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Permit ( , ,,,,A ,.,. CITY OF TIGARD /4,, �� DEVELOPMENT SERVICES MASTER PERMIT -!�+� jl� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE PERMIT ISSUED:. 12 / 1 - 0550 PARCEL: 1 S 135CC -00200 , SITE ADDRESS...: 11250 SW TIGARD. ST SUBDIVISION. • ZONING: R -4.5 BLOCK LOT • Remarks: Construct a 300 Sq Ft addition to residence PATH I -- - - - -- -------- BUILDING — ---- -- - -- - -- - -- - ---- -- - - - - - - -- REISSUE: STORIES : 1 FLOOR AREAS — BASEMENT...: 0 sf REQUIRED SETBACKS -- REQUIRED -- — CLASS OF WORK.:ADD HEIGHT • 12 FIRST • 300 sf GARAGE 0 sf LEFT : 19 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT • 0 PARKING SPACES: 0 TYPE OF CONST.:5N . ,DWELLING.UNITS:, 1,_ • . FINBSMENT; 0.5f - RIGHT 0 OCCUPANCY GRP.:R3 BDRM: 1 BATH: 1 TOTAL -- - -: 300 sf VALUE..$: 20070 REAR • 0 - - - -- - -_ , - - - -- -- PLUMBING - - -- - -- — -- . ---- - SINKS • 0 WATER CLOSETS.: 1 WANING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0 'LAVATORIES...;.: 1 , DISHWASHERS...:. 0 ._ ,. FLOOR .DRAINS.,. _0 _, _ SEWER LINE, ft: ,, 0 , , SF, RAIN DRAINS:, 0 CATCH BASINS.::. 2. , TUB /SHOWERS...: 2 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 • 2 CLOTHES DRYERS: 0 /6AS/ / / FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0 MAX INP.: 0 BTU FLOOR, FURNACES:. 0. VENTS 2 WOODSTOVES....:: 0 GAS OUTLETS...: 0 - ----- - - - - -- - - - - - -- - ---- ELECTRICAL - — - -- - -- - - RESIDENTIAL UNIT -. -- SERVICE /FEEDER -TEMP SRVC /FEEDERS -- - -- BRANCH CIRCUITS-- -,, --- MISCELLANEOUS - - — ADD'L INSPECTIONS - 1'w SF OR LESS: 0 0 - 200 amp..: 0 0 - 2w, amp..: 0 W /SVC OR FOR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.: 0 • . 201 - 400 amp..: 0 ' 201 7 4ew amp..: 0 . 1st W/O SVC /FDR: 1 . ., SIGN /OUT LIN LT: 0• PER HOUR • • 0 LIMITED ENERGY.: 0 401 - 6% amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 1 SIGNAL /PANEL...: 0 IN PLANT • 0 MANFHM /SVC /FDR: 0' 601. 7 1w, amp.: 0 ,'. •601 +amps- 1000.v: 0. H. , . MINOR LABEL -10: 0 1w amp /volt.: 0 - -- --- PLAN REVIEW SECTION — ---- ----- - - ---- -- Reconnect only.: 0 )=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.: ,...., N URSE CALLS • TOTAL B SYSTEMS: 0 Owner: - ---- — - -- — Contractor: — TOTAL FEES:$ 395.11 PAUL JACKSON. ,. . . . OWNER, . 10250 SW TIGARD ST TIGARD OR 97223 Phone B: • Phone B:.. Reg 0..: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. 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 180•days., . - - -- - - - -- ----------------------------- REQUIRED INSPECTIONS, .,...w „ - -- -- - Erosion Contgl , ._PoBeam.Mechan " Electrical:Servi.,,, . Insulation . Insp,. Plumb ,Final Grading Inspecti C / rawl Drain Electrical Rough Gyp Board Insp Building Final Footing I'nsp , , PLM /Underfloor L , ., Framing Q lnsp ,. ,__p Rain' drain Insp, ml .. , Foundation Insp Mechanical Insp Shear Wall Insp Electrical Final Post /Beam Struct Plumb.,Top Out „_! Low,» e ,;; Mechanical Final Permittee Signature: 1iCfi2 -- Issued By: 1/� EL , G t Call for inspection - 639 -4175 Plan Chuck 4 2..- 2_0. CITY OF`TIGARD Residential Building Permit Application Reg IBv , ,(X, 1312 , SV HALL BLVD. New Construction Additions or Alterations Date Recd l 14 TIGA RD, OR 97223 Single Family, Detached /Attached (1 or 2 units) Date to P E _I 0 (o ,503) 639 -4171 Date to Ds rtet -f - Print or Type Permit /v l6 C i ' (o -0 5� called 11-19- Incomplete or illegible applications will not t•: accepted Name of Project N e Job Be4room /1gANl -. 14-e(&‘"1-1‘611 , L Jrro /flc i - aSi5n S e Th Address Architect Mailing Address Site Address -� J c1 /72-5 7 25 5 10160 SW I I CU. arc( J"1 City/State Zip Phone / 'L[ I Pau F7• Jackson take OSiveso OM- ,0 1 Owner Mailing Address Name 10250 5k) Ts d Engineer Mailing Address C.tyrState Zip Phone g T Sa.t -c l O(2- 6i34 - tA AF/ ( Name I Cutytstate Zio ` Phone General - p a .l eR Jac.esc v Describe work New 0 Addition t Alteration J Repair 0 Contractor Mailing Add to be done 1c'2-5 o S Ld 1 iC� -e( Type of Use City/State Zip J Phone I/ 0 M Q— Tr sand OW_ 68'(-611/‘ Type of Construction I /A/0 Orego Const. Cant Board Lic # Exp Date Attach Copy of ` Occupancy Class I Current COT Business Tax or Metro » I Exp Date Licenses Will it be spnnklered Yes❑ Nog Name If Yes. separate FLS plans and Mechanical -P&,( )ae sue aooucatton a of Ston � Number of Stones Sub- Mailing Address Contractor J Proposed Use C tyrState Zip Phone Previous Use I 9 Oregon Const. Cont. Board L.c # Exp Date o c f 0 70, e..•• Attach Copy of Valuation I $ Current COT Business Tax or Metro » I Exo Date v Licenses NEW CONSTRUCTION ONLY eIA,. P3 Name Building ID I a bk/k lc (vl\ Plumbing ( R. Ja_c-�Sa�1 Y/ Sub Mauling Address Unit Types . sou a `t I x of ,;nits Contractor A.) I City/State Z:o I Phone B.) C.) 'I Oregon Const Cant Board Lc 1 Exp Date D.) I Attach Copy of Will the electrical succont•ac :or wire for ad restricted Current Plumping Lic ; ' Exp. Date I Yes i No energy installations' Licenses Has the Sucaiviston Peat recorcee I COT Business Tax or Metro a I Exp Date N/A C:1 I No I nereoy acknowledge that I nave reap this accncation that :he Name information givens correct. :nat I am :he owner or autncnzed agent of Electrical )• ( 'R. J adcsol the owner ana:hat plans submitted are :n compliance with Oregon Sub- Mailing .Address State : ash � Sig � j Contractor � � 1�� ` I Date 4I C,ty/State Zip Phone Cootact Person Nape , 4 01/ Phone al f/ t /eie/c on I C Y7 61 Oregon Cons: Cant Board Lac» I Exp Date ,FOR OFFICE USE ONLY: j) Attach Copy of c Current Eect � P at _I '- M 1 ap /TL;* Zone ncal Lic Exp Date l �J' ,f � t) Licenses NI( � P`N% �� I '3��C "'rot (``-f- COT Business Tax or Metro » Exp Date Engineering Approval Planning TIF 0 Td (3 (z /I OC' Approval -sts\resaco aoc Permit # Account Description Amount Amt Pd. Bal. Dy /it- MST Permit (BUILD) 06.56 /46 5-2) Plumb. Permit (PLUMB) 36.*0 36 Mech. Permit (MECH) 25.00 c 2 r ELC /ELR Permit ( ERPRMT) 114,4 /42,' State Tax (TAX) /2,3r 72 «f 3 Bldg: 7,33 / 33 ✓ Plumb: /, n/ Mech: f , Z ELC /ELR: 2.00 Plan Check MST: (BUPPLN) 95.23 l ib , 0 6� ` /5, tO) Plumb: (PLMPLN) Mech: (MECPLN) • CDC Review - planning (CDCPLN) G10, A CDC Review - bldg (CDCBLD) 0 q0, o ?o, 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) dd TOTALS: 395. /I I Id AE9, 2 ? I'.dssUesaoo doc rev 7090 Page No. 1 CASE HISTORY FOR CASE NO.. MST96 -0550 PAUL R JACKSON 10250 SW TIGARD ST 12/14/98 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By MSTA005 Application received / /' / / 12/16/96 PASS BON 12/18/96 PHN MSTAO08 Permit Created / / / / 12/18/96 PASS JSD 12/18/96 PHN MSTA010 Check for prcl. restrict. / / / / 12/18/96 PASS JSD 12/18/96 PHN MSTA012 Plans routed to Plans Examiner / / / / 12/18/96 PASS JSD 12/18/96 PHN MSTA026 Plans approved by RPE / / / / 12/18/96 PASS RT 12/18/96 BT2 MSTA030 Reviewed plans routed to DSTS / / / / 12/18/96 PASS RT 12/18/96 BT2 MSTA032 DST Post - Review Completed / / / / 12/19/96 PASS B 12/19/96 BON MSTA065 Hold for Pre -Job Conf / / / / / / 12/18/96 PHN MSTA080 (F) Ready to issue / / / / 12/19/96 PASS B 12/19/96 BON MSTA092 (F) Issue combination permit / / / / 12/19/96 PASS B 12/19/96 DST MSTA700 Erosion Contol / / / / / / 12/18/96 PHN MSTA703 Grading Inspection / / / / / / 12/18/96 PHN MSTA705 Footing Insp / / / / 12/27/96 pending- access; low point drain; no usa PASS RB 12/27/96 RB req'd MSTA706 Foundation Insp / / / / 12/27/96 see footing PASS RB 12/27/96 RB MSTA710 Post /Beam Structural / / / / 01/13/97 # -1- need under fl' plumbing DIS KS 02/05/97 KBS # -2- under fl mechanical ( heat ducts not installed this time # -3- provide crawl access either through existing fdn wall or through addition # -4- cover entire crawl with vapor barrier MSTA710 Post /Beam Structural / / / / 01/14/97 APP KS 01/15/97 KBS MSTA711 Post /Beam Mechanical / / / / 01/14/96 A/N KS 02/05/97 KBS # -1- insulate heat ducts to R -8- value MSTA713 Crawl Drain / / / / / / 12/18/96 PHN MSTA717 PLM /Underfloor / / / / 01/13/97 PASS MS 01/14/97 MRS MSTA720 Mechanical Insp / / / / 02/05/96 APP KS 02/05/97 KBS MSTA722 Plumb Top Out / / / / 02/05/97 APP GS 02/05/97 GES MSTA723 Electrical Service / / / / 09/14/98 PASS CD 09/15/98 J *H MSTA724 Electrical Rough In / / / / 02/05/97 add smk det in hall, and 2 bedrms and DIS GS 02/05/97 GES interconnect; use motor rated breaker for tub pump; seperate 20a cir for bth plug; use listed speaker wire MSTA724 Electrical Rough In / / / / 02/10/97 corrections complete PASS MJR 02/11/97 MJR MSTA725 Framing Insp / / / / 02/05/97 # -l- staples at vertical joints need to A/N KS 02/05/97 KBS be driven parallel with framing memeber= studs Page No. 2 CASE HISTORY FOR CASE NO. MST96 -0550 • PAUL R JACKSON 10250 SW TIGARD ST 12/14/98 Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By MSTA740 Insulation Insp / / / / 02/12/97 pending- vapor barrier where missed; PASS RB 02/12/97 RB chink window unit not installed at time of inspection MSTA745 Gyp Board Insp / / / / 02/18/97 APP KS 02/18/97 KBS MSTA790 Electrical Final / / / / 09/14/98 PASS CD 09/14/98 CD MSTA795 Mechanical Final / / / / 09/14/98 PASS WDJ 09/15/98 J *H MSTA797 Plumb Final / / / / 09/14/98 PASS RB 09/14/98 J *H MSTA799 Building Final / / / / 09/14/98 PASS WDJ 09/15/98 J *H MSTA970 Case Finaled / / / / 12/03/98 12/03/98 JT Permit #: Mt S I c / a — 0 5 L am) OF O �y Address: /0 7 50 J , ;z 5'7 ,,:.,im : 7 • Issued by: •M Date: 1 Z Ii 5 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. I own, reside in, or will reside in the completed structure. l iCd, Fl- 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. r i 3A. My general contractor is (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 il • F 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 Propert Owners about Construction Responsibilities on the reverse side of this form. 01 i. /irk_ / / -//6 / c (Signature of ► - 't applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) lInfo mat on it ■lace to Property Owners About CorostrucUon Fiespons des Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction"Coitraclors 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 prevent many problems by being aware of the following responsibilities and areas of concern. EMPL•YER GI ESP•MSI lUTiI S: 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 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. Internal Revenue Service: 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. •THER RESPONS1=11�1T11ES AND AREAS OF CONCERN: Code compliance: 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 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 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 tines so they ban 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 • • CITY OF TIGARD BUILDING INSPECTION DIVISION MST ( 76 " e l5 50 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 10U BUP Date Requested 9-/9- 9g PM BLD Location /Q 5 <kV j44t/ 5'1 Suite MEC Contact Person ,4_0 , betWiwie Ph � p 09-6 y7;, PLM Contractor Ph SWR BUILDING Tenant/Owner • ELC Retaining Wall 111A ELR Footing �" - Foundation Access: 1 `j " am FPS Ftg Drain Crawl Drain Inspection Notes: Slab 00 ii ' A � SGN A ofd , SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PA'SS BART FAIL = Iam Under Slab Top Out Water Service Sanitary Sewer rains PART FAIL - ' ANICAL 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 ( �, �, f Other Date /// I Inspector mot, Ex Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • CITY OF TIGARD BUILDING INSPECTION DIVISION MST - O 550 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP q Date Requested (7 / y — / 4 AM PM BLD Location /O'55) S (A) / / 44t,fd s7z- Suite MEC Contact Person . • & ,I- , a 4 , % . . r h ( _ G / PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation // /`/ � FPS Ftg Drain ! / SGN Slab Crawl Drain Inspection Notes: 500 # SIT Q� / � / /�� Post & Beam J G Y T Ext Sheath /Shear • Int Sheath /Shear Framing Insulation Drywall Nailing / / — ✓1 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 PART FAIL ELECTRICAL 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 inspect - no access ADA Approach /Sidewalk Ins v Other Date Inspector Ext p Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 631 -4171 ii/(25.57_Date Requested g ice/ � ` 90 G AM 11;°()PM BUD BLD Location /Oa at) / AC Suite MEC Contact Person /, : �i/ • ' 4 ' LIJu`' i ! Ph WV PLM • Contractor / Ph Ti SWR �BUI Tenant/• ner .t: 4 •-/ -4 ELC . Retaining Wall ELR Footing Access Foundation �� FPS Ftg Drain 4 Id _�`rK/! ���. �. ,O � SGN Crawl Drain l� . Pctio N • es: 7/ 6 , Slab i !� C/J( L/ d y e SIT Post & Beam 1 ' Ext Sheath /Shear 5' ► e`' 1 i �L % ` �j r Int Sheath /Shear Framing , y C lS Insulation Drywall Nailing ej4,1,Y) p )) P1440 / d'1 Firewall Fire Sprinkler eSp r e Fire Alarm Susp'd Ceiling Roof M's • ,4 111;PIP PART FAIL PLUMBING Post & Beam f Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smo. - _Dampers AS 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 reins ection RE: [ ] Unable to inspect - no access ADA Otheoach/Sidewalk Date Inspector � / �v �--� Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .