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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST1999 -00146 . �11, � DEVELOPMENT SERVICES DATE ISSUED: 4/22/99 '--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 16795 SW QUEEN MARY AVE PARCEL: 2S115BC - 16900 SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: KIN REMARKS: Alteration to an existing dwelling. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 704 sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: VALUE: $ 1,500.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 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 F.DR: 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: 0TH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 42.50 This permit is subject to the regulations contained in the DENNIS /PAT DIM BAT OWNER Tigard Municipal Code, State of OR. Specialty Codes and 16795 SW QUEEN MARY AVE SIGNED RESPONSIBILITY FORM all other applicable laws. All work will be done in KING CITY, OR 97224 IN FILE accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: 620 -9680 Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: 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 Framing Insp Final inspection �. Issued B : � �� ".., Permittee Signature : 401//0 401//0 l ip. �� l By API ' Call (503) 63!' by 7:00 p.m. for an inspection needed the next business day • ., . • CITY OF TIGARD Residential Building Permit Application Plan Che �# q - go ld 13125.SW HALL BLVD. Alteration - Interior Remodel Only Recd By •,,t . Date Recd TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. /S _ V 503 - 639 -4171 Date to DST • t& 'I-'t fi F 503 - 684 -7297 Permit # M sf /�4 t7/5/ Print or Type Called 34/-99 Incomplete or illegible applications will not be accepted °-`"/ Pa . / a : 55,0,.., Name of Project � /r � Name Job /67� 5 /� � , C ,C . Architect • Mailing Address Address Site A e . :.s / ! /i - City /State Zip Phone . / .....c.2, t \/ � y �. i Name Owner Mailing Ad.:dress 14 773 JO, ligAiti Engineer Mailing Address City Sate L Zip iip �' / Phon ne Z `i 6,20- 570 k) City /State Zip Phone General Name ,7 Contractor 1G Describe work New 0 Addition 0 Alteration Repair 0 Mailing Address to be done: Prior to permit Additional Description of Work: issuance, a copy City /State Zip Phone of all licenses h /L - 5 -- are required if • Oregon Const. Cont. Board Exp. Date PROJECT —./) c V� expired in COT Lic.# VALUATION $ ((�� database Mechanical "Name NEW CONSTRUCTION ONLY: Sub- -fS 7/ Sq. Ft. House: Sq. Ft. Garage Contractor Mailing Address Prior to permit (� Indicate the restricted energy installation by the electrical 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- G t-9`7 -ZP/J% apply) Contractor —Mailing Address Comer Lot YES NO Flag Lot YES NO. (check one) (check one) Has the Subdivision Plat recorded? N/A YES NO Prior to permit City /State Zip Phone issuance, a copy Solar Compliance of all licenses are Oregon Const. Cont. Board Exp. Date (Calculation Attached) 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 s mined are in compliance with Oregon State laws. Name ...0 . a,F • - of Owner /' ;L` t /ate Electrical it, - - — Sub- Maili g - tC ddress Contact Person Name / � Pho e # " Contractor , kJ A5 [�'�' - � ( P � FOR OFFICE USE ONLY: City /State , ip Phone Plat #: Map/TL #: Prior to permit issuance, a copy. Setbacks: • Zone: Solar: of all licenses are Oregon Const. Cont. Board Exp. Date . required if Lic.# expired in COT Engineering Approval: Planning Approval: TIF: database Electrical Lic. # Exp. Date . 1 I:SFREM2.DOC (DST) 8/11/98 Permit #:14 CO (4 1 OF �' Addres L t 7 9 5 QL U-1PQ(/ 4t/E., a. KI lJ Co `! 97 9.a.q :% 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: i0 % 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 ��JJ II before or upon completion. __, r 3A. My general contractor is C&-.6 _ _ (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 r ' s1 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 cgrrect and that I have read and do understand the Information Notice to P s 1 er y Owners about Con ion Res 1 onsibilities on the reverse side of this form. / c ir .; r ` � 2 r (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) .. . • n=ace 2© Propertly Owners J . \ ���U� K�� e���0U ��m���0k��^��^8N��� r -- - ----- '--�- '---'-- ' . ~ ` � � . This Notice &n 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 existi structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPL•VER REEPONSBB0LMES: If you hire persons not registered with the Construction 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: Oregon's withholding 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 insurance tax: 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. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for a LI claim costs if one of your employees is injured ontbc'oh. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-78Q8. US. Internal | evemtteSeovicm: 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 RE&•)0MSR:ALBTES AM AREAS OF CONCERM: Code compliance: As the permit holder for this project, yoomoroapouuihloforo:no|viogouyfai8o,cbnoeotoodo/cqoireoentu that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accident and omissions such as falling tools, paint overspray, water damage from pipe ponoturem, 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 additiona questions, write or call the Construction Contractors Board (PO Box \4l4O, Salem, [)llg7309'5052, 503/378-482]). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1/94 '41 KING CITY 15300 S.W. 116th Avenue, King City, Oregon 97224 -2693 IMICOMOmmem 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 permits at the City of Tigard Building Department for the following project: a 'r A 1 i ,i / J t / ord , 4 14 . 6441111 A located at: / /7T 4J aZL ine24. __-0-dc.i.,. \i) King City Representativ I:'DSTSV<CINST DOC 6/18/01 Activities for Case #: MST1999- 00146 12:00:46 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA150 Return permit to issued status 5/4/01 DLH DONE No Hold BLD 5/4/01 $62.50 reinstatement fee paid 5/4/01 - receipt #2001 -1860. DLH MSTA799 Building Final 5/9/01 KBS FAIL No Hold KBS 5/9/01 #-1- res, occupied no one available MSTA79° Building Final 5/10/01 KBS OP No Hold KBS 5/10/01 1- call for electrical final MSTA79e 5/18/01 :RP 0 No Hold ZZZ 5/18/01 MSTA005 Application received 4/15/99 GEO No Hold GEO 4/15/99 MSTA008 Permit Created 4/15/99 GEO No Hold GEO 4/15/99 MSTA012 Plans routed to Plans Examiner 4/15/99 GEO No Hold GEO 4/15/99 MSTA026 Plans approved by Pln Examiner 4/16/99 RDP No Hold RDP 4/16/99 MSTA030 Reviewed plans routed to DSTS 4/16/99 RDP No Hold RDP 4/16/99 MSTA725 Framing Insp 4/ . 99 4/16/99 4/22/99 TLP PASS No Hold AKJ 4/22/99 MSTA798 Final inspection 4/16/99 , /16/99 No Hold RDP 4/16/99 MSTA032 DST Post - Review Completed iii■ : 1/99 D DONE No Hold DRA 4/21/99 MSTA080 (F) Ready to issue 4/21/99 DONE No Hold DRA 4/21/99 Prior to issuance have ‘... homeowner sign the Owner Responsibility form. MSTA092 (F) Issue combination permit 4/22/99 GEO DONE No Hold GEO 4/22/99 MSTA722 Plumb Top Out 4/22/99 4/22/9 4 T. PASS No Hold AKJ 4/22/99 MSTA945 Request inspection research /5 J y :: • No Hold JMT 5/19/00 MSTA153 Expired by limitation 1/4/01 4 EXPI No Hold HAP 3/7/01 Card sent. // /Spoke with Mrs Dimbat 3 -7 -01 9:35. She will be i 0 in by 3-15 to pay $62.50 fee + tax to reinstate permit for purpose of final inspection. Return to issued status upon payment of fees...hap..3- 7 -01/// p �/� / f� , 4 c.„..yi ( d e l ".?.. S2 A ..-/---'° i — I irr1.-- Page 1 of 1 • . CITY OF TIGARD BUILDING INSPECTION DIVISION MST l -& 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Date Requested 5- / O AM PM . BLD Location ! C, 7 6 5 Sw QU at., MG r (/cc) Suite MEC Contact Person Ph Zv 16,1 PLM Contractor Ph SWR BUILDING. ° Tenant/Owner ELC Retaining Wall • ELR Footing • Access: Foundation FPS Ftg Drain SGN • Crawl Drain Inspection Notes: Slab - SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear • Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final, / ��, C • • PASS PART • FAIL / 7 Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL, '{ ; °; Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL Service Rough In UG /Slab . Low Voltage Fire Alarm • SS ' P ART FAIL SITEr _ . Backfill /Grading Sanitary Sewer Storm •Drain [ ] Reinspection fee of .$ 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 • Dated i / U ' �/ Inspector E Other p Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • CITY OF TIGARD BUILDING INSPECTION DIVISION p MST - UG� y b 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested / v AM PM BLD Location S 5w Qu'te.,rr /214 r'7 , �,�. r /CC Suite MEC Contact Person Ph PLM Contractor Ph SWR UI Tenant/Owner ELC ketain ni g Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear /, Framing r al EG�C?7Zi& L /4457 eTlc Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS 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� .P� 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 ;At Approach /Sidewalk Date S — /U' d/ Ins ec E Other p Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • g.)," CITY OF TIGARD BUILDING INSPECTION DIVISION MST /��j -d d / 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested S AM PM BLD Location / ( f 5 - 5 w 69u-0-2 , 1 . Y Suite MEC Contact Person Ph PLM Contractor Ph SWR BUILC.I 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 /t/e1 ®iVE liv4/ /.4 - 416, - - X57%` ,/69Q Le �✓J4,J Insulation Drywall Nailing \04/./A -4c' Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling . Roof • Misc: S PART (AIL 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 Service Rough In UG /Slab . Low Voltage Fire Alarm . Final 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 Approach /Sidewalk Other Date '5-- T r°_ Ol Inspector /L. Ext Final . PASS PART FAIL .DO NOT REMOVE this inspection record from the job site.. • CITY OF TIGARD BUILDING INSPECTION DIVISION l 00 / 24 -Hour Inspection Line: 639-4175 Business Line: 639 -4171 BUP Date Requested ,.� q ,/ /? AM PM BLD Location /6795 5&.J 9, ,"r /3,416e,/ � Suite • MEC Contact Person Ph PLM Contractor Ph SWR BUILDINGt.,� °ti 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 Drain n ion Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: F•= 1 - ART FAIL LUMBIN s ; " - • Post & Beam Under Slab • Water ervice Sanitary Sewer Rain Drains Fi•; '.;�r.� -1, PART FAIL Post & Beam Rough In Gas Line Smoke Dampers Final - PASS PART FAIL ELECTRICAL° ; 6 • 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 Date /4..2/7Y /77 Ext Other I nspector Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • •