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Permit 1 CITY OF T MASTER PERMIT PERMIT # MST98 -0292 a ( .. DEVELOPMENT SERVICES DATE ISSUED: 07/23/98 11. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115BC -16100 SITE ADDRESS...:12375 SW KING RICHARD DR SUBDIVISION - ZONING: . BLOCK.......... LOT - JURISDICTION: KIN Remarks: Enlarge an existing bedroom. 6' X 14' • ---- BUILDING --- - REISSUE: STORIES • 1 FLOOR AREAS — BASEMENT...: 0 sf REQUIRED SETBACKS ---- REQUIRED- - CLASS OF WORK.:ADD HEIGHT • 12 FIRST • 84 sf GARAGE • 0 sf LEFT • 4 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT : 0 PARKING SPACES: 0 TYPE OF CONST.:5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT : 4 . OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL - -: 84 sf VALUE..$: m REAR : 0 - ----- -- PLUMBING -- - - ---- -- SINKS . • 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 2 TRAPS • 0 LAVATORIES • 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 - --------- MECHANICAL --- — FUEL TYPES----------- FURN ( 100K ..: 0 BOIL /CMP ( 3HP: 0 VENT FANS • 0 CLOTHES DRYERS: 0 FURN ) =100K ..: 0 UNIT HEATERS...: 0 HOODS • 0 OTHER UNITS...: 0 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 0 WOODSTOVES : 0 GAS OUTLETS...: 0 M --------- - ----------- ELECTRICAL - -- -- - - RESIDENTIAL UNIT— — SERVICE /FEEDER -- —TEMP SRVC /FEEDERS— — BRANCH CIRCUITS— -- MISCELLANEOUS— - -ADD'L INSPECTIONS- - 1m SF OR LESS: 0 0 - 200 amp.. 0 0 - 200 amp..: 0 W /SVC OR FDR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.: 0 201 - 400 amp..: 0 .201 - 4',s amp..: 0 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: 0 PER HOUR • 0 LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0, EA ADDL BR CIR: 1 SIGNAL /PANEL...: 0 IN PLANT • 0 MANF HM /SVC /FDR: 0 601 - .10Y amp.: 0 601 +amps -1t'. v: 0 MINOR LABEL -10: 0 1000+ amp /volt.: 0 PLAN REVIEW SECTION -- - - - - -- Reconnect only.: 0 )=4 RES UNITS...: SVC /FDR) =225 A.: ) 600 V NOMINAL: CLS AREA /SPC 0CC: - -- — ELECTRICAL - RESTRICTED ENERGY --- ---- -- - - ----- A. SF RESIDENTIAL -- B. COMMERCIAL— — --------- -- AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM..: 0TH: .. BOILER HVAC LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK • INSTRUMENTATION: MEDICAL • OTHR: -- HVAC • DATA /TELE COMM.: NURSE CALLS : TOTAL 0 SYSTEMS: 0 Owner: -- --- ----- ---- --- Contractor: -- ----------- TOTAL FEES:$ 154.11 ELDON L WILLIAMSON OWNER • This permit is subject to the regulations contained in the 12375 SW KING RICHARD DRIVE Tigard Municipal Code, State, of Ore. Specialty Codes and all KING CITY OR 97224 other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is Phone 0: Phone 0: not started within 180 days of issuance, or if the work is Reg 0..: Om- suspended for more than 180 days. ATTENTION: Oregon law ------------ requires you to follow, rules adopted by the Oregon Utility Notification Center. Those rules are set forth it OAR 952 -001 -0010 through OAR 952 -001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246 - 1987. -- -M— ----- ---- -- REQUIRED INSPECTIONS - ----- Footing Insp Shear Wall Insp Foundation Insp Insulation Insp Post /Beam Struct Rain drain Insp Electrical. Rough Electrical Final Framing Insp Building Final Issued By By _ - P ermi-ttee Si- g- nature: - '1 r ;,. ..:� •..,, - -- + + + + + + + + + + + + ++ ++ + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day Plan Check # - r ::ITY OF TIGARD Residential Building Permit Application Rec'd By 13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd G 7--a -i 0 ','IGARD, OR 97223 Single Family Detached or Attached Date to P.E. • X93) 639 -4171 Date to DST ` li _i i S.� e Print or Type Permit # Jl?SrQ e r ' 9 Called O - '39 (. 3c , ,4 3 .--- Incomplete or illegible applications will not be accepted Olen-- Name of Subdivision Lot # Name N Job " / t ° C,a-,y f 4 /4, Mailing Address Address Site Address Architect g +2o2 7,r �'tle aw`c4 1`3! c.#, ,!) 1, City /State Zip Phone Name i; , t 4 v 4 &' . Oi6 l:4 A:),,c d i Name Owner Mailing Address v ` „I '�'A'�`�' � d�3 A' 0o$� - -� � , /6"? Engineer Mailing Address ._ , I City%State Zip Phone g City/State . Phone 'Name' (02 Vl • General 4> A ®, E 2 I/,-�,� / % '44 Describe work new 0 addition Se alteration 0 repair 0 • . Contractor Mailing Address to be done: ' kit; Additional Description of Work: City /State Zip' ' Phone /riG,e &1517/04-- &Norm Oregon Const. Cont. Board Lic.# Exp. Date - f Attach Copy of Project $ r ,,, 0 Current COT Business Tax or Metro # Exp. Date Valuation `P d� Licenses Name NEW CONSTRUCTION ONLY: Mechanical , . 73 ' Sq.Ft. Hou : G Sq.Ft.arage: Sub- Mailing Address �j __�J__ Contractor Corner Lot Yes No Flag Lot Yes No City/State Zip Phone (check one) (check one) • Restricted Audio /Stereo Burglar Oregon Const. Cont. Board Lic.# Exp. Date Energy System Alarm Attach Copy of Current COT Business Tax or Metro # Exp. Date Installation Garage Door HVAC Licenses Opener Systems • Name (check all that Other: Plumbing. ) . apply) Sub- ` Mailing Address Will the electrical subcontractor wire for all Yes No • Contractor restricted energy installations? City/State Zip Phone Has the Subdivision Plat recorded? • N/A Yes No Oregon Const. Cont. Board Lic.# Exp: Date Reissue of MST# Solar Compliance Attach Copy of • (Calculation Attached) Current Plumbing Lic. # - Exp. Date I hereby acknowledge that I have read this application, that the Licenses information given is correct, that I am the owner or authorized agent of COT Business Tax or Metro # Exp. Date the owner, and that plans submitted are in compliance with Oregon State laws. Name J Si atur of ege Date Electrical �.. + .-, `' R ,6.. , �,"=.:. �� Co on�fJa /,o Phorie Sub- Mailing Address tac (v'A Contractor FOR OFFICE USE ONLY: - City/State Zip Phone Plat # Map/TL #: 1 Oregon Const. Cont. Board Lic.# Exp. — — � s � ivC� ��`' Cc Oregon Copy of Setbacks Zone: ' Solar: I Current Electrical Lic. # Exp. Date Licenses �� rr COT Business Tax or Metro # Exp. Date Engineering Approval: 'Pla ning Approval: TIF: 2 sts\mstapp.doc - (- K.,1 -67 Permit # Account Description Amount Amt. Pd. Bal. Due MST. Permit (BUILD) Plumb. Permit (PLUMB) Mech. Permit (MECH) ELC /ELR Permit (ELPRMT) State Tax (TAX) Bldg: Plumb: Mech: ELC /ELR: Plan Check MST: (BUPPLN) 2 ' Plumb: (PLMPLN) Mech: (MECPLN) CDC Review (LANDUS) Sewer Connection (SWUSA) Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Residential TIF (TIF -R) Mass Transit TIF (TIF -MT) • Water Quality (WQUAL) Water Quantity (WQUANT) - Erosion Control Permit (ERPRMT) Erosion Planck/USA (ERPLAN) ,\ Erosion Planck/COT (EROSN) Fire Life Safety • (FLS) TOTALS: is \dsts\mstapp.doc Rev. 7/96 CITY OF TIGARD • 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ELDON WILLIAMSON 12375 SW KING RICHARD DR TIGARD OR Electrical Signature Form Permit # MST98 -0292 Date Issued.: 07/23/98 Parcel 2S115BC -16100 Site Address: 12375 SW KING RICHARD DR Subdivision.: Block Lot: Jurisdiction: KIN Zoning _Remarks: Enlarge an existing bedroom. 6' X 14' Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNER: ELECTRICAL CONTRACTOR: ELDON L WILLIAMSON ELDON WILLIAMSON 12375 SW KING RICHARD DRIVE 12375 SW KING RICHARD DR KING CITY OR 97224 TIGARD OR Phone #: 624 - 8609 Phone #: 624 - 8609 Reg #..: Sig � of tu re Supervising Electrician If you have any questions, please call 639 - 4171,_ ext. #310 f Permit #: t' T 9 S- O 0 �� , Address: .7 .-`'' Issued by: Date: 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 initial boxes 1 and 2, and either box 3A or 3B: `' 1 1 / 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 before or upon completion. n 3A. My general contractor is I (Name) 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 )) (`� 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 Property Owners about Construction Responsibilities on the reverse side of this form. ezo „ ,,,,, (Signature of permit applicant) _ L a te)_ (White copy to issuing agency permit file, pink copy to applicant) • RniPormann Notice Pl'operEcy ()limeys AbeQ_At Construction ResponsiMides 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 improvement to an existing structure, you can prev many problelLs by being aware of the following responsibilities and areas of concern. EMPLOY POMaJMILCIVIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement e.f a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the einp.loyer, you must comply with the following: Gregon's As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will '.)e liable fc 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 ttsaTence , Tsix: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For ino're information, call tie Oregon Employment Division at the Department of Human Resources at 378-3524, WorkeTs' compensation no rain= As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation 7•1surance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and wi:: be liable 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. lIntem.6' Revenue ac.!ir.7 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. OTHEM PIESPOMSBNJTES AND AREAS OF CONCEioi\l: C. compiiiaince: 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 proi 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 • • .: .„•f„. KI NG cirry Y Y 15300 S.W. 116th Avenue, King City, Oregon 97224 -2693 eMMEMONEERENI Phone: (503) 639 -4082 • FAX (503) 639 -3771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete. legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning_ submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue peiiiiits at the City of Tigard Building Department for the following project: //L located at: 423 15 SW K i RLdia.cd King City Representati I:'D STS\KC INST. DOC 1/10/2005 Case Activity Listing 8:31:42AM TIDEMARK Case #: MST98 -00292 COMPUTER SYSTEMS, INC. :�, { ssi ned -•: �D "one - - �:U dated a . ..,.. � ' � „6,,,,• A v\ � twit, bescr� tton ate 1 ate 3 H >�`D s To >B °�` y =� °=`" -B ��Notes MSTA005 Application received 7/7/1998 None RECD JSD 7/8/1998 GEO MSTA008 Permit Created 7/8/1998 None DONE GEO 7/8/1998 GEO MSTA010 Check for prcl. 7/8/1998 None KING GEO 7/8/1998 Approval letter received from King restrict. GEO City. 7-7-98 MSTA012 Plans routed to Plans 7/8/1998 None SENT GEO 7/8/1998 Examiner GEO MSTA030 Reviewed plans 7/21/1998 None APPR RDP 7/21/1998 routed to DSTS RDP MSTA032 DST Post - Review 7/23/1998 None PASS JSD 7/23/1998 Completed JSD MSTA705 Footing Insp 8/3/1998 None PASS WDJ 8/3/1998 WDJ MSTA706 Foundation Insp 8/3/1998 None PASS WDJ 8/3/1998 WDJ MSTA710 Post/Beam Structural 8/14/1998 None PASS WDJ 8/19/1998 WDJ MSTA724 Electrical Rough In None 8/28/1998 WASH CO J *H MSTA725 Framing Insp 8/21/1998 None FAIL RC 8/21/1998 NOT READY NEED TO BE ROC WEATHERTIGHT NEED ELEC INSP. Page 1 of 3 CaseActivity..rpt Case Activity Listing 1/10/2005 8:31:43AM TIDEMARK Case #: MST98 -00292 COMPUTER SYSTEMS, INC. ... i,,,qn„ . ^ r , ,;..r . - fir, ,fi�'✓r' �l . g( � 'ssi Done U dated`' � > °, ;"� e ., . „Date Date-- 2�:_:.; "•..;.., ,.,,,Date 3 ;:`;;Hald, Dis T.o- B ° =B: � Not s''�° _. Actrvrt Descrt tton, ..,.. � „h �<„ ' °s °= � , MSTA726 Shear Wall Insp 8/14/1998 None PASS WDJ 11/18/2003 hold downs, shear ok DLH MSTA740 Insulation Insp 8/14/1998 None PART WDJ 8/19/1998 underfloor insulation WDJ MSTA752 Rain drain Insp 8/14/1998 None PASS MS 8/19/1998 WDJ MSTA799 Building Final None 7/8/1998 GEO MSTA092 (F) Issue combination 7/23/1998 None DONE DLH 7/23/1998 permit DLH MSTA097 Issue electric 7/23/1998 None RECD JMT 7/23/1998 signature form JT MSTA093 (F) Reprint Permit 8/12/1998 None DONE B 8/12/1998 BON MSTA725 Framing Insp 9/7/1998 9/4/1998 None PASS WDJ 9/7/1998 NOTE: electrical approved by J *H WASH CO. 090398. MSTA740 Insulation Insp 9/7/1998 9/4/1998 None PASS WDJ 9/7/1998 J *H MSTA080 (F) Ready to issue 7/23/1998 None PASS JSD 7/23/1998 Needs Property Owner as Contractor JSD form signed off. jsd MSTA790 Electrical Final None 8/28/1998 WASH CO J *H Page 2 of 3 CaseActivity..rpt / 57 9 --%-/ K; R Go a-..gy p,- 5/11/99 Activities for Case #: MST98 -00292 9:17:35 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA005 Application received 7/7/98 JSD RECD GEO 7/8/98 MSTA008 Permit Created 7/8/98 GEO DONE GEO 7/8/98 MSTA010 Check for prcl. restrict. 7/8/98 GEO KING GEO 7/8/98 Approval letter received from King City. 7 -7 -98 MSTA012 Plans routed to Plans Examiner 7/8/98 GEO SENT GEO 7/8/98 MSTA030 Reviewed plans routed to DSTS 7/21/98 RDP APPR RDP 7/21/98 MSTA032 DST Post - Review Completed 7/23/98 JSD PASS JSD 7/23/98 MSTA705 Footing Insp 8/3/98 WDJ PASS WDJ 8/3/98 MSTA706 Foundation Insp 8/3/98 WDJ PASS WDJ 8/3/98 MSTA710 Post/Beam Structural 8/14/98 WDJ PASS WDJ 8/19/98 MSTA724 Electrical Rough In . J *H 8/28/98 WASH CO MSTA725 Framing Insp 8/21/98 RC FAIL ROC 8/21/98 NOT READY NEED TO BE WEATHERTIGHT NEED ELEC INSP. MSTA726 Shear Wall Insp 8/14/98 WDJ PAS WDJ 8/19/98 hold downs, shear ok MSTA740 Insulation Insp 8/14/98 WDJ PART WDJ 8/19/98 underfloor insulation 1 MSTA752 Rain drain Insp • 8/14/98 MS PASS WDJ 8/19/98 MSTA790 Electrical Final J *H 8/28/98 WASH CO MSTA799 Building Final GEO 7/8/98 MSTA080 (F) Ready to issue 7/23/98 JSD PASS JSD 7/23/98 Needs Property Owner as Contractor form signed off. jsd MSTA092 (F) Issue combination permit 7/23/98 DLH DONE DLH 7/23/98 MSTA097 Issue electric signature form 7/23/98 . JMT RECD JT 7/23/98 MSTA093 (F) Reprint Permit 8/12/98 B DONE BON 8/12/98 MSTA725 Framing Insp 9/7/98 9/4/98 WDJ PASS J *H 9/7/98 NOTE: electrical approved by WASH CO. 090398. i MSTA740 Insulation Insp 9/7/98 9/4/98 WDJ PASS J *H 9/7/98 MSTA970 Case Finaled 8/4/98 RC DONE No Hold JT 5/5/99 complete & finaled I Page 1 of 1