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Permit
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A, CITY OF TIGARD MASTER PERMIT PERMIT #: MST2000 -00164 �i�, DEVELOPMENT SERVICES DATE ISSUED: 6/12/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6i G I N A L SITE ADDRESS: 16688 SW QUEEN ANNE AVE PARCEL: 2S115BC -18100 SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: KIN REMARKS: void BUP2000 -00212 and made this permit Adding 220 sq ft to existing house BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 220 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 5 VALUE: $ 20,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 220.00 sf REAR: 15 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 LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: li SIGNAL/PANEL: IN PLANT: MANU HM/SVCIFDR: 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: $ 438.16 This permit is subject to the regulations contained in the JACKSON, GEORGE R AND CEDAR MILL CONSTRUCTION COMF Tigard Municipal Code, State of OR. Specialty Codes and JOYCE M PO BOX 1826 all other applicable laws. All work will be done in 16688 SW QUEEN ANNE AVE BEAVERTON, OR 97075 accordance with approved plans. This permit will expire if KING CITY, 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 #: LAC 131345 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 Erosion 844 -8444 Crawl Drain /Backwater Shear Wall Insp Building Final Footing Insp Footing /Foundation Drr Insulation Insp Foundation Insp Electrical Service Rain drain Insp Post/Beam Structural Electrical Rough In Electrical Final Underfloor insulation Framing Insp Final inspection IP I • Issued By : I � ' Permittee Signature : . , : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne "i • usiness day CITY OF TIGARD - Res Building Permit Application Plan Check# Recd By 13125 SW HALL BLVD. New Construction Date Recd s- Z S TIGARD, OR 97223 Single Family Detached ; Date to P.E. V 503 - 639 -4171 Date to D T°0 9 F 503 -684 -7297 r Permit # _ T��Cl ^Db��,y Print or Type Called. 6 g _ co.� 1- , PP P 9 Incomplete or illegible applications will not be accepted / ' Name of Project Name Job �2c>r� Sic I� u ✓I Architect Mailing Address Address Site Address I b b 6' 8 n 'erc) 5�) °uc¢ AAWc, /27 • City /State Zip Phone Name 6190 4 A C rc J(.x) Name Owner Mailing Address / (0 88 o (a)e'eij 4 eA ' City /State Zip Phone Engineer Mailing Address Kti,•10Ci OIL ' Z b3Y'3i/ City /State Zip Phone General Name Contractor l�C:p.e 1pp a, ( 1.12.4..),_itn. 1 CU, Describe work New 0 Addition( Alteration 0 Repair 0 Wailing dress to be done: Prior to permit v .0 , b ox l b t 6 Additional Description of Work: issuance, a copy ity /State Zip Phone P Of i r ( dt) To 11.0 !( DG 1fec./ of all licenses ncowartra 02 1'7O? 319-6cIOy are required if Oregon Const. Cont. Board Exp Date Q �, � ROJECT expired in COT Lic.# o» VALUATION $ Z p pO�rBy database /-.3/ I 1 Mechanical Name NEW CONSTRUCTION ONLY: Sub- Sq. Ft. House: Sq. Ft. Garage Contractor Mailing Address Indicate the restricted energy installation by the electrical Prior to permit issuance, a copy City /State Zip Phone subcontractor in the following areas of all licenses Restricted Audio /Stereo are required if Oregon Const. Cont. Board Exp. Date Energy System Alarms expired in COT Lic.# Installations Vacuum Irrigation database System System Plumbing Name (check all that Other: Sub- apply) Contractor Mailing Address Number of Units in Building Unit Number Designation Has the Subdivision Plat recorded? N/A YES NO Prior to permit City /State Zip Phone issuance, a copy of all licenses are Oregon Const. Cont. Board Exp. Date required if Lic.# expired in COT database Plumbing Lic. # Exp. Date I hearby acknowledge that I have read this application, that the information given is correct, that I am the owner or authorized agent of the owner, and that plans submitted are in compliance with Nam& -- Oregon State laws. Electrical C-ck Il_. )L. EL )j < t C Si ! nature o�� Went Date M ailing Address ' =y-' , - r - S 2y Uri Sub- 'n act Person Nam Phone # Contractor I S $ 3 a j 4.1 CJ nary ci � Ai. f s iL._ cj J 3 Ci fate Zip Phone J • Prior to permit J )O%o 4915- 3 issuance, a copy FOR OFFICE USE ONLY: of all licenses are Oregon Const. Cont. Board Exp. p Plat #: Map/TL #: ' required if Lic.# // expired in COT PC database Eledr I Lic. # Exp. t d Setbacks: Zone: -S I- 43? - E i a /% /av Electrical Supervisor Lic. # Exp. 7te engineering Approval: Planning Approval: TIF: ;ZX SS /0 /0 / ad Pk" i Igo. 73 i:Wsts \forms\sfd- new.doc 11/20/98 Date Rec'd: CITY OF TIGARD Rec'd By: • SINGLE FAMILY ATTACHED OR DETACHED (New, Addition) Plan Check #: APPLICATION /PLANS SUBMITTAL REQUIREMENTS Applicants: Please complete 1. APPLICANT NAME: G494/t 1/ ( )5 ;ter. int) (BHONE #: 5c).3 6 `/Utz 2. SITE ADDRESS: / 1 1( / 00 5 /,J Otieedt ) hL 2/?. FAX # ; 57O3- / Z©-w 70 . 1. 5 SITE PLANS (Fully dimensional, drawn to scale) labeled with: ❑ map & tax lot #, ❑ subdivision name, ❑ subdivision lot #, ❑ site address, ❑ zoning, ❑ applicant name, ❑ phone number. Size requirement: 8 -1/2" x 11" to a maximum 11" x 17" and NOT attached to building plans. A. North Arrow. B. Scale (any standard, architectural or engineering only). C. Street Names. D. All building plans shall reflect actual building dimensions. E. Finished floor elevations (all levels, actual topographical). F. Garage finished floor elevation (actual topographical). G. Corner lot elevations (actual topographical). H. Driveway corner elevations. I. Zoning setbacks (front, side and rear). J. The location of all public and private easements. K. The location, termination, and all invert elevations of all drainage piping (sanitary and storm) showing all elevations necessary to show positive gravity flow to the approved drainage device (i.e.: peepholes, storm lateral, sanitary lateral). L. Residential driveways, sidewalks and wheelchair ramps will be shown on site plans and will be in accordance with the CITY OF TIGARD standards. Drive -way cuts shall not be permitted within 30 feet of intersecting right -of -way lines nor within 5 feet of property lines. Weep holes /drain pipes will be installed 5 feet from adjoining property lines. Multiple driveways on individual parcels of land must have 30' of separation; joint use driveways require a formal agreement. M. Show all erosion control devices proposed for site; refer to UNIFIED SEWERAGE AGENCY (USA) Technical Guidance Handbook (Revised 1994), or telephone USA at 648 -8621 for assistance. N. Show location of existing facilities and new or relocated structures (mailboxes, power poles, water meter, light pole, stop sign, etc...). O. Indicate property slope directions. P. Existing and finished contours when slope in any direction exceeds 20 %. (ADDITIONAL REQUIREMENTS MAY APPLY, SEE GRADING POLICY). i:\dsts \forms\sfreq.doc 4/14/99 . - OVER - THE - COUNTER (OTC) PERMIT PLAN REVIEW COMMERCIAL (STRUCTURAL) BUILDING PERMIT CHECKLIST DESCRIPTION OF PROJECT: 47,D CLASS OF WORK: lav) FLOOR AREAS: EXTERIOR WALL CONSTRUCTION TYPE OF SE: FIRST ZZO SQ. FT. N: S: E: W: TYPE OF CONSTR: IN SECOND SQ. FT. PROTECT OPENINGS ?: OCCUPANCY GRP: �"3 THIRD SQ. FT. N: S: E: W: OCCUPANCY LOAD: TOTAL SQ. FT. ROOF CONSTR: FIRE RET: STOR: HT: FT: BSMNT: SQ. FT. AREA SEP. RATED: BSMNT?: MEZZ ?: GARAGE: SQ. FT. OCCU.SEP.RATED: FIRE FIRE SMOKE HANDICAP SPRINKLER: • ALARM: DETECTOR: ACCESS: I • COMMERCIAL INSPECTION ACTIONS FEE MENU I F oot ou ~ Post/Beam $ t -1(.J Permit Fee ,......- i 13 Masonry Framing $_ Plan Review . v Insulation Shear Wall $ I1 8% State Surcharge Firewall Gyp Board $ FLS Plan Review Suspended Ceiling Sprinkler Rough -in $ ✓fig 0 A &Se- Sprinkler Final . Fire Alarm $ A l l A Smoke Detector Approach /Sidewalk $ Inspection Miscellaneous $ MIS Fee FOR OFFICE USE ONLY: TYPE OS USE OPTIONS (COM= commercial; CMS= commercial manufactured structure) CLASS OF WORK OPTIONS FOR ALL PERMITS (NEW =new; Add = addition; ALT= alteration; ACS = accessory;FND- foundation; OTR= other, DEM= demolition; REP= repair; FPS =fire protection system, NOTE: USE OTR FOR FENCES, RETAINING WALLS, DETACHED DECKS, SIGNS, AWNINGS, CANOPIES) I:bvrcntr2.doc (DST) 9/99 - - • MAY -30 -00 TUE 09:51 AM City of King City FAX:503 639 3771 PAGE 1 Itie , KING CITY 15300 S.W. 116th Avenue, King City, Oregon 97224.2693 • Phone: (503) 639.4082 • FAX (503) 639 -3771 • Notice To Contractors Working In Kin° 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 sighed 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 permits at the City of Tigard Building. Department for the following project: 1 # Lo V. e�4-(r' located at:•- OB RQn lan ttz51 King: City Representative 5- 36 -60 . • • 1' 'STSKCINST. • • • • • • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 02-0( 001C Y 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 9- (y AM PM BLD Location /6688 Sw 4,N ,P,cry. 4 i h Suite MEC " ffil Contact Person A„N Ph -3(/ y — V y PLM Contractor Ph SWR BUILDING % Tenant/Owner ELC „'' Wall ELR Footing Access: Foundation FPS Drain Crawl Drain Inspection Notes: ��]] r SGN Cr D Slab O� �/� SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler li Fire Alarm ` , Susp'd Ceiling V Roof in . / r, f' .1)1 _s 7 PART FAIL BING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL 0 Service Rough In ( UG /Slab U � \ Low Voltage Fire Alarm Final 9 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 Approach /Sidewalk Other Date _ Inspector Ext Final • PASS PART FAIL DO NOT R' MOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST oZGati — vU /Cr e l 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested '2 9 AM PM BLD Location 5&' Suite MEC Contact Person .)/ h-, Ph 3.4-'0 ya y 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 Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS FAIL EL CTRICA Service Rough In UG /Slab Low Voltage Fire Alarm 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 ins pect - no access ADA Approach /Sidewalk Other Date 7/00 00 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION Msr 2000— 00 I G`f. 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ,�►/ BUP Date Requested AM /" PM BLD Location ( 6 6' `f) € J -et.i Suite MEC Contact Person D 1/1 v\ Ph 7 6 - 7727_ PLM • Contractor Ph SWR Ui .c: Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: si . SIT • ost & Bea • _ : Shear Int Sheath /Shear Framing Drywall Nailing Insulation OP Drywal Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Ro• • inal PASS PART PLU Po- & Beam — i nder Slab Top Out Water Service Sanitary Sewer Rain Drains Final � PART FAIL ICAL ost - - Rough In Gas Line S oke pers F I ASS P RT FAIL LECT AL S 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 Approach /Sidewalk Date (9('2) � Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST - vU 60® 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 l f ' // BUP Date Requested (- AM PM BLD Location I w & es (a wer2M (.'Y A*..J Suite MEC Contact Person Ph PLM Contractor - AA_ J Ph 7 5' /L 7 7 SWR BUILDING Tenant/Owner ( ELC Retaining Wall EL _ R ootin •r Access: •un•atio`>> FPS Crawl Drain Inspection Notes: SGN Slab Gf er.) � SIT Post & Beam , Ext Sheath /Shear 7: & 4' ' / i Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Fi � r S PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service _ Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL 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 ,! Other ( Approach/Sidewalk theoach /Sidewalk Date r � Inspector ( 1 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MsT 60 / , y 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BLD Location / / 8 r I 5 c✓ Qt4"..,, Ai i h Suite MEC J Contact Person , G I vk Ph 74I 772 7 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 xt eath/ 1- mi nsul • rywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: C(A/4 I n 1p. CT : AZ PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer • Rain Drains Final PASS PART FAIL CH ANICAL Est & Beam Gas Line Smoke Dampers Final PART FAIL L RICAL 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 � Approach/Sidewalk Other D Inspector / Ext Other /// Final PASS PART FAIL DO NOT REMOVE this inspection record from a job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 0o / 51 . 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested / AM PM BLD Location 1 C t/iJ g g GC12,2 A Suite MEC Contact Person Ph ( g- PLM Contractor �� 5 = 7 Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation —,--flc" � FPS Ftg Drain Crawl Drain Inspection Notes: SGT Slab [ � v SIT Post & Beam Ext Sheath /Shear C t.U44.- f , o Int Sheath /Shear J Framing Insulation Drywall Nailing Fire wall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final P FAIL EL CTRICAL Rough In UG /Slab D Low Voltage Fire Alarm Fi 40 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Other Date 7 -- - Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.