Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2000 -00100
IIl DEVELOPMENT SERVICES DATE ISSUED: 04/14/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10454 SW KENT ST PARCEL: 2S114BB -14300
SUBDIVISION: SWANSONS GLEN NO.2 ZONING: R -12
BLOCK: LOT: 084 JURISDICTION: TIG
REMARKS: Second story addition w /loft.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 18 FIRST: 71 sf BASEMENT: 0.00 sf LEFT: 8 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 71 sf GARAGE: 0 sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: 0 sf RIGHT:
VALUE: $ 16,732.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 142.00 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 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:
GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 1 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: 1 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: 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: $ 498.15
This permit is subject to the regulations contained in the
FIDDES, RUSSELL GORDON AND NORTHWEST WILDERNESS CONST. Tigard Municipal Code, State of OR. Specialty Codes and
DEBRAH SUE . 14127 SE 12TH STREET all other applicable laws. All work will be done in
10454 SW KENT CT VANCOUVER, WA 986837007 accordance with approved plans. This permit will expire if
TIGARD, OR 97224 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
Reg #: LIC 107172 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
Footing Insp Crawl Drain /Backwater Framing lnsp Plumb Final
Foundation lnsp . Footing /Foundation Dr; Insulation Insp Final inspection
Post/Beam Structural Mechanical Insp Rain drain Insp Building Final ORIGINAL
Post/Beam Mechanical Electrical Service Electrical Final
Underfloor insulation Electrical Rough In Mechanical Final
—
-- - - - - - -- -- - - - -- - - -- - - - - -- - - - - --
By : 6,4,Agiv,i_.... g � tr�/ L Issued B Permit Signature : C1 , r
•
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
CITY OF TIGARD Residential Building Permit Application ��/�,
.5 ` `
Plan Che
13125 SW HALL BLVD. Additions or Alterations Recd By O-
Date Rec'd d a'9
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. q -'9- O d
V 503 - 639 -4171 Date to DST <f -/v - 6 0
F 503 - 684 -7297
fiq---- Permit #r -2000 ` �loa
Print or Type Called 4'/4 - Gl q -row
Incomplete or illegible applications will not be accepted O A - z - w / ' . 5 . - c t •
Name of Prrojeect nn Name
Job F=i eS Architect Mailing Address •
Address Site Addres . ' ] 7r
(09`7 S� F- e-t. k j T City /State Zip Phone
Name
011° ci--)c 4 ` ACQC-S Name
Owner Mailing Address
O�t5 V ' ` ' . Engineer Mailing Address
Ci> /State Zip Phone
'Pa° l:to pt q,,, 6341-76q1 City /State Zip Phone
General Name
Contractor ( AiAs,4 itorI � ' 6 0V �: Describe work New 0 Addition"( Alteration 0 Repair 0
(rib Address to be done:
Prior to permit f'-4 11,:i S 1)._�� .�� a o f a D ��. 7 r� �p o�
of
a $3r,`" + 9 l
issuance, a copy City /State ip one 1 ` - '" 10� i �W
of all licenses ika�tAx o / � 1 y 446-4/{/;,.�tly�.i
are required if Oregon Const. Cont. Board xp. D to 1 PROJECT
expired in COT Lic.# f . ) 6 ' As .., / df- VALUATION $ ( 6,
database 1071 7, I `
Mechanical Name NEW CONSTRUCTION ONLY:
,, Sub- 00 -)Acv- v e,y, v r _ S Sq. Ft. House: Sq. Ft. Garage
. Contractor Mailing Address ,
Prior to permit _ S Sly �Lr'+ 54--- Indicate the restricted energy installation by the electrical
issuance, a copy i ! t to Zip Phone subcontractor in the following areas
of all licenses ity`> 1 01 R1 - &3 9 ')AeC __ Restricted Audio /Stereo
are required if Oregon onst. Cont. Board f Exp. Date Energy System Alarms
expired in COT Li Installations Vacuum • Irrigation
database System System
Plumbing Name {� (check all that Other:
Sub - DL.'t,�
O1° C�®octwk �oi)K...5 apply)
Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO
1+ (check one) (check one)
�d S t+hT c JT Has the Subdivision Plat recorded? N/A YES NO
Prior to permit Cit / tate Zip Phone •
issuance, a copy ' t � Okk Cr i x)3 -4 63c1.710:0_,
of all licenses are Oregon Const. Cont. Board Exp. Date
required if Lic.# I hearby acknowledge that I have read this application, that the
expired in COT
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
• Ore* on tate laws.
Name g� Sign.; r e gent tee
Electrical O��WeAr v■ '`d y_ i'' lL
M a iling Address r
Sub- ( Contact Pers Name Phone #
c W 3rs�.sov�. � .36G - �i6 ~
Contractor log 41 5 k) c�r� ittsq
City /State Zip Phone
Prior to permit ` � A
issuance, a copy if " e 4 ( A . - q 7u1 639 ' - ' FOR OFFICE USE ONLY: •
of all licenses are Oregon Const. Cont. Board Exp. Date . Plat #: Map/TL#
required if Lic.# R50 45-1C/ 3 D d
expired in COT ���y,
database Electrical Lic..# Exp Date Set cks: f 49,e: Solar:
Electrical Supervisor Lic. # Exp. Date Engineering 1 pproval: Planning Approval: TIF:
•
.'#/ - • G?/ is \dsts \forms\sfaddalt.doc 11/18/99
Permit #: I S Y 2 0 O -- 00/60
OF
/ K r;
� ' ' c� S �f S S- -
�� �•' � �, Address: /
Issued by: D I\ Date: 4/—/ I I-
� 85
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 ini ial`box 1 and 2, and - 3A or either bo - 3B: - 4
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
I I before or upon completion.
3A. My general contractor is \� �'1 \ae°r (k-e � - v ( O 7 1, 7
f\
.(Name)�uls* � ��-. 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
n 3B. I will be my own general contractor.
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 Pr :i ty I ., s a .1 i t Construction Responsibilities on the reverse side of this form.
z4 (1 .tg
ature of permit applicant) (Date) : j
(White copy to issuing agency permit file,
pink copy to applicant) __;
Inftrma'don NoNce Ro ProperRy Owners
No ConstmcVen ResponsitiMes
Note: 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 irr.7 to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas e meern.
EMPLOV2R RESPONS3BDILMES:
If you hire persons not registered with the Consn 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:
aregon's withaolding '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 imaranee taT:.: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
1:ompeufaIion Cin5; As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensatiel insurrirce for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Intez-nal Reinnue Ser-,..7e,1:: 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.
OTHER HESPONSlEalTES AND 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 prorty 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, OR 97309-5052,
503/378-4621), The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
1/94
�_�� Case Activity Listing Listin 1/6/2005
2:54:39PM
TIDEMARK Case #: MST2000 -00100
COMPUTER SYSTEMS, INC.
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' s si nett :
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ate 2,.. ate�3 :Hold. Dis .� � B °
escri tton' ,, D Fa v ..
MSTA005 Application received 3/29/2000 None RECD DEB 4/7/2000
GEO
MSTA008 Permit Created 4/7/2000 None DONE GEO 4/14/2000 No parcel check done, 2nd story
GEO addition is within the existing foot
print.
MSTA012 Plans routed to Plans 4/7/2000 None SENT GEO 4/7/2000
Examiner GEO
MSTA026 Plans approved by Pln 4/10/2000 None DONE BT2 4/10/2000
Examiner BT2
MSTA030 Reviewed plans 4/10/2000 - None DONE BT2 4/10/2000
routed to DSTS BT2
MSTA705 Footing Insp 4/19/2000 None PASS TLP 4/19/2000
AKJ
MSTA706 Foundation Insp 4/19/2000 None PASS TLP 4/19/2000
AKJ
MSTA710 Post/Beam Structural 4/24/2000 None PASS RB 4/24/2000
AKJ
MSTA711 Post/Beam 4/24/2000 None PASS RB 4/24/2000
Mechanical AKJ
MSTA713 Crawl 4/24/2000 None PART RB 4/24/2000 sump
Drain/Backwater AKJ
valve
MSTA720 Mechanical Insp 5/8/2000 None PASS TLP 5/8/2000
AKJ
Page 1 of 3 CaseActivity..rpt
1/6/2005
Case Activity Listing 2:54:41PM
TIDEMARK Case #: MST2000-00100
COMPUTER SYSTEMS, INC.
!Ng - ..y. si ned „ ,�Dane: °N�:: "?U ilafed
.u ,,•• his <,.,;
rep
. •.Date3.” ;Hold B
, `Ds" To;� , .�, \,,tit.
ivtt GDescri t 9 �
,
":�:
MSTA723 Electrical Service 5/8/2000 None PASS TLP 5/8/2000 sign off elec sticker at final for rough
AKJ in, signoff card misplaced
MSTA724 Electrical Rough In 5/8/2000 None PASS TLP 5/8/2000
AKJ
MSTA725 Framing Insp 5/8/2000 None PASS TLP 5/8/2000
AKJ
MSTA740 Insulation Insp 4/24/2000 None PART RB 4/24/2000 1) move hose bib
AKJ 2) elec conn for sump pump needs to
be app
ok to deck
MSTA790 Electrical Final 2/12/2001 None PASS BRP 2/12/2001
AMS
MSTA795 Mechanical Final 2/5/2001 None PASS KBS 11/5/2001
RB
MSTA797 Plumb Final 10/24/2000 None FAIL MRS 10/24/2000 co. needs to be lowered and capped
MRS no hot water
MSTA032 DST Post - Review 4/13/2000 None DONE DEB 4/13/2000
Completed DEB
MSTA080 (F) Ready to issue 4/13/2000 None DONE DEB 4/13/2000 Must have owner sign Owner
DEB Responsibility form 'signed by owner.
If owner does not sign before or at
issuance, Jeanne T said she would
mail out the form and treat it like the
ELC & PLM signature forms.
MSTA092 (F) Issue combination 4/14/2000 None DONE BON 4/14/2000
permit BON
Page 2 of 3 CaseActivity..rpt
1/6/2005
Case Activity Listing
2:54:39PM
„411
TIDEMARK Case #: MST2000-00100
COMPUTER SYSTEMS. INC.
vitav nwArggigottimgpfri-6 qP: 000731 akti9;:7::??
(fo: 741r4w,:',6*
h;A:-.`ia;iriagill'C; 7 Ili* Eqkir '
MSTA199 4/25/2000 None RECD JMT 4/25/2000 mailedowner own eikesponsibility
-- JMT form to sign and return.
Owner/contractor
MSTA740 Insulation Insp 5/8/2000 None PASS TLP 5/8/2000
AKJ
MSTA722 Plumb Top Out 5/8/2000 None PASS TLP 5/8/2000
AKJ
MSTA093 (F) Reprint Permit 8/8/2000 None DONE ZZZ 8/8/2000
ZZZ
MSTA799 Building Final 2/5/2001 None PART KBS 2/5/2001 #-1- need electrical finaled
KBS
MSTA798 Final inspection 2/12/2001 None PASS TLP 2/12/2001
TLP
MSTA797 Plumb Final 2/12/2001 None PASS TLP 2/12/2001
TLP
MSTA970 Case Finaled 2/12/2001 None PASS TLP 11/5/2001
RB
Page 3 of 3 ' CaseActivity..rpt
CITY OF TIGARD P' IILDING INSPECTION DIVISInN MST 4'- JOG,
24 -Hour Inspection Line: J-4175 Business Line: 63. .171
BUP
Date Requested � -- ( �" V / AM PM BLD —
Location /0 V S q Suite MEC
Contact Person Ph ,� G 7 7� f - 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
PLUMBING:4 4: - ..
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
•
Rain Drains
Final
PASS PART FAIL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELEGTRI t
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fina
PASS PART FAIL
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 - - — .
Other oach /Sidewalk Date 2 / Z Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.