Permit •A-- CITY OF TIGARD MASTER PERMIT
PERMIT #: MST1999 -00358
llii DEVELOPMENT SERVICES DATE ISSUED: 10/28/1999
--� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12475 SW 121ST AVE PARCEL: 2S103BB -07100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: URB
REMARKS: reroofing changing roof line approx.285 sq ft
BUILDING
REISSUE: STORIES: 1 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: $ 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: 1 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 SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 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: $ 155.91
This permit is subject to the regulations contained in the
HARBOUR, KELLY
HARBOUR, U 121ST K 9 L AVE A Tigard Municipal Code, State of OR. Specialty Codes and
1247 5 TIGARD, 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 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
Framing Insp
Insulation Insp
Rain drain Insp
Plumb Final
Final inspection , • ■ `
Issued B : 4 / J I Permittee Signature :
By 9
l
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next • usin • - • -
CITY OFTIGARD Residential Building Permit Application Plan Check#
13125 SW HALL BLVD. Additions or Alterations Recd By
Date Rec'd
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. AD - ?/ "T. 1
V 503 - 639 -4171 Date to DST /0 - 2 ,) f
F 503 - 684 -7297 Permit # 1 7 1 1 s t /ff y. -d°
Print or Type U� Called /V/2? 4) /o `• 3 5 q••
Incomplete or illegible applications will not be accepted le-(' I. w ' S 3 °" re ,J-'-4_
Name of Project Name
Job
Address S iteg dress 7061:1- + Architect Mailing Address
I LLi i- W ' Z-1 Alit it - i i h%:i City /State ip Phone
Name f H
Y i (�,
i ( I, L (40 1^ r Name
Owner Mailing Address G �� ,
' v) I .1 �lr
Engineer Mailing A. >ress
City /State Zip Phone . g
//' ij O cf ?Zr 3 574- b iO;
C' State Zip Phone
General Name
Contractor i PT Describe work New 0 Addition 0 Alteration 0 Repair 0
Mailing Address ', to be done:
Prior to permit Additional Description of Work:
issuance, a copy City /State Zip Phone
of all licenses
are required if Oregon Const. Cont. Board Exp. Date PROJECT / "'i X
expired in COT Lic.# VALUATION $ c ) d ( )
database
Mechanical Name NEW CONSTRUCTION ONLY:
Sub - :. Ft. House: Sq. Ft. Garage
Contractor Mailing Address
Prior to permit Indicate - restricted energy installation by the electrical
subcontracto
issuance, a copy City /State Phone the following areas
of all licenses Restricted Audio /Stereo
are required if Oregon C . Cont. Board Exp. Date Energy System „, Alarms
expired in COT Lic. Installations ■ •cuum Irrigation
database Sys - • System
Plumbing Name (check all that Ot : .
Sub- apply)
Contractor Mailing Address Corner Lot Y s NO Fla• of YES NO
(check one) (check o -
Has the Sub•'flsion Plat recorded? N/A YES NO
Prior to permit City /State Zip Phone
issuance, a copy
of all licenses are Oregon Const. Cont. and Exp. Date
required if Lic.# I hearby acknowledge that I have read this application, that the
expired in COT
database Plumbin ic. # 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 o Owner en Date
Electrical f / X , t 1 , ,kZ) 4 6)1. 111).A Sf 1() 1 r j `"f ,
Contact Persoti Name, Phone #
Sub- Mailing Address s L 7
Contractor K IL I I ,. 1 -�I,1.1 1 Lll P X l��l Ill
City /State Zip Phone
Prior to permit
issuance, a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const. Cont. :card Exp. Date plat #: Map/TL #:
required if Lic.#
expired in COT 04503_08-07100
database Electrical Li . '• Exp. Date Setbacks: Zone: Solar:
Elec ' -I Supervisor Lic. # Exp. Date Engineering Approval: Planning Approval: TIFF
i:\dsts \forms\sfaddalt.doc 11/20/98
CITY OF TIGARD = ' G INSPECTION DIVISION MST /`9 —
24 -Hour Inspectio i e: 639 -4175 Business Line: 639 -4171
�UP
Date Requested / �� AM PM BLD
Location / 7 5 I / S Suite MEC
Contact Person o E.01F. A � r„le th • �' PLM
C. d7zo E.LL
BUILDING Tenant/Owner ELC
' all ELR
Footing ocess: FPS
Foundation
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int 1- - /Sh r /
Z-44-_
sulation
rywa Nailing • /11 O _
Firewall
Fire Sprinkler r 6
Fire Alarm
Susp'd Ceiling '�• 61o�'IX CZ ` dt A
Roof / �/
Misc: (� /� Co
Final GJet /� _., Lc.� V:'
PASS PART FA /
PLUMBING Q. t - J D� ,G,/'$ det
& Beam
Un 5 , v �/
Unde lab �� QD 77L
Top Out
Water Semi
S PART FAIL
MECHANICAL /\4L
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 [ ease call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date / ' ' Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION Msr L 9 5 t e2O2 c 2
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / ( _ 4 AM PM V BLD
Location I J 4 1 , l c 1 4 , Suite MEC
Contact Person K Qe _ - t ' ,& PLM
Contractor U Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing 5:
Foundation c FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam /
Ext Sheath /Shear (62-6.°11/11-7--C"°€"—°
Int Sheath /Shear
sulatio
rywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Fin
PASS ART FAIL
P G
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 q
Other Date / <2) Z_ )-- ! 7 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.