Permit ' 1 ---
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP96 -00503
`,. '�� DEVEL R9 I l 639 -4171 DATE ISSUED: 10/11/96
- 13125 S PARCEL: 2S110CD -07000
SITE ADDRESS: 12010 SW QUEEN ELIZABETH ST
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 040 JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 0 sf N: S: E: W:
TYPE OF USE: SF SECOND: 0 sf PROJECT OPENINGS?
TYPE OF CONST: 5N 0 sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 0 BASEMENT: 0 sf AREA SEP. RATED:
STOR: 1 HT: 12 ft GARAGE: 0 sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 40 psf LEFT: 0 ft RGHT: 0 ft FIR SPKL: SMOK DET:
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM : HNDICP ACC:
BEDRMS:0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0
VALUE: $ 4,000.00
Remarks: enclose existing covered patios (2 walls)
Owner: Contractor:
BRAZEN CONSTRUCTION
MARK GLEN PETERSON
21313 NE 115TH ST
Phone: BRSH e PRAIRIE, WA 98606
on
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Framing Insp
PRMT BON 10/11/96 $44.50 96- 285091 Insulation Insp
Misc. Inspection
5PCT BON 10/11/96 $2.23 96- 285091
PLCK TAT 9/17/96 $28.93 KING CITY
PRMT CTR 4/6/01 $62.50 27200100000
(additional fees not listed here)
Total $143.16
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Pen Signature: • //�
Signaur .S' �___,ZIA
Issued : y: • , ;il , ' dr < /14-g _
Call 639 -4175 by 7 p.m. for an inspection the next business day
BUP - Building Permit EL C - Electrical Permit
J Inspection Description Date Passed By 1 Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 1 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing At Inspection Description Date Passed By
Suspended ceiling Post/beam mechanical
Engineered soils Gas line
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Duct work
Bolting Lab Final Smoke detector
Fireproofmg Lab Final
Mechanical final
Structural observation
Final inspection 4/10/0
PLM - Plumbing Permit
Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit _ Sanitary sewer
J Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils / Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS
CITY OF TIGARD
,,
//9„.„,,, �� (-A DEVELOPMENT SERVICES BUILDING PERMIT
.. J. "'� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 PERMIT # • BUP96 —'503
t T TE E Q I I SSUED: 10/11/96
FPARG�I� CD- 07000
SITE ADDRESS...: 12010 SW QUEEN ELIZABETH ST
SUBDIVISION • ZONING:
BLOCK • LOT •
' REISSUE: FLOOR AREAS -- -- EXTERIOR WALL CONSTRUCTION —
CLASS OF WORK.:ALT FIRST • 0 sf N: S: E: W:
TYPE OF USE...:SF SECOND...: 0 sf PROTECT OPENINGS?
TYPE OF CONST.:5N ...: 0 sf N: S: E: W:
OCCUPANCY GRP.:R3 TOTAL . 0 sf ROOF CONST: FIRE RET ?:
OCCUPANCY LOAD: 0 BASEMENT.: 0 sf AREA SEP. RATED:
STOR.: 1 HT: 12 ft GARAGE...: 0 sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REDD SETBACKS REQUIRED
FLOOR LOAD : 40 psf LEFT: 0 ft RGHT: 0 ft FIR SPKL: SMOK DET..:
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP ACC:
BEDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0
VALUE. $ : 4000
Remarks: enclose existing covered patios (2 walls)
Owner: FEES
EMIL WIRKLAN type amount by date recpt
12010 SW QUEEN ELIZABETH PRMT $ 44.50 B 10/11/96 96- 285091
SPCT $ 2.23 B 10/11/96 96- 285091
KING CITY OR 97224 PLCK $ 28.93 TAT 09/17/96 KING CITY
Phone #:
Contractor:
BRAZEN CONSTRUCTION
MARK GLEN PETERSON
21313 NE 115TH ST
BRUSH PRAIRIE WA 98606
Phone #: $ 75.66 TOTAL
Reg #..: 111638
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Framing Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Insulation Ins p
applicable laws. All work will be done in accordance with Gyp Board Insp
approved plans. This permit will expire if work is not started Rain drain Insp
within 180 days of issuance, or if work is suspended for more Final I n s p e c t i o n
than 180 days.
Permittee Si nature:
Issued By: gi� (n/
Call for inspection — 639 -4175
Plan Check #
CITY OF TIGARD Residential Building Permit Application Recd By I. 'ale"
13125 SW'HALL BLVD. New Construction Additions or Alterations Date Recd _ 141 - 9 49
TIGARD, OR 97223 Single Family Detached or Attached to P.E.
(503) 639 -4171 )070rn& -to- - —
Print or Type Permit # gl1P% -0'03 .�
Called k g:5S <10/
Incomplete or illegible applications will not be accepte " . ,
Name of Subdivision Lot # Name rV�
Job K144 Cry 7
Address Site Addr ss Architect Mailing Address
Name City /State Zip Phone
/402- $ No., EA c. oh/La .( Name
Owner I Mailing Address
/ 24/0 .4s w 4v.Ezzy 6,7 L/Za4E77-1 Engineer Mailing Address
City/State Zip Phone
; IG ✓Gj C...ry c, 6`03 - Gro - 7957 City/State Zip Phone
Name .
I
General ,,¢a goniyriu,,,c.rroA/ Describe work new 0 addition 0 alteration 0 repair 0
Contractor Mailing Address j!o be done:
2/3/3 MY. //5 s r. Additional Description of Work: +r
Enclose e ii €o► patio -e t••'�''I ,
Ecl
City/State Zip Phone 5
,B srf / cda - V 640 6 19 - 2s4 - 1 0739 lis •
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of ii/ <3k 4/97 Project $ Qv
Current COT Business Tax or Metro # I Exp. Date Valuation
Licenses
Name >�8 4'7S - NEW CONSTRUCTION D UCTION ONLY:
Mechanical ; Sq.Ft. House: Sq.Ft.Garage:
Sub- i Mailing Address
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 i Opener Systems
Name (check all that Other:
Plumbing apply)
Sub- Mailing Address Will the electrical subcontractor wire for all Yes I No
restricted energy installations?
Contractor Has the Subdivision Plat recorded? ( N/A Yes I No
C4/State Zip Pone I l 1
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 • Si • nature of Owner /Agent D to
Electrical . tact ••rso , "ame Phone
Sub- Mailing Address l'rn.,,K . - }p , 3&o sikt,„7S
Contractor FOR OFFICE USE ONLY:
City/State Zip [one Ph Plat # Map/TL #:
•
Oregon Const. Cont. Board Lic.# Exp. Date A<Y (II] AS I /0 CO- Ono°
Attach Copy of Setbacks / Zone: , /
Current Electrical Lic. # Exp. Date ( ///
Licenses
COT Business Tax or Metro # Exp. Date Engineering Approval: Planning Approval: TIF:
• •.dstsrrnstapp.doc
Permit # Account Description Amount Amt. Pd. Bal. Due
R641:445o_3MST. Permit (BUILD) viii-150 W
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT)
State Tax (TAX) ✓ Z A 3 A. a 5
Bldg: AP 4- 3
Plumb:
Mech:
ELC /ELR:
Plan Check
MST: (BUPPLN) ,/ a7, 93 G26,,93
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS)
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (T(F -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: 75 (D 2 gq $7)
i:\dsts\mstapp.doc t� /
Rev. 7/96 •���
02/22/2001 Activities for Case #: BUP96 -00503
4:20:05 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPA008 Permit created 09/18/1996 TAT PEND BON 09/20/1996
BUPA010 Check for prcl..restrict. 09/17/1996 TAT 09/17/1996
BUPA015 Routed to Plans Examiner 09/20/1996 B PEND BON 09/20/1996
BUPA020 Plans checked/approved by PE 10/02/1996 RT PASS BT2 10/02/1996
BUPA025 Reviewed plans routed to DSTs 10/02/1996 RT PASS BT2 10/02/1996
BUPA028 DST Post - Review Complete 10/09/1996 DRA PASS DRA 10/09/1996
BUPA725 Framing Insp 12/13/1996 KS DIS KBS 12/13/1996 #-1- renail ext siding ( loose)
spots #-2- insulate under mud sill
#-3- if ceiling is insulated vent
each rafter space and furr rafters
to allow air space min' one inch
BUPA740 Insulation Insp 05/07/1997 GL PASS KAS 05/08/1997 SEAL AROUND WINDOWS
AND DOORS. OK TO
DRYWALL & MUD & TAPE
(SMALL JOB)' CALL FOR
FINAL WHEN COMPLETE.
BUPA745 Gyp Board Insp - TAT 09/17/1996
BUPA755 Rain drain Insp TAT 09/17/1996
BUPA799 Final Inspection VLN 09/18/1998 Inspection request for research
to Hap W. 9/18/98.
BUPA007 Application received 09/17/1996 TAT RECD DRA 10/09/1996
BUPA080 (F) Ready to issue 10109/1996 DRA PASS DRA 10/09/1996
BUPA090 (F) issue building permit 10/11/1996 B PASS BON 10/11/1996
BUPA700 Framing Insp 04/25/1997 KS PASS RDP 02/22/2001
BUPA800 Misc. Inspection 11/18/1998 KS NOTE J *H 11/18/1998 Attached not to door for request
to contact inspection request
line.
BUPA150 Expired by limitation 04 /17/2000 HAP DONE No Hold AKJ 04/17/2000
•
Page 1 of ,1
kc
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulatio ► - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 5 l 7 I ' ?') A.M. /� P.M. Entry:
Address: / ?-G / Q • _�
Tenant: Ste: MST:
BUP:
`o /Own: 3( to MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
- 5 6041 per ✓H 0( KJrKd arll I om�s
6'I( +o 66- / et if T mud ,I- -/e_
6r l ) D�
Ca,11 6 p :exec' 1.J he CaAl (r's(C
Inspector: • e a Date: S TV
!A PPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO
45 1 olcel
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceilin - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out nsulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: q
Date: l 2_ -13 - `7'C., ( A.M. P.M. Entry:
Address: _ all JO A. - . mac 1 - Ge j F
Tenant: Ste: MST: -
BUP:
Con /Own: k PL k.-.) MEC:
/� 2-00 P,7
(p - ELC:
THE F LT -4 " � E�CTJ�NS C UIR J I L cZ
AP - 6 -'° G 1
X?" c - Li i .4-C, , lcaDS'r: CWQ_
�f �,.. /!4o:C_(] 1 ei6L/7 - AziJ4LT�!.V
erg) /f C1 ,-S-/5' liter' >2.A-7 7
A/ ,_� 'r744-7 nEr�elfi 5.--#4-. z
�/�l�G -Td41 ,__, b/u �r�s� o
die largo / A-tSU L el -ri d by e-» 77,,, arc- » , € . e , ,
Inspector: ' Date: /Zg,6
l
_APPROVED uiSANPROVED /CALL F0 CF CO
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP 96 -6r.5
Date Requested AM PM BLD
Location /t/-OM 67-1- � G[���� E he-1 Suite MEC
Contact Person Ph PLM
Contractor BCC .v,r) (D17'1 S7Y��Q» Ph SWR
BUILDING Tenant/Owner erlt . /ij/'' ./Q 4 ELC
Retaining Wall ELR
Footing F
Foundation NOT REQUESTED 1 FPS
Ftg Drain FOUND DURING RESEARCH SGN
Crawl Drain Slab NO INSPECTION(S) IN FILE SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing ' Oc,/L r. QS' A/6
Firewall
Fire Sprinkler /iw.7.= cAdo..) ex-- A,p. c , c; :a � �1
Fire Alarm
Susp'd Ceiling / �ui2 i...c 4 —�T, /AI .S - cnj A.1 ` —Q ' s T
Roof
Misc: 2 / 4// 75 e27-«
Final
PASS PART FAIL �eP v �
PLUMBING
Post & Beam
•
Under Slab
Top Out
Water Service
Sanitary Sewer _ /
Rain Drains A JO lT /� - ,)/}1I/�2 E i,,' /7
Final
PASS PART FAIL e.A3 rA_C =/ — 70 Z o
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
Approach /Sidewalk
Other Date ` / — / 7 fg Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION t6a b `' ate ti_.4"'...--
MST
24 -Hour Inspection Line: 639 -4175 Business Line. 639 417
Date Requested - 2 I AM PM ` P \ °
_ OW ?s
Location /2e9/O S !A. W -4-- C4 74 4 f•1., •k C Suite MEC
Contact Person • -,,, ' Li Ph 08 6d6 PLM
Q
Contractor �0 5 e R ocrt - L,r., Ph SWR
/ r BtlIEDTSIG> Tenant/Owner : -: , 4 6 r, .E_-/ , :. :.4 (,. _ ELC
Retaining Wall ELR
Footing ti.._ ...,2,..-:',.,2.i' • s ,; - T .. ,�,�_ •. .I, - t
Foundation .4• c ti:►`rni. ; ' ` �c' !,.` >� + . 'r= ' 1�;,.= } » ∎•;.•j "r :- 'Y:- _ FPS
Ftg Drain ;z 1 ;t7,.9„ ,Y- a..x;,1 =r_ � ;^ -;i . a' � '.'':�.1`si' Lri .'
,T-'_•: :;).f�' �4 .
Crawl Drain Inspection Notes: / -^�, ( (� SGN
Slab t. — a0 S U .1 (1GG,-,vC SIT
Post & Beam
Ext Sheath /Shear ,(7 /- ' " _ , ` • - L ��t�`E _ Q,9f
Int Sheath/Shear t
Framing .6-- .6-- C' 6.- -7 1 t.:4 ,, - -. 4/i -?% od k
Insulation ._._ .
Drywall Nailing
Fire wall / 2 d7T � o Co 7 ( £ , / - --
Fire Sprinkler !� t -U
Fire Alarm ,In "
- Si
—A--
Ceiling ��U I�1r c.�(T� ��Sr7 .�... _ -;���,,^ -� �'�l _ c�- . ��$.�-
Roof
Misc: —x `- "' ---( 6 'I, ill�� - S`Gt v`l
1=i AS PART FAIL N 1 `"''� 4 _5. "' � °
Post & Beam _mom p
Under Slab a / A , ` _C_ - -. ».
Top Out
Water Service t.1 ■ 4
Sanitary Sewer .
Rain Drains - / /1
Final / I - " /' � /
PASS PART F • L —, /1 t ./l_,e . S' - 4,
MECHANICAL I L
(
Post & Beam / // (
Rough In 1 ) ` 3 Z) 7 . 1 1. . -�-�'-
Gas Line
Smoke Dampers ■ z
Final ' 1 5 t
PASS PART • IL �-"'�'�� I
ELECTRICAL 3
Service N—/
Rough In
UG /Slab •
Low Voltage ) J �- . t--�n „ - I cz o v.,.__A
Fire Alarm (1 ' ' J� V
Final
PASS PART FAIL
SITE U C 7 ,, — . 0_ , 2-0,4 S l..t�,J \ c
SankflWGree
Sa Sewer -� r _p 1 ti ��
c _ XJ4 %• .
a
Storm Drain [ ] Reinspection fee of $ required before next iipection. Pay at C Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: - [ ] Unable to i. spect - no access
Fire Supply Line
ADA Approach/Sidewalk /
Other
Date -2 /z//0 f Inspector / 1 t �
Final
PASS PART FAIL DO NOT REMOVE this inspectio}irecord from the job site.