Permit CITY OF TIGARD MASTER PERMIT
, A PERMIT #: MST1999 -00411
.��� DEVELOPMENT SERVICES 4 3' DATE ISSUED: 12/30/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15030 SW 96TH AVE // // PARCEL: 2S111 BD -00800
SUBDIVISION: DARMEL NO. 2 ZONING: R -3.5
BLOCK: LOT: 015 iRISDICTION: TIG
REMARKS: Add patio covering. Work has been completed prior to the issuan a of this permit.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT:
VALUE: $ 2,500.00
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 FDR: 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: SIGNAUPANEL: 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: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 142.50
This permit is subject to the regulations contained in the
JOSE VERGARA OWNER
all other Municipal Code, . All work k will Specialty Codes and
15030 SW 96TH AVE OWNER RES PONS FORM SIGNED all other applicable laws. All work will be done in
TIGARD, OR 97224
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: 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
Footing Insp
Slab Insp
Framing Insp
Final inspe ' n
Permittee Signature : Yf
Is uedBy: te r ; r1 itik / /// !, g
Call (503) ... -4175 by 7:00 p.m. for an inspection needed the next busines
I
Plan Check ( -�
:-
CITY u TIGARD Residential Building Permit Application ,
13125 SW HALL BLVD. Additions or Alterations Reca By 0
Date Rec'd ) / -
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. ii- - 7 G
V 5d3- 639 -4171 Date to DST 12 (aaAP
F 503 - 684 -7297 L i Permit #A4 5 if cC9'- CON Print or Type 1 ' Called /211..9/9 9 - 3, ti v1
Incomplete or illegible applications will not be accepted
Name of Project Name
Job Architect Mailing Address
Address Site Address Set b.e1e,.„
Name, i / City /State Zip Phone
r s e V e7 ��� Name
Owner Mailing Address ' ,411
f ��jjl 0 tiC) ..3tAg / /// iiii7777 Engineer Mailing Address
ity/State Zi p l Phone
T/ �Y�' y /a.il 6W/2-CI-• City /State Zip Phone
General Name
Contractor . r Describe work New 0 Addition Alteration 0 Repair 0
Mailing Address to be done:
Prior to permit Additional Description of Work:
issuance, a copy City /State Zip Phone I 1' , --h i - •1 'L v + , .,
of all licenses
are required if Oregon Const. Cont. Board Exp. Date PROJECT
expired in COT Lic.# VALUATION
database
Mechanical Name NEW CONSTRUCTION ONLY:
Sub- Sq. Ft. House: // /) ,�11 Sq. Ft. Garage
Contractor Mailing Address - � l I
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- I " apply)
Contractor Mailing Address Corner 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
of all licenses are Oregon Const. Cont. Board Exp. Date
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 submitted are in compliance with
Oregon State laws.
Name Signature of Owner/Art Dat
Electrical 0 ' Of I Z fi r
Sub- Mailing Address Contact Person Name — ? 7
Contractor - (� L � C
City /State Zip Phone
Prior to permit
issuance, a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const. Cont. Board Exp. Date Plat #: Map/TL #:
required if Lic.# 7 ? i1
expired in COT 1'7-01 I ,> _ V
) U Q Qb
database Electrical Lic. # Exp. Date Setbacks: . Zone: Solar ^ /
IV Electrical Supervisor Lic. # Exp. Date Engineering Approval: Planning Approval: TIF:
i:\dsts\forms\sfaddalt.doc 11/20/98
Permit #: X1115 7 1 9'79 - OO / /
.F
Q � ,
Address C7 3 O So 9 (a' 4v �_
). =
Iss ed by: - D ate: ' - 9?
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.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
�1J before or upon completion.
n 3A. My general contractor is
I (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
3B. I will be my own general contractor.
, E .
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 Property Owners abou C nstruction Responsibilities on the reverse side of this form.
/ --1
/ 2// a /if
(Signature of pe _ applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
11/19/99 Parcel Summary Report For Parcel #: 2S111 BD -00800 ( �
11 :29:35 AM
Size: 0.00 Acres Notes:
Zoning: R -3.5 Status: Active
Complan: L Creation Date:
Legal Lot ?? Updated: 01 /14/1999
Parcel Use: Single Family Updated By: LOAD
TOPO Map: 4519
COMM PNL #: Water Service TIG Jurisdiction TIG
Flood Zone: NON Sewer Service? CIT: S
Plat Name
Subdivision: DARMEL NO. 2
Div: Block: Lot: 015
Valuations
Land Value: $64,930
Building Value: $62,180
Total Value: $127,110
Site Address
Status Address
15030 SW 96TH AVE
People
Role
Type Last Name M.I. First Name Address 1 Address 2 City State Zip Phone 1 Ext. 1 Phone 2 Ext. 2
OWN .31tt5E*7 - I4 VS C' P 0 j0,57 BY BEACON HOMES 7125 SW HAMPTON PORTLAND OR 97008
Notes:
CITY OF TIGARD BUILDING INSPECTION DIVISION MST Ng 0
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested , ' I /� / AM PM BLD
Location / in 0_ '' L `/ . (� Suite MEC
Contact Person Ph 6 : 7,D-07 PLM
Contractor Ph SWR
UIL Tenant/Owner ELC
Retaining Wall /4" Footing Access: A `1�� Foundation , FPS
Ftg Drain — GN
Crawl Drain Inspection Notes: + o I'" ,-
Slab / SIT
Post & Beam r IV 1 4 ( d ' /
Ext Sheath /Shear f
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
�� PART FAIL
" : ING
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
Other oach /Sidewalk Date 2/ 5/6 Inspector 1 VV\ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
05/30/2000 Activities for Case #: MST1999 -00411
10:19:16 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA005 Application received 12/10/1999 KJP RECD No Hold KJP 12/21/1999
MSTA008 Permit Created 12/21/1999 KJP DONE No Hold KJP 12/21/1999
MSTA012 Plans routed to Plans Examiner 12/21/1999 KJP DONE No Hold KJP 12/21/1999
MSTA026 Plans approved by Pln Examiner 12/28/1999 RDP DONE No Hold RDP 12/28/1999
MSTA030 Reviewed plans routed to DSTS 12/28/1999 RDP DONE No Hold RDP 12/28/1999
MSTA705 Footing Insp 12/28/1999 12/28/1999 No Hold RDP 12/28/1999
MSTA707 Slab lnsp No Hold RDP 12/28/1999
MSTA725 Framing lnsp 12/28/1999 12/28/1999 No Hold RDP 12/28/1999
MSTA798 Final inspection 12/28/1999 12/28/1999 04/10/2000 TLP PART No Hold AKJ 04/10/2000 extend rain drain away from
patio towards street area
all other work OK
MSTA032 DST Post - Review Completed 12/29/1999 KJP DONE No Hold KJP 12/29/1999
MSTA080 (F) Ready to issue 12/29/1999 KJP DONE No Hold KJP 12/29/1999
MSTA092 (F) Issue combination permit 12/30/1999 DEB , DONE No Hold DEB 12/30/1999
MSTA093 (F) Reprint Permit 04/05/2000 BON DONE No Hold BON 04/05/2000
MSTA093 (F) Reprint Permit 04/05/2000 BON DONE No Hold BON 04/05/2000
MSTA799 Building Final 05/15/2000 TLP PASS No Hold AKJ 05/15/2000
MSTA970 Case Finaled 05/15/2000 AKJ DONE No Hold AKJ 05/15/2000
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