Permit '',,,s _ i%
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00121
I 4, DEVELOPMENT SERVICES DATE ISSUED: 4/8/2005
` I' l l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S103CB - 07000
SITE ADDRESS: 12435 SW HOLLOW LN ZONING: R -4.5
SUBDIVISION: QUAIL HOLLOW - EAST LOT: 019 JURISDICTION: TTG
Project Description: Interior remodel, loft addition.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 196 sf GARAGE: sf FRONT: PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT:
VALUE: 11,200.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 196 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 SVGFDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 100 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: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
MORA, STAN & KELLY ED PARSONS REMODELING & CONS and all other applicable laws. All work will be done in
12435 SW HOLLOW LN INC accordance with approved plans. This permit will expire
TIGARD, OR 97223 13783 S FORSYTHE RD if work is not started within 180 days of issuance, or if the
OREGON CITY, OR 97045 work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503 Phone: 503 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
Reg #: LIC 136199 direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 331.99 1 - 800 - 332 - 2344.
REQUIRED ITEMS AND REPORTS
/9
Issued By : --(:4eX�/ /l Permittee Signature :'
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.. ..
., _ ,
._ 4 • M'1r4;6o — COI 3 " f
Building Permit A � . 1 �e
� pp�� 9 1 ` < >' - .:,FOR OFFICE USE ONLY „ � ..
C ity of Tigard Received - Permit No.: '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Date/By:
,C Q : It V y1�yilr 0 4 ry 1
Phone: 503.639.4171 Fax: 503.598.1960 py�g7 Plan Re
r�AR 2 2 200 Date : A J - q- 05— Other Permit:
Inspection Line: 503.639.4175 • a`' I ! Date Rea. /B
L , �� I 2r �W. B Y Q7 '� See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Methoo d: r �j/ ��.� Supplemental Information
CITY OF TIGARD 1 �Q sTe��/
iR v v ' , K w , w,�. 'r s. N w ` `" i:v,i;F t:). .
W.T µ"� ll , t . I o ixi ON E :"k*: S � = >'REQ,UIRtti T4':'1 F4MILYDWELLING
` ,y&.3.lw. 14� *3] . w. -k:,,,,.4,..� -..in._ -.: ; 7 - . " I : _ 4..."30,- )i* rIA4Agii ' '• �: < .. -. ..,. . -.., : -
�g: ti
� *�.. � Xk. S' tA' �-. i '�„y'n'a ?"A7#]R�Ft�Fwz:l:v1$ � .�'':� e °4 �, ' G ` 5 k " ' -„ ' .
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Addition/alterati Indicate the value (rounded to the nearest dollar) of all
on/replacement ❑Other:
equipment, materials, labor, overhead, and the profit for the
;^v=¢ :: � , �:a, w ° e=� ,;.i.. a:tr.= '.<; u� r t, 4si it:i �.<.,; : rxa::e °=vfi a`t
yep. "' : erg "" ' =' r' == `' work indicated on
� ,! ` t. I € C:ATEGORT hz.. eGONSTRUCTION z' .`. ",•- ii! o this application.
"�: .:.. ' :�:�ti s, � .`�.'�'ar.� .,»�: >.. '..av �- '.its. �Z_';'" < .,, asp -� �;,. ` � e: �:. • '� "��. .. ._ t,;r " v. ::
Valuation:
►; 1- and 2- family dwelling III $ Commercial /industrial I I r . Z 60
•
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
't` "'� o<z4 z::. 3 7, o- qs „ .*.. 4' 14i4%;c ' 4Yt, -; > ..,„1. ,n,GP
�� di J STT'E D LOCI ONE
`.; Total number of floors: '
a� a,� b,ba- < aa ... fit ;.: , ,-.0 ° ..4 w,, , I; ,r;w: l'A
Job site address: I 4 '3 5 Shi ._j b II p y „ r i, A . , New dwelling area: + of f- square feet t q i
City/State /ZIP: T fl �� 1 ( J q I ,1p Garage /carport area: square feet
Suite/bldg. /apt. no.: J Project name: M pra Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
° «fir °� ¢ ^,pa �; � ��.`.aaa�:;�° „:mta•r ❑•a;'. - -,:,. ,, . •;?
`i i ii i v D ATA.,, ' t O MIGIERC'"IAI; ,. ' US E l ife ' IS `
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map/parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
0 - a ` 4 NESCOfrON ®B W ORK _ °� ; work indicated on this application.
:01 < a ,,. _ ..t6 - :,mac L .:. ...3 . t - , Ian ..a=te '�
1 T i P r I h Y t o f f ' Cl ( l ty}� Valuation: $
Existing building area: square feet
New building area: square feet
- . � .i� ...p`+c�Yi,'���. wrm"�`. " 3°�.',`.:.F;3. Iru�� ..p, �.. ° <'r+ � a;q;�;, � i••L1, - ':;#�,A� ". ".a;„$}!>;�: n•^ �"'.7:; :'^r-•t
,., PROP, ERTY ®W ER < < i ,4 A ' . )` TENANT' ? r
�_.,� �`'(iiw.. �,,.. ���,�". '' , ' �r.�1 ”. � r��` � Number of stories:
Name: Dt Keith.' l 0 ro Type of construction:
Address: 1.2) 5 ,S H o 1 I ow Lc ,, Occupancy groups:
City/State/ZIP: 'i� 1 c a • 3 Existing:
Phone: (SO) C7 � q _ . 5 2-O Fax: ( ) New:
j q±, - .t+.a+ , . \. ` r° ' n, ;a, ',Tit n.. S >a s3 . t.s.:4 ;,C %s 'lx €f r`: i' tr + }4: - rt < .., � y .. s
^ ;x0. .. ,,„ - - x .: .p . 'r. ,, , "T'„+,< %. < a..a3 A",`, : @,*? ."�rr;t. xz p� " .�i7' : t - .., x- :
y .. � »AE�L'I�IC �., - �,'t,°�i °� � � � „�„ .� s..,< ;,�-:' ,., ° -� - �.�..�.,:�
",fi . H:".#x.; w " t . '2„' .. } ;,:'!a, ^'.,ut t a«. « <,<,.- yre`` ,.vr'Y Sh
. �� }���.' n%���, 3... �:.� .. °:`�. > <... .:s,.,r,^� �,..< �t��ryNw ,:a.;..,?<�, ttt }:�'�,!,';n,..,...,..,�<..�r: -:.,� ,"R, ;,%1N r '�'” ',.>.M ! r.r
Business name: Ed PO4, S r c Re (n� [ "4� ,(� �' All contractors and subcontractors are required to be
{'� �y�r y, licensed with the Oregon Construction Contractors Board
Contact name:
! �� par / t- - , under ORS 701 and may be required to be licensed i n the
Address: i ?) 3 - , F -r R i fhb Ed jurisdiction in which work is being performed. If the
City/State /ZIP: � rr f t , l (� r1 �i LS applicant is exempt from licensing, the following reasons
Phone: (C,)3) i /lO " rl 2 � � J F ax:: ( L _3 1 (o - (09 (p7 apply
� I
E -mail:
, h, a k t - F .�f;tit
i :a CONTRACCOR ,:,.
�;§:,'.` �. = x: rte .. ��r, u : xr 3 . : ,€ . .. c , �, - � ;r. � �� � °�`i
Business name: F{ Pa .r c y I` r mnrtil i P J I
�_„_ �� ,, ° " 1 -',., - -• ` i , JILDI „,PERMIT FEES*
Address: (3'183 C l L)f Cl , . k f l
`�` { Please refer to fee schedule. .
City/State /ZIP: DreA i V
,
e ,, t n ( r� () 11.E
v l / l_' Fees due upon application f D3 0 3
Phone ( 9) ; p i r � l I 0 __ A �� `/ Fax: ( 6601 :1 G _ "1 „G 0' Amount received
-/
CCB lie.: -'I 4 1p I ! q P„. 1 - -- 2 -'G Y' V
r Date received:
Authorized signature: t 7 f �/r �(� (14,,d/970 �; J f7 /l/ L This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: L, / "5 .< I 1111-`- Date: 2 A * Fee methodology set by Tri -County Building Industry
Service Board.
is \ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11 /02 /COM/WEB)
•
Building Division
6 Plan Submittal Requirement Matrix
A- 6 11. • Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type ofSubmIl�ta2�� ` "fit 0 bof Tails
cliides ne a ditions andalt
fw; l { �„ 2e q ulr d at
0 �t n tf � . �, � �E Y.. S' O t k"E S 0 '.a. P , �
.m=. > ' ..e
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the .applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:\ Building \Forms \COM- PlanSubRe 12/24/03
,fr
Mar Mar .22. 2005, 7._
foi No.2371 P. 1/1
p . 1
11- 1ECEOVEL...,
Electrical Permit AppUr ti nn 2 2005 rinflr
4 ( 3 ) tz - 6 - bq 6
Washington County Phone: 503446-3470; Fax: _01= 46,-3993 InspeetiOh Request: 503
0
ISSN. 1' AV, Suite 350-12, Hillsboro, 0R97124 - , ,g -Co., : -' -. :- Qll j . - . 7- _
l 1
onp Land Use Approval: p ..i # , ; .1 - ... ...tn.. 1-r:A TT MI IN„;_ ---
- • '' -•• :•••• • •• - •• ••••••••••••'''''':••"•• " .. ••••••••• . •.••• •••• - •••••• • ...- • ••7- - . ' ..;' . ies__
l Please check all that apply:_
0 Now cotsattuction rAddilion/oiterattuivreptsteentent
1 ,C1S4tr4oe over 225 inapt, coaran't 0 tiwanlaus. location
0 Demoltrion 0.0tItet
OServiee twer t 20 amp.- nning pIttillibig :WU 10„Miti at n.,
t .........'....Ntim, v , utr • , • • . . • ' of 1. and 2 family dwelling. 4 or mum new rtsitidnial
••• • •• • " -------,, • - • • "•• ••••• • • : - .2• ••••-• -- - • --• - • - •• - • 2 • •••` ' ••••• • ••• • 0Syszern over 6110 volts nmninal units in one atrotturc
s jsa i - and 2 dwelling 0 Commercial/industrial 0 Accessory building Onuibling_mcr three maim OFlcis, 400 amp Or mote
Litiduiti 0 Mauer builder Ej Odom (DOccupant load oral 99 perninu IMManuh abucturto or
:'' : '''
• DESilltatighting plan RV park
: .-:::... -.:-:': .- • -,....:- : ".;.'.--..:49 '','''' :...-:- ', . OHtalih - ("KAU
.. . _ °other.
lob no.; _ Job address: ,i........ .. , A., ,..,._, iL Suitt:tit 2 acid of plant I _auk Ely Of the .buve,
•
Thenbove nota • attic•t a ••• orvn___ •
___,.
City/SeattiZW: 'y 4 ,..
Sone/bldg./apt ' . Project name: A4 L ,... 4 . Decriptioa - - 10 - =Mal
_ l New tvaidettent single or multaiiiailly - par di.riling unit,
Cross streer/directions tojob site:
,81. ,___Nutaeried i na i r so ag o,,, e.
..,-....___. =--- . ` _L000 v tt.,uute86-
4
Ea. 143'1 500 sq, R. mportion 42.00 — I - 1
I Subdivision: I LA:it no,:
Limited energy. reside GOA_ .__. _ 2
—••----.
Ltniittst energy, noilli-family ___ 40.00_ ._ _... ,...2
m !Inv/parcel no
. , Each niiitti.iiiclored or Modular .
::.;:-::- :: , • ,i - - - g , 1. :-•.; : i--7,, ,IP,Irj*,;-017:',1#1401C y.;;;'.-:.-, .. : › 1' ; ''':,',...; -- 1 1 7 41 1 - i -St; 5 -.-:r ed __ -11txli ri it °: ittliCr- a - hen, to 1U2 r cad. .
i 4 It 1200 sol es ur Ices ------- n' 90.00 _ u ,
p_
WI am • a lo 400 s . a tai.o0
.00* "Tow...1,44..0.- :,..:,:.„..-.....•.;:. -.-; _ ......_2.......
,- 601 to f,0004inp; 2711.00 _ .2
f K .5. ,it k tt y.___,Als ro !_.:),,,, 1,000 amps or vgils - �Q "
. Z
A.ddresi:
Temporary services or feeders inatetintiou, alteration, moan
City/State/ZIP: ---. c7IZZ3 ritucidati
2 00 - antr - orirss -- , , MO4) 2
Phone! CSTD7.3 ). S7, _. 7 - . 5.-- ,l- i . 1 , 14„ . x: ( )
- 201 ulnP4 to 400 amp IOR no 2
I ions:ails-non: This inatAlation is heieg made.on propa.ty that I own. which ig not 401 amps to 600 snips_ __ ..- - moo ,,.-., - r
intended for sale, lease, rem, Or ex-changc-- .
Brandt circuits - wesr, Or extension,. ■ or
Owner signature:
Dote: A. Foe ter•bruncri circuits wink - - -
', 1; ,..1. '-'. ;eititiiiiMT;■•■■ - 477 . -- 4 7; ' *:•rrigt ur it•Odyf 1 #..tradi
NM
...!
2
.. Business nanf4iP
. • .., - . . . ' ' CeL • 1,,K._ -1- 5' 1 W 17 /to ftw ot b se m r: ch i-c c :fetir lei, 6 0-.00 —1
.Z (mum: _ ‘ ,1 4 . 13 .3. 411 ._
• firtiantath citron _- - 2
___I____ ---
:: ---------. Each add' i branch iiiicTlit ing ..,a
LI e! IF-47 hiliscelianeoue (service or feeder not inch __
(
City/State/ZIP: ..• _ , , C t • o -- 9 0/1,-c- 1 P.oltin cim -
ie • - ' •-- 6070 - o - --• -
I - Sign' ut mulinc.. le 3iiing - --- 6 - 0:th;
c ,-- ..'-- "R 6 ) tict -6:76 - 7 Signal circuit(s) or waded.
- - ---
• Einzil:
energy penel. Or
60
..O9 .
.eftkeston, best:raw
e0
1 :':''';''. , ‘ ,. `' ' ;;l 0 1it . ,..)101rnt i:..: :-•-•'-f,''' :: ","-.\''..- '-'-'.-:; - -
; . - ' ' Each additional in sp ec t l on - overationable - firany - olleheolFlive. ....
-Business name
• il:.--__,_-_4„.6_ 4.2.14_,114-A2,._________ f Per inspection I_ f 9° • 6° - L,_ - ,....1....
Addless: ?...CD‘ oy T\- I P... §:.:"C,...., - investigation fee (SIEll-COMPLIANCt!). .
•_.
.0ther:
Cityistup-- R :
- -: ,.:'::7.-., •.:;;k: .-
Fax: ( C`i I ) c1 - 7 -6- - Z kfc C7 l'" -
Subtotal $
Lie, no.: 2 - -,2_--7 7 C CC? he. no,: 9 C) C) - 7 -
Plan review (25% of permit fee) S
- _
-SUpervising electrician _ : _
_- ..
state surceafge (ph of permit roc). S
_
_ ...
TOTAL-TERMIlr nit, , S
Print name: - -
n.m.
3- ?r - eas- - Thu, - - r p
th , . • . -------- "-..
• perant app tea n asires tin portent is not obtain
Authorized
.
ttithin 100 days after What been accepted as complete
...
at:: atom .. _ •-• „ v.
- • Fet Miltditts Enttiny Soriicv Ilimil
— ' • Nurnbtr - of inaseettoralioloweds remit.
• Piint tiglij \ _ I Date 3 1- Os
440 (7/03/COM/W Ell)
Received Ti,n Mar,21-. 7:13AM
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005.00121
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/8/2005
Phone: (503) 639 -4171 �ngi��uNit 1, :tA
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/12/2005 TIME: 7:0sAM PAGE: 47
SITE ADDRESS: 12435 SW HOLLOW LN CLASS OF WORK:
SUBDIVISION: QUAIL HOLLOW - EAST LOT #: Q19 TYPE OF USE:
PROJECT NAME: MORA
DESCRIPTION: Interior remodel, loft addition.
OWNER: MORA, STAN & KELLY, PHONE #: 503-579-2520
CONTRACTOR: ED PARSONS REMODELING & CONST INC . PHONE #: 503..656 -7232
Inspection Request Scheduled For: Date: 5/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final V 00669901 503 - 539 -0832 Y �° �`�
/
Corrections /Comments / Instructions:
•
. ( / igfri — dd5e(--"
i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ C L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
ir
Inspector: Date: 1.0.c Phone #: (503) 718-
b
CITY OF TIGARD ., ,. .
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: MST2OU°a - 40121
Phone: (503) 639 -4171 i o v��yp „��, �I ;I 4/0120
Inspection Requests (24 Hrs.): (503) 639 -4175 AL
INSPECTION WORKSHEET FOR DATE: 6/10l200� TIME: PAGE:
7:16AM 10
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 12435 SW HOLLOW LN LOT #: TYPE OF USE:
PROJECT NAME: QUAIL HOLLOW- EAST 019
DESCRIPTION: MORA -
Interior remodel, loft addition.
OWNER: PHONE #:
MORA, STAN & KELLY, 603 -5579 -2520
CONTRACTOR: ED PARSONS REMODELING & CONST INC PHONE #: 503- 656 -7232
Inspection Request Scheduled For: Date: Pour Time:
6/10/2005
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 0065515 -02 503-539 -0832 N
Corrections /Comments /Instructions:
S --. 'ELe F Atil 'g-tqfO
p ” ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
7 FAIL • ' L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
3 Inspector: Date: _d ,)hone #: (503) 718-
/