9430 SW MCDONALD STREET-1 14 v e—
c
CT
r
j
O
� CL
s t 1
77 C
o
LL
vj
\ V) <S
ter,• Yj v 1 - . � � a ,
ta
NIZ
a
zV1x � ,Cl t�
Ora C)
(V)
tq) CL ..r
4--AAid, ---- a
�
fI i j,
,
ca
0
0
U
CO
O N
0
C
If this notice appears clearer than the
document, the dOct"nent iS of marginal q!!ality. MAY 1 91997
JjIIIII � I � I � f � l I � l ; lll � lllll 11111111 VIII I ' lllIIII 1111111 11111 i � l I ISI I C ! ` i ! I ! III ' + I I '
INCH I I I III i t I � , Mil I I � i 1 1 1 1 1 1 1 1 1 i I I I
MSE IN CHINA � ( � � � � � III l i 1 1 1 1 1 1 III I I I I i I l i l l l l l l l l I►
I II III III 1111
� i I<<i ��� iiiliiii.,fiilii��liii�liiiiliiiiliiii,:iiilli��liiii�ciiili�ii►�iiilii�i�iiiil��ii�ii�iliiiilii��liii��i f � If 107- ,
III III lo
I
i
9' rod v e
•
rl"
1
4
i
Q r
..,�, 0 p
w � z
Z
v �{
V)
.� N tc1
Y) o f /4:��` ' v l
til 1.J U ; 0 4-
40
O
75
9� f
,
t 3 �c a
c Q J i t a �: 3 '�� •_ �''
xV1
ro
v n 9
o + V v V)
v 1'
O
0
U
O CV
CY) 4-
V' O
O N
If this notice appears clearer than the
document, the document is of marginal quality. MAY 1 91997
(tip 11111, 111Jill Illl1111111Jill s ;
. . INCH M�� �N ,N� � II � III ► { � III � � � � t � llll � � �
,
I il � il III II IIII � � II ► I � � I � � I � � � � I � � �
I I I Iillll III I � i �
cm 2
I
I�IIIIIIIIIIIIIIIIIIIIIIillllll�lllIIIIIIIIIfilUllll'I I �! Ii t I t'� t t =
Ililllllll (1111 IIIIIIII.,fIIIIIIIIIIIIIfiIIIfIIIIIIiI,IIIiIIIIIIIIiIIIIIIIIiIllllllllillllllllllllllllilllllill�llllll�lllllllllti� II I � :�
.I Ilfl I Illllillllllli�llllllllllfllllll�lllllllilllllllllll�lilllllllllllllilllllillllllflillllillillilil
.�.q ,,,'- Jq ni.Pvg1^. .,,�.:. ;,; .._ .... . ... .. ,.. iri�;-�, �,� •:'�,g+ p.taa.,.„n b,„eti��,s �•...�,•. �n 4,e;,:, k�SR^'yy ;�,:
'� '�S'.e �' ! R��i"t1i t� 7 � .A �.� ,., � ,k� ' k:•k V�� � y�k s�af,� k�k e}j �� Vi.
��1t” ru 9 � ����� �-�w i - v a �,•. C� �A ,JJ��y-1 4 ry�A�'nd
ADDRESS:
rn C.",b ri d re-ct
s f':
Id:
t:
f
i,
f'
f
i%
f
i
t
S
iArecor•ds\microfIm\targets\b riIding.doc
r
,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639.4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service AL:
Foundation Water Line Calling Plumb.
Post/Beam Mach. Shear/Sheath 2su
!ion
-Mach.
Plbg.Und/Fir/Slab Plbg.Top Out -Ele
Post/Beam Struct. Mech. Rough-in Gyp. Bd. •Bldg.
San. Sewer Gas Line Appr/Sdwlk Bins.
Other: // — c� _
Date: _- —�'—/� _1jn_ A.M. ___A_P.M.�� Entry:
Address: �X e1 al-) Al C /✓r�'l �'�� --
Tenant: Ste: MST: /
Cori wn: ^- P flb MEC: —
PLM,
ELC: _._._...._._ ..r
THE FOLLOWING CORRECTIONS ARE R.:QUIRED: ELR: _
Inspector: v.. _ Date. f /m
UJ
_APP _._.DISAPPROVED/CALL FOR REINSP. CF CO '
4 '
.tr.
CITY,6F TIGARD BUILDING INSPECTION NOTICE
In action Line: 639-4175 Business Phone: 639-4171
oot' Rain Drain Cover/Service FINAL ,
s
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing Mach.
Plbg.Und/Fir/Slab Plb,Top Out Insulation -Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg. xY
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: .- -- --- --
Date: �e - A.M. �/P�.M. Entry
Address: _` L/- c�_— �� K1,UVL�.
C
Tenant: Ste: __ MST: _ ,t
— ya
BLIP:
Con/&:— _— MEC:
PLM:
ELC: _-_
T E FOLLOWING CORR CTIONS ARE REQUIRED: ELR: — I
1 - - _ _S-jS `I
rib L)
00
W & &cc
ri"��� Pyr,�,'d Ct t* j^r p ^ ✓\ � �. .._
—
pp
Inspector - - 1. Dat
' PROVED DISAPPROVED/CALL FOR REINSP. CF CO
AP
g
• , ^f �F
f �l
1
'�"iICPI�TM�%lr'mil`.i.Yn..✓�...p+.1�NWeW6rw�IfEt4.NN1'T'Vd!NuwRM+:n....... '4 rv..an.•....-.. w ..
BUILDING PERMIT
CITY OF TIGARD PERMIT #. . . . . . . : MST96-0a'59
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 09/10/96
13126'1W Hall Blvd.Tigard,Oregon 97223*8199 (603)830-4171
PARCEL: 2S111AB--03300
911"E ADDRE yS. :, . 09430 SW MC DONALD ST
SUBDIVISION. . . . : ZONING:R-4. 5
SLOCK. . « . . „ . „ . ,. LOT. . . . . . . . . . . . . :
---------------------
I REISSUE: F=LOOR AREAS_____... ___..__ EXTERIOR WAI_I_ CONSTRUCTIONY-
CLASS OF WORT',. ::ACS FIRST. . . . .. 0 s f N: a: E: W
_
TYPE (.]F USE. . . M«Sf” SECOND. . . 0 S PROTECT OPEN IN(3S?------._.___...__
FYPE Of= CONST. -5N . . . . 0 sf N: S: E: W:
OCC.:UP ANCY GRP. :M TOTAL--------: 0 s f ROOF CONST: FIRE RET?:
OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEF'. RATED:
:: TOR. : 1 HT: 10 ft CARA(5E. . . : 5;20 s f OCCU SEP. RATED:
115MT?: MEZZ?: REND SETBACKS----•--•---•---- REQUIRED-----------------..
FLOOR LOAD. . . . : 0 psf LEFT:42 ft RGHT: 0 ft FIR SPKL: SMOK DET. . :
DWELLING UNITS: 0 F'RNT : 0 ft REAR: 0 ft FIR ALRM: HNDICP ACC:
BEDRh15: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 1)
VALUE. $ : 6214
Rpmarks> : Erect new pnle stri_icti..lr,e
-..
: --..--_--.___------_____-.---__._.-.._-..-__--_._.--_._._.-.-.-_..-.._.._.--_---- FEES
Owner
FRENI 'THOMAS type amol_int by date recpt
9430 SW MC; DONALD STFEET CDC $ 40. 00 JMH 09/10/96 96-2:83771
PLCK $ 4.0. 63 JMH 09/10/96 96--x:83771.
( l'GF1R1:) OR PRMT $ 62. 50 JMH 09/ 10/96 96-2:83771
F hone #: 503--664-11136 5PCT $ 3. 13 JMH 09/ 10/96 96-283771
OWNER
I
i
F�,hone #: _._.._..__.$ 146. 26 TOTAL
Reg
Reg #. . : OWNER
_ -- -- - REQUIRED INSPECTIONS -_ - ----
This pereit is issued subject to the regulations contained in the F o e t i n g I n s p
Tigard Municipal Code, State of Ore, Specialty Codes and all other Fr^am i n g I n s p
applicable laws. All work will be done in accordance with Rain dr-a i n I n q p
approved plans. This pereit will expire if work is not started Final Inspection
within 188 days of issuance, or if work is suspended for tore
than 188 days.
Ir•.rm:iJ;tee Signat�.lre : _ _ _ __ __
Call For inspection 639--4175
f
e.
Plan Check# O l/c
,ITY OF TIGARD Residential Building Permit Application Rec'dBy
3125 SW HALL BLVD. New Construction Additions or Alterations Date Recd
TIGARD, OR 97223 Single Family Detached or Attached Date to P E k'
Date to DST
(6:3) 639-4171
Print or Type Perm,t# Mst 6�• o ZS
Incomplete or illegible applications will not be accepted ` alter,
Name of Subdivision Lot# Name
iJob ,5300
Address Site Address Architect Marling Address — —
``
0 S,�. �yIL.L- nG1I(� ��. City/State v Zip Phone
Nam
iTh-o a S I-_��'►'� r _— _
Owner Marlin Address Name
S.w. --
City/State ,I Zip Picone ) Engineer Marling Address
T1 0�( �� 7 '=1— �y-'I � City/State Zip I Phone --
Name�J I
General Y{A n(,Aj Ne�:R-- Describe work newj addition O alteration 0 r--epair O
Contractor Mailing Address to be done:
Additional Description of Work:D ),y
City/State Zip — Phone 0 a;}(-"-n k r } �7/P a t if I
Oregon Const.Cont. Board Lic.# Exp. Date (r-'i r f( �Do A kvic; t�)1-3VX1 V- a�Z
I Attach Copy of Project —tom–
Current COT Business Tax or Metro# Exp. Date Valuation Is
Qo_ `j
Licenses
Name _—" NEW CONSTRUCTION ONLY:__
Mechanical IL11A Sq.Ft. H,_ise: Sq.Ft.Garage: ---,,, �• . .•
Sub- Mailing Address _ 15"W.0
Contractor Corner Lot Yes No Flag Lot Yes No
City/State Zip Phone (check one) (check one) _
Restricted Audio/Stereo Burglar
)regon Const Cont. Board Lic# Exp Date Energy System Alarm
4ttach Copy of I
Current oT Business Tax or Metro# Exp. Date Installation Garage Door HVAC
Licenses Opener I Systems
Name — _ (check all that Other:
Plumbing A/� apuiy)
Sub- Ma rng Address Will the electrical subcontractor wire for all Yes No
restricted energy installations? _
Contractor Has the Subdivision Plat recorded? N/A Yes No
City/State! _ Zip Phone
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:hat I have re2,l this application, that the
Licenises _ information given is correct. that I am the owner or authorized agent et
COT Business Ta,:or Metro# Exp.Date the owner. and that plans submitted are in compliance with Oregon
State laws_ _ __
Narne __. -Si pre of.Own�4swfirl— Date
6,P J,
Electrical /V' /'1 -- --- ---- -rryZ' �.�_ /2-4 Cl
Contact Person Name Phone
Sub- Mailing Address
Contractor FOR OFFICE USE ONLY _
City/State 71p Phone Plat# Map/TL# _
Oregon Const Cont Board Lic# Exp Date
Attach copy of Setbacks Zone Solar:
Current Electrical Lic # Exp Date v
Licenses U
COT Business Tax or Metro# Exp. Date Engineennq Approval: Planning approval TIF T
4 r
Permit# Account Description Amount Amt• Pd. . Due
mjLk, MST. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT) —:�2
State Tax (TAX) _ _ -
Bldg: _�- 3
Plumb:
Mech:
ELC/ELR:
Plan Check 3
MST: (BUPPLN) `�
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review / ' - '�G'0,v ) / (I.ANDUS)
Sewer Connectiont'r x�, (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (F'KSDC)
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,100T (EROSN)
Fire Life Safety (FL S)
TOTALS:
i'dsts\mstapp doc
Rtv 7/96
I
, ri
,Y
1
f'
f
Permit#:
r Address: 3 `+ 30
ISSUM by
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 app tcan s exempt rom registration under ORS 701.010(7),
need not submit.his statement. This statement will be filed with the permit.
Fill in the appropriate blanks ano initial boxean 2 and either box 3A or 3E:
F1I. �o n reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
D3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must he
registered with the Construction Contractors Board.
OR
\� F� 313. I will be my own general contractor.
If 1 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 pro ,rty Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Nnte: Viis 10I i'i?Ui/ioii,ld:l ,,,11111 j'I(jt)t'Pli' oit,ci-N Nh(,,0 t_%ev.S'll((,,tir)n >Crspons'ibilities
will del'1'i'opeel 1,1'thi, C'111,Y11,1lt'lion Cootrm hu.V .Ilwlt/in .1 ,'eikmre vvirh (.!f(_rf
{
If you are acting as your own k'ontrilicl(lr 10 ct)lt,lill; i :. IltW honit: ni,mak.,,l $111)"l lnl.lal i mplo'l omielit ill fill existily. "In' 11.1w '
you can prevent marry prol'.lc ivis by beil't_f;aw;llt,c+I I tr 111Ho',vin" rcp+insll:IilItir�,Intl"Iraew,,,f t;(,;I--L'I II
EMPi_OYER RESPONSIBILITIES':
_ s
11 you hire per'SMIS 111111 1,Cgi`tciv(I t1 i,111 t )t' ul.11-11 Ctill( ;1:11`t kkoid to d ? Likoi ill t:onsirilclino Or ass ill tho
constniclion or irtiprtivt"niviit o', re,,Kt-imal ;,Irl_I(lull, },Ulf trill, it) til,).( M"t;W,"i, hl' rult�d tO!ll^ all c(llplowl and the,f.Ieoid:
You hire 1>,�ill hr'rrnpilycv:, As th1't:(niIlu�cr, You Inu.�l col-111+ .x'illi 1111 frtllraviri
Orelymi's withholding tax law: Av an omlilmv-,yoll 1111INt withhold ft-,m ompl') -,r, lvtt„tl�,at 1111:'rim("c(rlph mater �
l'li!111, YMI 1,011 IV liable flit tilt,• IAA pavilltnIs ov-1 Wyou Jon't 'v llttlllt' 1,':(I'll)( 111 illi•til`: troill V 1r1 r olliplt)"cos, Fol'loorc
inforination, call the Oti'pon Dept. of Roventio at 94'18091 ,
:y.
Uitem pillymeot in url vice tax. AS ar! t"Illpluyer, }'Oil lilt' Il'U11)lvd ill J',I` ;t 1,1K I1,1 Iit-le nliln)'1"flow (n,Stiralice l)Llr'pl"'es till illi' T
ixgtis of all employe(?s. I•t;r Inure lrlf'(rrnlatlon.call ihG Orct;un 1,it i ion at the 1)glartmerit of Human Reswirces
at 378-3524
'I orkvrs"Cunt lensation insilrr�nc e: A lilt ,`iI1 141 1'I, .1111' ;Ir, ,Illi t_ +,:
I � 1 tC ( t�l,' 1 rp� itll 1��i,rG.,� t,�.flniflt'nit<?fl I i1W:,J1I(l iIll JSi
1� obtain 1 olk-ers,comp i-i"a ,mi iw' drill(, till vt,91r Ciril)lt+Ll't'°, II '1++1! 11.1111 I�'+1111 )ii' +.Fr,11., 1': 011111"+Cti'r<ttl(111 1111 U1'fi(lCf'.�`,1111 1161)' t..
suh:jccl to Penalties alld H ilt he i443h,fol ;ill c'l,.titll l:rif rml' f',,i,lu 1 1,;1,1;, " . k iniuted l,n ill.' jt)h. For marl'illl'urrlilt It it l:
call the Workt_"rs'G) mpew,;itlon I)Ivtsi(ni ai tilt' I)+'lvli(tllrrll f C' )il�,tl,:,t1 ;.:0 ki-,im Sc"ivicrs'rt 945.78M
4-
' Ll. .luter"ailleveIItlt.sc1,iiit'v: "iall sal'III]o yet,'r't)uIIIIIstit'lilIfit)ICll :ilii)lilt,I:1dfro 111t'1'1II)Joyees,lNart )c
F' liable for the tax pat'tilcxii c,., 'n if 'm ill,110 lctllall; taithhold the tit X, i I r twl ;. it Ili ifin'ltiIn.""ill tl''o I1w!rllal krrIli1 '';c1'vict•
fit 1.8004929-10411.
CITHER RESPONSIBILITIES AND AREAS OF CONCERN:
J (.,OdeClimplilince.: A"th1'perillif.holder IorIllk11tlIrl,.1, ',1it1;.11-t`It"�poll',1111l,fol ;l."10%hill;.m 1.11 Itit-It)tilt"d'1.i'odorr'llilirt'1"11rill�
that may be brought to your allentiun through inspochow"
l.lahiili:; ;11111 property damage i11S111r1nAX: (7011tat:t y'Uut'InSur':ItK 'iti ','li its t;t` If VYolj 11I11'q;:Odequatc ill;11r%u1cC Ct+' 6�r
,i tAdci&, itltI onlis�.ilms such as fnilir,g itl,,Ie, painI orel;sprity, welter lf;Inlilpi (rolll pipe pruirUire s, fire, of xtirl, iiini IMI'1 ht
�. rclit�nc:.
i
Time la supervise employees: Make sure),oil have" saff icie.nt h+lit to ,til)r►N ise ytlur rinplo}l t s
i hxpertise: Maks:surto yon havt the I�xperiisa�to act a',l nurown srcncr;i)r�rnir;lc'tt,r to t:nrlydituilo the work of ronfih-in'Ind finivh
tn(lles. and to notify huilding officials 3)I the aplrropli;lt("titywi; See they cern pt'rf'Orm the required inspecti'lnw.
if you 11,1W Additional yucrtit,nr, tint('of call the Construction ( e vt mt,tor,, llwm,l (11) Box 1414111,Salem,OR 47309-51)5'.
503/378•-4621 1. The 13oard is lot.;i1vo at 700 Slimmer tit Ni: Shite 3INl, in Salem.
prt)p-n%%wptiA
I rl4
r.
i
7
i$
I�]
.Ir
A
[h
I ••
4.
5 i
(. I I 'V ISI I .I r'il�:f{I� - ��.% I ! I • ' 1 „1 f 1;, I ,I I.�I F;i..( f,. II ''I Nla. »"4:��,• it'.5,�..'1! hl ''
INIAMKs F`RM.W I fl ICIh1119i f i Ik (.! I1t4lJL1P4 I
ADURF, 3.3 o L.YNNF'.-P'NV'N.1 ! F`r1I i - i rI'rl+ All 0il',I1 � Iiht%
-•t.l' t'1I rlt I)iII�, UI`f:` 11t1r`fP;,
qd1 3@ SW I�IC':C1111V�11 1 rt iirn I 1 `Y 11Ihi
t'11�{E:�fir Fi. up. t'64YtyIF.I'J't
f'{Mt.1i IN I I" 41 h 14 It I IF
Iat.I I i
{
t
a
i
Mb 1
om a IN r
07
r
3
e
4� n
11 •T{
+'P
M`.
-„.}q... ,,. �$ i.y.:,: ] .,., .x.,.:11. ..;.,. ..•..... .. ,• .. dry”' <. 'caK f ,.rv,r ,,, rt.. ,..{�yr yq•�,q'a�(Ij
1 4 yy''11s t Yry: �,', v71'c•1t!{{(Y# 4V a n 1a1"' r r '�
f P�YtIY•�A. � ���-
�Jf
Ar (tr
4i"'"'
�ys' ' r Y, Y•
P,E
i`
1 ,
CITY OF TIGARD F,ERMIRUI#. . . . .. . .. SUP196--0475
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSJED: 08,116/96
I 13125 SW Hall Blvd.Tigard,Oregon 97223.9199 (503)039.4171
} PIARCEL: :-:'S I 1 1 AS-'03300
SITE ADDRESS. . . : 0'"j4"10 SW MC DONALD ST
SUBDIVISION. , . . : ZONING: R-4. 5
BLOCK. . . . . . . . . . : L.O1.. . . . . . . . . . . . .
: N �
REISSUE: F=LOOR AREA.___.._-___._— EXTE:RIOR WALL CONSTRUCTION ' �
CLASS OF WORK. :DEM FIRST. . . . : 0 sf N: S: E: W:
TYPE OF USE. . . :SF SECOND. . . : 'a sf FIROI`ECT -
FYP'E OF CONST. :5N . . . : 0 s f N: 5: E:: W-.
OCCUPANCY CARP. :R3 TOTAL - - - -_: 0 s f ROOF CONST: FIRE. RET"' :
j OCCUPANCY LOAD: 0 VASEh1E:NT. : 0 S AREA SEF'. RATED:
STOR. : 0 HT: 0 Ft GARAGE. . . : 0 sf C)(.-,CU SEP,. RATED: I
81-;MT?: ME:ZZ?: REInD SETBACKS------'---
FLOOR LOAD. . . . : 0 ps f LEFT: 0 ft RGH I`: 0 Ft F I R Spl-"L: `3MUK DET. . :
DWELLING UNITS: 0 F•RNT: 0 ft REAR: 0 ft FIR AL.RM: HNDICP' ACC:
BEDRIvIS: 0 BATHS: 0 IMP SURF=faCE: 0 PIRO CORR: PARK I NG: 0
VALUE. $ : 0
Remar-ks : Demolish pale str,_rc:tt_rr^e -- This was or^iginally created ,As. MST96-0401 but
changed to a BUP' as it is the appr,opr,iate tvpe.
Owner: ___.___.__.__________----___._.____.__________ FEES
FRENI THOMAS type amol.rnt by date recpt
9430 SW MC DONALD STREF_T P'RMT A 25. 00 JSD 08/15/96 96--282914
;ol-'C,T $ 1. c:a JSD 08/1U/96 96-282914
T'IGARD OIT
Phone #: 503-664-1106
Canty^actor: ----____._--____ ._.___..___....___ ._._._....._
OWNLR
Phone #: 26. 25 TOTAL
Reg
REQUIRED INSP'EC'TIONS
This pertit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. This pereit will expire if work is not started ____�„ .____•_�_ ___ —Y� i.
within 180 days of issuance, or if work is suspended for tore
than 188 days.
A-5
P a r•'m i t t e e S i g n a t u r e s
r
ii Call for- insper..ti.on '- 639--4175
I '
a
1
r
4
Plan Check#
ITY OF TIGARD Residential Building Permit Application Recd By
13125 SW HALL BLVD. New Construction Additions or Alterations Date Rec'a�
-1GARD, OR 97223 Single Family Detached or Attached Date to P E.
.03 639-4171 Date to DST
Print or Type Permit# l
Incomplete or illegible applications will not be accepted called_—� �F'�'�Q J
Name of Subdivision Lot# Name
Job . �00 Architect Mailing Address
Address S�ljeAd22dress .�M I
L/=70 5 01 ) `"r' City/State Zip Phone
Name
I hOrYl C, p Name
Owner Mailing Address r —
'IY30 S.W. Shna I L_ Engineer Mailing Address
City/State Zip Phone t g
—r C 'r'k ri 7 1, �y (' City/State Zip Phone
Name
General v 8JAI iF/f- Describe work new O addition O alteratior O repair O
Contractor Mailing Address to be done
Additional Description of Work'
City/State Zip Phone r U LT
514 ped L C 9-9, LAC rI JLC
Ore'-m Const. Cont. Board Lic# Exp Date �( !�10�
Attach Copy of — Protect I�
Currtnt COT Business Tax or Metro# Exp. Date Valuation ���� _
LicensesName --- NEW CONSTRUCTION ONLY:
Mechanical /V,;4 Sq.Ft. House: Sq.Ft.Grarage:
1-2
Sub_ Mailing Address -- — T J
Contractor Corner Lot Yes No Flag Lot YeSIN_0
City/State Zip Phone (check one) _ (check one)_ —
_ Restricted AUCio/Stereo Burglar
Oregon Const. Cont. Board Lic.# Exp Date Energy System Alarm
Attach Copy or Garage Door HVAC
Current COT Business Tax or Metro# Exp Date installation9 --
Licenses Opener Systems
Name (check all that Other
Plumbing ���',I apply)_ —
Sub- Marling Address Will the electrical subcontractor wire for all Yes No
restricted energy installations? _
Contractor Has the Subdivision Plat recorded? N/A Yes No
C ty/StateZip Phone
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 — Sig f ownerfA Date
Electricali�<''`
Cont. erson Name Phone
Sub_ Mailing Address
Contractor FOR OFFICE USE_O_NLY:
CityrState Zip Phone Plat# MaplTL#:
Orecon Const r,ont.Board Lic# Exp Date
Attach Copy of Setbacks Zone. Solar:
Cur,-ent Electrical Lic p Exp Date
Licenses _ __
COT Business Tax or Metro# Exp. Date Engineering Approval Planning Approval TIF:
i:Wsts\mstapp doc
NSVSIPYYA04'n1'%fNwflx-.apNW4WINM?'..YM1:RYf.•'::••r..• .'., ..•
1 •'e
T p
I kN
Pelt # Account Descri tR ion Amount
A�.LP_�L Bal. Due
MST. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH) _
ELC/ELR Permit (ELPRMT)
State Tax (TAX) ,.
Bldg:
Plumb:
Mech:
ELC;ELR:
Plan Check
MST: (BUPPLN)
Plumb: (PLMPLN) _
Mech: (MECPLN)
CDC Review (LANDUS)
_ 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)
Erasion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
f Fire life Safety (FLS)
TOTALS:
i ldstslmstapp doc
Rev 7/96
d
if
I(i14 NI I,F i t' +1'f It4 4�t+til'�tE frtl i'1 t t aI I t�ftS,. a )i.
idl '..It F'itr(rli 1 !! i.itil' kit.,
i 0 1 1i I If 1,1,If
1 1 r I , CJ r
t'r n vtt'i`t0-N r
i
II 11' ! ;0_ !�", � u4tl7v 1 t' t'I I I I t t.f+ !''� t ;t i t rid +
.t i I!i '! S�f�l ' y;�t4't .! ttl" ! I a• i !, i `'v �,
':3 4:34! !iini M(.;I�1:lhd4'►L.0 1h�.! ''.�(^+ 4'►tJl,�'1.
PLAN C;HIA:K #00-4414 fJIN D 1.11-NO
tt.)Tdal t1MCAINU 1-4411
Y
R.
,F
y ',J
1
y
it
i
M')
INSPEMn'Ojl NOTICE n
city or Tigard Building Depactmetnt
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection
/Line (Rec-O.-Phone): 639-4175 Business Phone: 4
Inspection:��-��f - �li� ��i ` t` —--- — �►
Footing Ptbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL
w
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. Ejt
i
Date Requested(:: �� Time: _ X_AM L/
--_PM
Addreea: � Permit f: 6�c (i�J
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i�sr���.•� i o_ ins c%�- ��,,�,,cL Tia/c�`
Inspector
lJ/1 - ---- Date:_[/�f�t-l� /
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call Por Reinap.
li
f - CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT MECHANICAL
13126 9W Hall Blvd.Tigard,OregonFERMI Tpon 97223•E199 (503)639-4171 PERM I T #. . . . . . . . MEC94-0.=50 a+
C,:?;' 41 '7 i DATE ISSUED: 09/13/94
PORCE:L: 2S I 1 1 AB--03300
SITE ADDRESS— : 09430 SW MC: DONALD ST
SUBDIVISION. . . . : ZONING: R--4. 5
BLOf_;K. . . . . . . . . . 1-01.. . . . . . . . . . . . . .
-----------
CLASS OF WORK. . :ALT FLOOR TURN. . . . a EVAP CO01__E:REi:
TYPE= OF' USE. . . . :SF UN 1 T HNA-f ERS. . : VENT FANS. . . :
OCCUPANCY GRP. . :R3 VENTS W/O APDL: VENT SYs-rEMS:
STORIES. . . . . . . . : 1 BOILERS/COMPRESSORS HOODS. . . . . . . :
FUE=L 0.-3 Her. . . . : DOMES. I NC T N.
: /OIL/ / / 3-15 HP. . . . : COMML. INCIN:
MAX INPUT: BTU 15•--30 Hf'. . . . : REPAIR UNIT"S:
FIRE llAM�'ERS?. . 30- 0 HF'. . . . : WOODSTOVES. . :
IFAS PRESSURE. . . : 50+ HP. , , , CLO DRYERS. . : P
NO. OF UNI"I"B--___..-_-_._.__.__ A1R HANDLING UNITS OTHER UNITS. :
TURN ( 1001; BTU. 1 ( = 10000 cfill : CTAS OUT'[-l---'TS. :
FURN ) =100K BTU: > 10000 c f m :
t
yrc`ly' Remar-los : OIL.. FURNACE-
Oo)ner: FEES
F RENI THOMAS type amol_int by date recpt
9430 SW MC; DONALD SIRE_ET' PRMT $ 25. 00 JF 09/13/94 -
5PC;T $ 1. 25 JF 09/13/94 -
I TIGARD OR
Phone #:
Contractor-.
N--ACCURATE OII_ CO
6732 NE; 47'TH
PORTLAND OR 97218
Phone #: 281 -6212 t 26. 5 TOTAL
Rey #. . . 53391 �
--- _-- - REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Mechanical Insp
Tigard Municipal Code, State cf Ure. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with �—
approved plans. This permit will expire if work is not started —~�-
Nithin 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee
(-'all for i nf,Pect ion - 639-•4175
r
f
i
CHAMCAL PERM ' '
City of Tigard _-.--_-
13125 SW Hall f_'.i' APPLICATION I
PO Rox 2.3397
1 igard, OR 97"LL,
(503) 639-3171
Table 3A Mechanical Code _ QTY PRICE AMT
Job « '3 (/ j 1�J ^ C-: 1) Permit Fee -0- -0- 10.00
Address
1 "n q l'-,41 2) Supplemental Permit 3.00
umace toCY0 BTU A)
- orj �p(yy AR 1) incl.duds a vents 6A0
«. Furnace 100,000 BTU +
Owner c '{ 2) incl.duds 8 vents 7.50
bFloor Fumanco
3) incl.vent 6.00
.-. — Suspended heater wall eater
4) or floor mounted heater 6.00
mam A4.* Vent not incl.in
Occupant 5) appliance permit 3.00
NVAM LP Repair of heating,re r7 ig.
6) cooling,absorption unit 6.00
.m. Boiler or comp to 3 HP
�- F T rN cbr (��� 7) absorp.unit to 100,000 13TU 6.00
.q ,tYw P� I of Of COrTIp l0 3 15HP
8) absorp.unit to 500,000 BTU 11.00
Contractor Boiler or corip to 15 oTM—
O r.a 2 a { ; 9) absorp.unit.5- 1 million BTU 15.00 ti
w .n•ai h •,N� I er or tbmp to 36- 50
33i
�- 6 10) absorp.unit 1 - 1.75 million BTU 22.50
50 HP
7Fe`reFy—a—cWowI9dg9 that I have read is apprcauon that die Boiler or comp to
Information given is correct,that I am the owner or authorized agent 11) absorp.unit 1,750.000 BTU 31.50
of the owner,that plans submitted are in compliance with State Air iann ing unit to
laws,that I am registered with the State Builders' Board,that the 12) 10,000 CFM 4.50 _
number given is correct (If exempt from State registration, please Air handing unit r.
give reason below.) 13) 10,000 CTM+ 7.50
Non portable
14) evaporate cooler 4.50
Vent fan connected
15.1 to a single dud 3.00
Ventilation system not
c c 16) included in appliance permit 4.50
sw�- Hood served
17) mechanical exhaust 4.50
i
Describe work new Q a ikon a terabrin C-) Domesfic type
to be done residential non-residenthaY() 18) incinerator 7.50
xisting use o ommeraa or m stns
building or property �r?_.J (d'(' ,:ti f r, 19) type incinerator 30.00 _
Other i.e.,woodstove,water
Proposed use of 20) heater,solar,clothes dryers,etc._ 4.50
building or pmparty
21) Gas piping one to four outlets _ 2.00
Type of fuel-oilnatural q'as O LPG O electric O
22) More than 4-per outlet
_ r 5 I
_ Minimum Fee ik'!fV0 d SUBTOTAL
PERMITS BECOME NULL AND VOID IF WORK OR
CONSTRUCTION AUTHORIZED IS NOT COMMENCED 5%SURCHARGE —
WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 126AWREVVIE+N e5%OF 91:118TOM
DAYS AT ANY TIME AFTER WORK IS COMMENCED.
TOTAL
Special Conditions _
Date iswed _ by
t.�cceprr
I
i
I
i'
1
M
i L l 1 Y if 1 I l:3wVl?t) 1t► I.. .l 1'r I IV I•'(IYvil I I ! 4+i t. I r w'1 IV1'1, tf i c.'. i64
x,111 a w! AC."A'I..11�w1T1- Mil, C;I) I ilrr'INIW1 11w11t: 1 0y
�r
t� l'I ', e 67 ' N 44114 II 1)1)lVL!'i11..N d.
,I FaIJN C l..wllVn, fJF? �
}
l;. l . 1:11' PHYMEN] wltnl.uirar 14110 NI' t 11rII'fit 1j +
IYII 1.11w1tU t 1 .wtl r'I Mt I'.94-•illi.NA
Wit
MAU) VA
I l'' I(11 w11,11 11.1rd I t-'wl l t►
t
AIL
F
.g