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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST1999 -00218 DEVELOPMENT SERVICES DATE ISSUED: 6/23/99 �'�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11185 SW 109TH AVE PARCEL: 1 S134DB -03900 SUBDIVISION: CARNAHANS ADDITION ZONING: R - 4.5 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: Interior remodel only of an existing dwelling.adding two fire places BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT 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: $ 3,000.00 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: BOILICMP < 3HP: VENT FANS: CLOTHES DRYER: GAS 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 FOR: 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: 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: $ 148.60 This permit is subject to the regulations contained in the KEITH JERGESEN CE BRUNK, Ill PROPERTY MAINT Tigard Municipal Code, State of OR. Specialty Codes and 11185 SW 109TH 14314 SW ALLAN BLVD all other applicable laws. All work will be done in TIGARD, OR 97224 SUITE 601 accordance with approved plans. This permit will expire if BEAVERTON, OR 97005 work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: 620 -8111 Phone: 641 -0451 Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: LIC 83557 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 Gas Line Insp Building Final Gas Fireplace Insulation Insp Meehan" Issu d By :. _ ∎ .l .:1 I l . o_iL... _ Permittee Signature : ~ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne usiness day . .CITY OF TIGARD Residential Building erms 'cation Plan Che 0 , • 6-/(0g, 11125 SW HALL BLVD. Alteration - Interior Remodel Onl Recd By !NA, Date Recd _ TIGARD, OR 97223 Singl Family Detached or Attached (Duplex) Date to P.E. /I' - V 503 - 639 -4171 Date to DST &-/4 F 503 - 684 -7297 (;)04.-- - 1 i ' 4 . - - Permit #P r Ob 2 4 Print or Type Called l0 -18 9:14 Incomplete or illegible applications will not be accepted `" r 7J Y VrY10 f - . Name of Project Name ,E5 • Job ,}Vt7(% Jt K , °'d . ' . Address Site Address Architect ailing Address I l l ' .%N lO1 r1 - tC1_1 - 'Q - City/State Zip Phone Name _ KiZ.1 i l 4 , Kr ... ` T eri.. �IJ r- . Name Owner Mailing Address tkk -= f Ocl T City/State Zip Phone Engineer Mailing Address �, r,�l . b — 4 I 12,4' GZ© f I _ City/State Zip Phone General Na ne , 2.1,>, r1"40..//-sit: e, C f3iccfri// ` r f/, Y+ ,t, , Describe work New 0 Addition 0 Aiteration Repair 0 Mailing Address S( /,/ ?e-✓ /4eCAY0) �� 0 to be done: Prior to permit 7'755 S°,, 8A,Q/1/A,&) /, C,o / Additional Description of Work: issuance, a copy Ciy /State Zip Phone 5 of all licenses /; , c 92 1 /eC' iv5 j are required if Oregon Const. Cont. Board Exp. Date ,i PROJECT expired in COT Lic.# ■ . I/ ' `' VALUATION G� 5� �. /t% ,i�'1���� / $ ©Q� database Mechanical Name NEW CONSTRUCTION ONLY: Sub - S E ,4, r c , 4.(ev,i. Co 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- apply) Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO (check one) (check one) Has the Subdivision Plat recorded? N/A YCS 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.# 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 State laws. Name Sig " er /s .e Date Electrical Con a son ame �3) Phone # Sub- Mailing Address Contractor e' • $2�ti 21_ 4.y / ~a (/ / FOR OFFICE USE ONLY: City /State Zip Phone Plat #: Map/TL #: Prior to permit / 5/ j) - 6.5foc issuance, a copy of all licenses are Oregon Const. Cont. Board Exp. Date Setbacks: Zone: Sola : required if Lic.# �� £' expired in COT Engineering Approval: Planning Approval: TIF database Electrical Lic. # Exp. Date _ I:SFREM2.DOC (DST) 8/11/98 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 L � BUP Date Requested 1 7 1 AM L-' PM BLD Location / / / 8S /2 7 1 Suite MEC Contact Person Ph PLM Contractor ( c 6/7A-L -'n _ Ph . 3 ..,3S? SWR BUILDING Tenant/Owner o S C ) ELC Retaining Wall ELR Footing Access: Foundation N40, � / / FPS Ftg Drain h SGN Crawl Drain Inspection Notes: i v / Slab ` /t/ SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear I Framing rV irk► �� �.i�s' � A '! , �. ►:+ V`r �� !- �:���. Insulation ` r/ iej� �� rif t r 'I Drywall Nailing !.. �,_ L_�.,. �[ a - e _'� /, w ' � Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: tr151 ,r7gq 3 ' PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final AS - T FAIL CHANIC Post . ' - Rough In Gas Line S I • ke Dampers r PART FAIL EL TRICAL 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 Hail, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA l / Approach/Sidewalk Other Date I 2 oU Inspector Ext Other Final - - PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 05/30/2000 Activities for Case #: MST1999 -00218 11:27:38 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes MSTA005 Application received 06/08/1999 BON RECD No Hold GEO 06/14/1999 MSTA008 Permit Created 06/14/1999 GEO DONE No Hold GEO 06/14/1999 MSTA012 Plans routed to Plans Examiner 06/14/1999 GEO SENT No Hold GEO 06/14/1999 MSTA026 Plans approved by Pln Examiner 06/14/1999 BT2 DONE No Hold BT2 06/14/1999 MSTA030 Reviewed plans routed to DSTS 06/14/1999 BT2 DONE No Hold BT2 06/14/1999 MSTA735 Gas Line Insp 06/14/1999 06/14/1999 07/15/1999 KS FAIL No Hold AKJ 07/15/1999 no pressure on gas piping MSTA736 Gas Fireplace No Hold BT2 06/14/1999 MSTA725 Framing lnsp 06/14/1999 06/14/1999 07/02/1999 KS PASS No Hold AKJ 07/05/1999 MSTA740 Insulation lnsp 06/14/1999 06/14/1999 No Hold BT2 06/14/1999 MSTA795 Mechanical Final 06/14/1999 06/14/1999 04/27/2000 TLP PASS No Hold AKJ 04/27/2000 MSTA798 Final inspection 06/14/1999 06/14/1999 No Hold BT2 06/14/1999 MSTA799 Building Final 06/14/1999 06/14/1999 04/27/2000 TLP PASS No Hold AKJ 04/27/2000 MSTA080 (F) Ready to issue 06/18/1999 DEB DONE No Hold DEB 06/18/1999 MSTA092 (F) Issue combination permit 06/23/1999 DEB DONE No Hold DST 06/23/1999 MSTA735 Gas Line Insp 07/18/1999 07/18/1999 07/16/1999 PG PASS No Hold AKJ 07/18/1999 MSTA770 Misc. Inspection 02/23/2000 02/23/2000 02/23/2000 JMT DONE No Hold JMT 02/23/2000 research inspection request MSTA970 Case Finaled 04/27/2000 AKJ DONE No Hold AKJ 04/27/2000 Page 1 of 1