRADE LEVEL DECK
I
/
ii o j 0
N I /
`. _> N
L — - u-- 0 L Q Q
C 1. _ 63.9T± � C]6) ��
• d -To I ■
r _ _ �6� O
NEW 6'- I �V2" x 9'- I I �h" ADDTION TO BATHROOM. o M +; ill
SITE PLAN " � `� t ,
-4tea-o- , 3
cz . SCALE: I" = 20.00' Q 0 U
• 0 LOT 59$ PT 58; _
LEKON HEIGHTS NO.3
THESE PLANS ARE DESIGNED TO MEET THE 2000 EDITION OF ( 16 September 2003
THE INTERNATIONAL RESIDENTIAL CODE w/ 2003 OREGON
AMENDMENTS AND THE 1997 UNIFORM BUILDING CODE WITH EXISITING HOUSE: 2065 SF �� C°1
CURRENT AMENDMENTS ANY OTHER AMENDMENTS AND ADDTION: 6 I SF 1
SUPLEMENTS CURRENTLY IN EFFECT. .
TOTAL LIVING AREA: 2 1 SF SP 18 2003
THESE PLANS ARE THE SOLE PROPERTY OF NEIL KELLY CO., INC
AND ARE FOR OUR USE ONLY. THEY ARE NOT TO BE USED FOR CIT ' OF TIGARD
. BIDDING, PERMIT, OR CONSTRUCTION BY ANYONE ELSE LOT SIZE: I I ,325 SF BUIL ING DIVISION
WITHOUT WRITTEN PERMISSION OF THE NEIL KELLY COMPANY.
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