Permit CITY OFTIGARD `
MASTER PERMIT J
% _ i � DEVELOPMENT SERVI P ISSUED: �4 MST98 -0065
4& PARCEL: 2S104AA- -02100
SITE ADDRESS.. - :12335 SW 127TH AVE
�
SUBDIVISION -BELLWOOD •NING: R -4.5
BLOCK LOT •070 4 al RISDICTION: TIG
Remarks: SF addition PATH I
BUILDING —
REISSUE: STORIES • 1 FLOOR AREAS-------- BASEMENT...: 0 sf REQUIRED SETBACKS— REQUIRED -
CLASS OF WORK.:ADD HEIGHT • 12 FIRST • 330 sf GARAGE 0 sf LEFT • 18 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT • 0 PARKING SPACES: 8
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT • 27
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL --- -: 338 sf VALUE.. $: 23037 REAR • 52
— - -- PLUM(BING ---- -- - ____ - --
SINKS • 8 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0
LAVATORIES • 8 DISHWASHERS...: 8 FLOOR DRAINS..: 8 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 8
TUB /SHOWERS...: 0 GARBAGE DISP..: 8 WATER HEATERS.: 0 WATER LINE ft: 8 BCKFLW PREVNTR: 8 GREASE TRAPS..: 8
OTHER FIXTURES: 0
MECHANICAL — FUEL TYPES --- FURN ( 180K ..: 0 BOIL /CMP ( 3HP: 8 VENT FANS • 8 CLOTHES DRYERS: 0
FURN ) =180K ..: 8 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 1 WOODSTOVES • 0 6AS OUTLETS...: 1
ELECTRICAL ---
- RESIDENTIAL UNIT— --- SERVICE /FEEDER— —TEMP SRVC /FEEDERS— — BRANCH CIRCUITS — — MISCELLANEOUS— - -ADD'L INSPECTIONS-
1000 SF OR LESS: 8 0 - 280 alp..: 0 0 - 200 alp..: 8 W /SVC OR FDR..: 8 PUMP /IRRIGATION: 8 PER INSPECTION: 0
EA ADD'L 500SF.: 8 201 - 400 amp..: 0 201 - 480 amp..: 0 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 8 401 - 688 alp..: 0 401 - 600 alp..: 0 EA ADDL BR CIR: 1 SIGNAL /PANEL...: 8 IN PLANT • 0
MUANF HM /SVC /FDR: 8 601 - 1080 amp.: 8 601 +amps -1800 v: 0 MINOR LABEL -10: 0
1000+ amp /volt.: 0 — - - - -- ---- -- PLAN REVIEW SECTION
Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR) =225 A.: ) 688 V NOMINAL: CLS AREA /SPC OCC:
ELECTRICAL - RESTRICTED ENERGY — A. SF RESIDENTIAL B. C@MERCIAL
AUDIO i STEREO.: VACUUM SYSTEM..: AUDIO X STEREO.: FIRE ALARM • INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: BOILER • HVAC • LANDSCAPE /IRRIG: PROTECTIVE SISNL:
GARAGE OPENER..: CLOCK • INSTRUMENTATION: MEDICAL • OTHR: ::
HVAC DATA /TELE COMM.: NURSE CALLS • TOTAL 9 SYSTEMS: 0
Owner: -- Contractor: - TOTAL FEES:$ 387.91
JERRY VANDERVORT ROYAL REMODELING This permit is subject to the regulations contained in the
12335 SW 127TH AVE PD BOX 230805 Tigard Municipal Code, State of Ore. Specialty Codes and all
TIGARD OR 97223 TIGARD OR 97281 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone 9: 590 -5281 Phone 9: 684 -7873 not started within 188 days of issuance, or if the work is
Reg A)..: 008987 suspended for more than 180 days. ATTENTION: Oregon law
- - -- requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001-0010 through OAR 952- 081 -0088. You may obtain copies of these rules or
direct questions to OUP by calling (503)246 -1987.
REQUIRED INSPECTIONS — ----
Erosion 844 -8444 Crawl Drain /Back Shear Wall Insp Rain drain Insp
Footing Insp Mechanical Insp Low Voltage Electrical Final
Foundation Insp Electrical Servi Gas Line Insp Mechanical Final
Post/Beam Struct Electrical Rough Gas Fireplace Building Final
Post /Beam Mechan taming Insp Insulation Insp
Issued B �j/ d ,e2„!/' Perm ittee Signature .I
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
Plan check 0, . P/ '
Y OF TIGARD Residential Building Permit Application Recd By __..=?, 2-f7‘
125 SW HALL BLVD. New Construction Additions or Alterations Date Rec'd ■ '
- G,ARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E. - — , -
503- 639 -4171 Date to DST • li -
' 303 -684 -7297 (� � r Permit* V T , OIL 1 S -
Print or Type l Called
•
Incomplete or illegible applications will not be accepted
Name of Project Name
Job VA►.!_t j 6r-1 o---{J ga--I 3fCA G��) e�
Address Site Address J
A M ailing Address „�
12. W Z T ' ' y �� .2 c) 0.1 ale. totem e S
Name 35 1 �"� C /State Zip Phone
.:•rz - y' \./A,.IrpEte./02-r .,2.'1 /QD ®lq- 77Z'iZ Zg (-7kI.r
Owner Mailing Address Name
Mk
IZ -3 2'S 'S14-1 121
City /State Zip Phone 9 En sneer Mailing Address
i t 2p CF '17223 67o 5' z i City /State Zip Phone
Name O /
General 4 - ' I`-ei`'�Gt.�1.t.-46- L^ 6 • Descnbe work New 0 Addition 'pc Alteration 0 Repair 0
Contractor Mailing Address to be done:
PO Q 230$or, Additional Description of Work:
City /State Zip Phone
114:plte
Oregon Const. Cont. Board Licit Exp. Date
Attach Copy of c7101 5— 9 q
Current COT Business Tax or Metro S Exp. Date PROJECT
Licenses 3 eid 1 I Z. -.9 r6 VALUATION $ 2 -. 0.
Name � ,¢ n'& y /Iq NEW CONSTRUCTION ONLY:
Mechanical A - �ti 44 ,
Sub Mailing Address t� >\( Sq. FL House: Sq. Ft. Garage
Contractor 7 q I 45 . C<.• . C omes' of YES NO Flag Lot YES NO
phi/state Y . - Phone (check one ) (check e)
1 `` ? estricted ` Audio /Stereo Burglar
Oregon CO C ont Board tic* Exp. Date
Attach Copy of Energy System Alarm
Current COTBusiness Tax or Metro S Exp. Date Installation ` Gara Door HVAC
Licenses 0 er Systems
Name
(check all that ther.
Plumbing g/ - 2- , -.► apply)
Sub- Mailing Address Will the electrical subcontractor wire for all YES NO
Contractor P o / restricted energy installations?
cay /State ip phone Has the Subdivision Plat recorded? N/A YES NO
'r ,fo.L tt , '7b(.2 61Z
Oregon Const ••nt. Boa • Licit Exp. Date issue of MST#: Solar Compliance
<ttach Copy of g -"1 • 12 -0j$ (Calculation Attached)
Current P!umoin Li• * Exp. Date I hearby acknowledge that I have read this application, that the
Licenses . / . 4 it-e• Pr 7 - - 9°) information given is correct. that I am the owner or authorized
COT Bu ,Hess Tax or Metro x p. Date agent of the owner, and that plans submitted are in compliance
Name I gO4 I Ex r � with Oregon State laws. p
Sign lure f 0 er /Agent Date
Electrical �Ser -.>Z I;I.EL � }°`n ,� _ / � e
Su b- Mailing Address Contact t'erson Na Phone #
Contractor I4 - 67_ 1 1 5y.( 64AR,1.4,,IA.`1- 0,b.,74° _ i/- 7,73
City/State Zip d Phone FOR OFFICE USE ONLY:
1 Ggi, 3Tt °1'7 v f I r 7 7°J- ' S Plat- 10 I t M�/TL #: �.
Oregon Const. Cont. Board Lic.x Exp. Date / I
d6/0q4 - . �e';' I ttach Copy of ' o g" j L -9% Setbacks.1 Setback I Zone:
Solar.
Current Electrical Lic. * Exp. Date P — PM i , L ' �'
Licenses 3 di Tax 42— or C_ 10 -9 En Approval: 1- Planning Approval: TIF: ` „
COT B.Jsrness Tax or Metro # I Exp. Date �� - 6-
4: _ 9 i :lsfapp.doc (dst) 1/97 2
Permit # Acc9unt Cescription Amount Amt. Pd, 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)
Reimbursement District ( )
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)
TOTALS:
i:'sfapp.doc (dst) 1/97
6/19/00 Activities for Case #: MST98 -00065
2:10:56 PM
Assigned Hold Updated O
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
vNf
MSTA005 Application received 3/13/98 DLH RECD BT2 3/16/98 i �
MSTA008 Permit Created 3/16/98 B DONE BON 3/16/98
MSTA010 Check for prcl. restrict. 3/16/98 B PASS BON 3/16/98 O
MSTA012 Plans routed to Plans Examiner 3/16/98 B SENT BON 3/16/98
MSTA026 Plans approved by Pin Examiner 3/16/98 RT PASS BT2 3/16/98
MSTA030 Reviewed plans routed to DSTS 3/16/98 RT PASS BT2 3/16/98
MSTA032 DST Post - Review Completed 3/17/98 B DONE BON 3/17/98
MSTA155 Development conditions met BON 3/16/98
MSTA700 Erosion 844 -8444 BON 3/16/98
MSTA705 Footing Insp 7/2/98 WDJ PASS WDJ 7/2/98 1. Provide keyway in footing 2.
Be sure to provide low point
drain.
MSTA706 Foundation lnsp 7/24/98 KS PASS J *H 7/28/98 Install back flow preventer at
low point drain and connect to
storm line or provide sump
pump. Needs approval from
Plumbing Department. Do not
deck until plumbing is aproved.
MSTA710 Post/Beam Structural 7/24/98 KS PASS J *H 7/28/98 Approved as noted at
foundation.
MSTA720 Mechanical lnsp 9/30/98 RB FAIL RB 10/1/98 Fireplace not installed at this
date. Heat duct boots not thru
floor yet. Do not conceal gas
line shut off in wall w/o access
panel. Flame spread fireplace
cavity.
MSTA724 Electrical Rough In 9/30/98 CD PASS CD 10/1/98
MSTA725 Framing Insp 9/30/98 RB FAIL RB 10/1/98 Mech rough incompleted.
Electrical cover req'd prior to
cover- Once approved ok to
insulate.
MSTA726 Shear Wall Insp 9/30/98 RB PASS RB 10/1/98
MSTA735 Gas Line Insp 9/30/98 RB PASS RB 10/1/98 Tagged 323371
MSTA740 Insulation lnsp 10/2/98 KS PART KBS 10/5/98 #-1- fireplace not installed @
this time do not cover until
inspected
MSTA755 Rain drain Insp 8/4/98 MS PART MRS 8/4/98 sump for underfloor crawl
MSTA790 Electrical Final BON 3/16/98
MSTA795 Mechanical Final BON 3/16/98
MSTA799 Building Final BON 3/16/98
Page 1 of 2
6/19/00 Activities for Case #: MST98 -00065
2:10:56 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA080 (F) Ready to issue 4/1/98 DLH PASS DLH 4/1/98
MSTA092 (F) Issue combination permit 4/22/98 DEB DONE DRA 4/22/98
MSTA097 Issue electric signature form 5/5/98 JMT RECD JT 5/4/98
MSTA712 Underfloor insulation 7/31/98 KS PASS J *H 8/4/98 Underfloor insulaton: Dave -
need to insulate exposed wyes
at heat ducts.
MSTA717 PLM /Underfloor 7/30/98 MS PASS J *H 8/4/98 Sump pump installed.
MSTA722 Plumb Top Out 9/30/98 RB PASS RB 10/1/98 1- hose bib at rear (behind
kitchen sink- underfloor- ext.
rear wall.
MSTA735 Gas Line Insp N/A RB 10/1/98 Re -check for access panel for
gas shut -off.
MSTA720 Mechanical Insp 10/5/98 WDJ PASS WDJ 10/5/98
MSTA725 Framing Insp 10/5/98 WDJ PASS WDJ 10/5/98
MSTA740 Insulation Insp 10/5/98 WDJ PASS WDJ 10/5/98
MSTA945 Request inspection research 6/8/00 JMT DONE No Hold JMT 6/8/00
MSTA153 Expired by limitation 6/11/00 HAP DONE No Hold AKJ 6/11/00
Page 2 of 2