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Permit
C ITY OF TIGARD MASTER PERMIT ' PERMIT #: MST99 -00120 ,� I�.; DEVELOPMENT SERVICES DATE 4/7/99 • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15675 SW QUEEN VICTORIA PL PARCEL: 2S110CC -09700 SUBDIVISION: KING CITY NO. 3 ONING: BLOCK: LOT: 010 JURISDICTION: KIN REMARKS: Enclose existing patio. Non- Habitable Room ' BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED • CLASS OF WORK: ALT HEIGHT: . FIRST: 90 sf BASEMENT: 0.00 sf LEFT: 0 SMOKE DETECTORS: Y, TYPE OF USE: SF FLOOR LOAD: 0 SECOND: 0 sf GARAGE: 0 sf FRONT: 0 PARKING SPACES :. 0 TYPE OF CONST: 5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT: 0 VALUE: $ 1,400.00 OCCUPANCY GRP: R3 BDRM: 0 BATH: 0 . TOTAL:. 90.00 sf REAR: 0 PLUMBING SINKS: 0 WATER CLOSETS: 0 WASHING MACH: 0 LAUNDRY TRAYS: 0 RAIN DRAIN: 0 TRAPS: 0 LAVATORIES: 0 DISHWASHERS: 0 FLOOR DRAINS: 0 SEWER LINES: 0 SF RAIN DRAINS: 0 CATCH BASINS: 0 TUB /SHOWERS: 0 GARBAGE DISP: 0 WATER HEATERS:, 0 WATER LINES: 0 BCKFLW PREVNTR: 0 GREASE TRAPS: 0 . • OTHER FIXTURES: " 0 MECHANICAL . FUEL TYPES FURN < 100K: 0 BOIUCMP < 3HP: 0 VENT FANS: 0 CLOTHES DRYER: 0 FURN > =100K: 0 UNIT HEATERS: 0 HOODS: 0 OTHER UNITS: 0 MAX INP: Obtu FLOOR FURNANCES: 0 VENTS: 0 WOODSTOVES: 0 GAS OUTLETS: 0 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS ' 1000 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 - 400 amp: 0 1st W/O SVC/FDR: 0 SIGN /OUT LIN LT: 0 PER HOUR: 0 • LIMITED ENERGY: 0 401 - 600 amp: 0 401 - 600 amp: 0 EA ADDL BR CIR: 0 SIGNAUPANEL: 0 IN PLANT: 0 601 - 1000 amp: 0 ,601 +amps- 1000v: 0 . MINOR LABEL: 0 1000+ amp /volt : 0 Reconnect only: 0 PLAN REVIEW SECTION ' >=4 RES UNITS: .. SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY • A. SF RESIDENTIAL • B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO S 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: 0 Owner: Contractor: TOTAL FEES: $ 42.50 MARGARET SCMNAND CC CURBS INC This permit is subject to the regulations contained in 15675 SW QUEEN VICTORIA PL 690 E WILLAMETTE Codes Tigard all Municipal f other applicable ble laws. of O All w wi Codes and all other applicable laws. All work will be KING CITY, OR 97224. SHERWOOD, OR 97140 done in 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: Oregon law Phone: Phone: 625 -6890 • requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth Reg# 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 . • Building Final . • r 1, . 64 ,0 t.p55- eh-75- a tom- '7'09 P41 � -F TIGARD Residential Building Permit Application , Plan Check# = :3125 SW HALL BLVD. Additions or Alterations Recd By '`TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date Recd 3 9 y Date to P.E. ,2 - - 4— • V 503 - 639 -4171 Date to DST 3 - - onifr F 503 - 684 -7297 /6-R5- Permit # /jrfJl'2 - ' 0 / Print or Type Called 1 vole 4.01A Q Incomplete or illegible applications will not be accepted it:500- • Name of Project • Name Job /} , &ire 7 , .._CCJ%. L oa. ,.) ci Address Site Adress ( Architect ' Mailing Address • J, 5t7S S t- , '9 ee,J / c•: r- i -l j City/State Zip Phone Name ..i=3,rri e' Name Owner Mailing Address City/State Zip Phone Engineer Mailing Address '--- /i "^'/ d. alt 9 "7 ` . 4 _w -0 . 5-4,5 " City/State Zip Phone General Name Contractor Describe work New 0 Addition O- Alteration 0' Repair 0 Mailing Address to be done: Prior to permit • Addition I Descri tion issuance, a copy City /State Zip Phone d of all licenses are required if Oregon Const. Cont. Board Exp. Date PROJECT 0-z9 expired in COT Lic.# VALUATION $ ` 4/ o d database Mechanical Name NEW CONSTRUCTION ONLY: Sub- 0. 2 . ( -L. .2"0 . Sq. Ft. House: Sq. Ft. Garage Contractor / Mailing Address Prior to permit (v /�O E. (A / /G r77i*TT� Indicate the restricted energy installation by the electrical issuance, a copy Ci /State Zip Phone subcontractor in the following areas of all licenses ` �j j cdcr,./, ar 97 [ 4e) �::�5 t,>;''C ?:-- Restricted Audio /Stereo are required if Oregon Const. Cont. Board Exa-,D8p7 5 Energy System Alarms expired in COT Lic.# /6-a;,�3 -7 OO ��__ // �� Installations Vacuum Irrigation database System System - Plumbing Name (check all that Other: A . %ate- i 7% 0 . Sub- aPPly) • Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO (check one) >C (check one) 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 • I hearby acknowledge that I have read this application, that the 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 Oregon tate law . Name Sign . of-0 er /Ag t Date Electrical . .23 - Sub- Mailing Address act Person Name 2 - Phone # Contractor ) " L /Crci Le ;"r, /t- k- : -L� ©v City /State Zip Phone Prior to permit , issuance, a copy FOR OFFICE USE ONLY: of all licenses are Oregon Const. Cont. Board Exp. Date Ma Plat #: Map/TL#: required if Lic.# P expired in COT database Electrical Lic. # Exp. Date Setbacks: Z � t � So lar: Electrical Supervisor Lic. # Exp. Date Engineering Approval: ning Approval: TIF: r 9 9 JILL 0 : \fists \f rms\sfaddalt.doc 11/20/98 • KING CITY. 15300 S.W. 116th Avenue, wing City, Oregon 97224.2693 Phone: (503) 639 -4082 • FAX (503) 639 -377] 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: - / _& C ,v1� �SCGt.e� located at: /5675 5i) C ao%n I u1 King City Representative 1:'DSTSr1:CU: °_T. DOC 5 /17 /99 Activities for Case #: MST99 -00120 9:07:14 PM • Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA005 Application received 3/23/99 GEO RECD GEO 3/29/99 MSTA008 Permit Created . 3/29/99 GEO DONE GEO 3/29/99 MSTA012 Plans routed to Plans Examiner 3/29/99 GEO SENT GEO 3/29/99 MSTA026 Plans approved by Pln Examiner 3/30/99 RDP APPR RDP 3/30/99 MSTA030 Reviewed plans routed to DSTS 3/30/99 RDP APPR RDP 3/30/99 MSTA032 DST Post - Review Completed 4/7/99 BON DONE DJL 4/7/99 MSTA725 Framing Insp GEO 3/29/99 MSTA799 Building Final 4/9/99 RC PASS AKJ 4/11/99 MSTA080 (F) Ready to issue 4/7/99 BON PASS No Hold DJL 4/7/99 MSTA092 (F) Issue combination permit 4/7/99 DEB DONE No Hold DST 4/7/99 MSTA970 Case Fineled 4/11/99 AKJ DONE No Hold AKJ 4/11/99 Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST qg -iE/j3+r'Z0 • 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 p BUP G Date Requested l - q'9 / AM l� PM BLD Location t 1 L07 S Q(keur V 1 C Suite MEC Contact Person Ph PLM Contractor Ph SWR UILDI Tenant/ nvA3 /AA" 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 Fire Ceiling Al (` // Roof ." SS PART FAIL PL I 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 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 9,1 Other Date (� 9 Inspector ■C Ext Final - PASS PART FAIL DO NOT REMOVE this inspection record from the job site. L __