Permit CITY OF TIGARD
,a �,,,a DEVELOPMENT SERVICES MASTER PERMIT
��� Ai PERMIT # MST97 -0181
. - -._.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/23/97
PARCEL: 25110CC -16600
SITE ADDRESS °..:12445 SW KING GEORGE DR
SUBDIVISION ZONING:
BLOCK.......... LOT • JURISDICTION: KIN
Remarks: Fire restoration
---- — — - -- BUILDING
REISSUE: STORIES • 1 FLOOR AREAS ---- BASEMENT...: 0 sf REQUIRED SETBACKS ---- REQUIRED
CLASS OF WORK.:REP HEIGHT • 0 FIRST 0 sf GARAGE • 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD • 40 SECOND...: 0 sf FRONT • 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT • 0
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL ----: 0 sf VALUE..$: 1ru',,a REAR : 0
PLUMBING — —_— ---- -- - - -- — -- - - - - --
SINKS • 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0
LAVATORIES • 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS...: 0
TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
-- - --- -- -- — - ---- MECHANICAL
FUEL TYPES---- ---- -- FURN ( 100K ..: 0 BOIL /CNBP ( 3HP: 0 VENT FANS • 0 CLOTHES DRYERS: 0
FURN )=1wwK ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 0 WOODSTOVES • 0 GAS OUTLETS...: 0
----- -- - - -- - -- ---- -- — ELECTRICAL ---- -- - - - -- - -_-- --
-- RESIDENTIAL UNIT -- -- SERVICE /FEEDER - -- - -TEMP SRVC /FEEDERS -- -- BRANCH CIRCUITS --- -- MISCELLANEOUS - -- - -ADD'L INSPECTIONS- -
1m SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp..: 0 W /SVC OR FDR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 amp..: 0 ' 201 - 400 amp..: 0 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0. EA ADDL BR CIA: 2 SIGNAL /PANEL...: 0 IN PLANT • 0
MANF HM /SVC /FDR: 0 601 - 1'' amp.: 0 601+amps -1000 v: 0 MINOR LABEL -10: 0
1'Y+ amp /volt.: 0 PLAN REVIEW SECTION
Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR? =225 A.: ) 600 V NOMINAL: CLS AREA /SPC OCC:
--- -- -- - ---- -- ELECTRICAL - RESTRICTED ENERGY - ------ ---- --
A. SF RESIDENTIAL -- - -- - - - - -- B. COMMERCIAL -------- -
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM • INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: .• BOILER • HVAC LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK INSTRUMENTATION: MEDICAL OTHR: ..
HVAC • DATA /TELE COMM.: NURSE CALLS • TOTAL g SYSTEMS: 0
Owner: ----- - ----- ---- -- --- Contractor: -- -- TOTAL FEES:$ 136.86
WILLIAM DAVIS PREMIER RESTORATION
12445 SW KING GEORGE 15865 SE 114TH
KING CITY OR 97224 STE 0
CLACKMAS OR 97
Phone 0: Phone 8: 655 -0815
Reg 0.,: 000893
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and 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 work is suspended for more than 180 days.
_�-- _____ —__ _---- ---- -- - REQUIRED INSPECTIONS -- -- — --- - ---- --
Framing Insp Building Final
Insulation Insp
Gyp Board Insp
Rain drain Insp
Electrical Final -
Permittee Signature: • -ti _ _ Issued By: i /.�� .�_!� �.��_.,[ //. , /1i
Call or inspection -- 639 -4175
Y A ?
�`r OF TiU'ARO Plan Check /6 U S_
Residential Building Permit Application Recd By
4125. SW HALL BLVD. New Construction Additions or Alterations Date Recd - 2 - 1 - 1
r1GARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. 62-1 '1
503 -639 -4171 Date to DST
503- 684 -7297 Permit ' 1 - OI `6(
Print or Type Called '- 2-2-
Incomplete or illegible applications will not be accepted
• Name of Project Name
' Job - 100_c? / . __
Address Site Address // Architect Mailing Address
l? Cf S CO k�ac (�r 2Ptr • City/State
N� / / h fate Zip I Phone
Owner Mailing Address k - - Name
/D //� Co 3 k t - c..2 _ Engineer Ma iling Address
City/State Zip 7 Phone g _ • • •
N d �r City /State Zip Phone
a
General Peejyt I Q/..- �� cry _ Describe work New 0 Addition 0 Alteration 0 Repair 0
Contractor Mailing Address to be done:
��� fl� STE Additional Description of Work:
Ci Zip ��-� Phone _ - -
a /OP k G avr 7 � ]S 6"
-
- C - -- ()%1 , �� /
O on Const. Cont. Board Lic# Exp. Date r ' eL3-49eQ-k ^ �-
`
Attach Copy of g `,� ( W' ®S `3RD - _
Current COT Business Tax or Metro # Exp. Date PROJECT
Licenses N Al 72- 7 _/---;,1 VALUATION $ / 0 ( . _ - •
Mechanical NEW CONSTRUCTION ONLY:
Sub- Mailing Address - Sq. Ft House: Sq. Ft. Garage
Contractor Corner Lot . YES NO Flag Lot YES NO
City/State Zip Phone (check one)
(check one)
Oregon Const. Cont. Board Lic.# Exp. Date Restricted Audio /Stereo Burglar
:tech Copy of Energy System Alarm
Current COT Business Tax or Metro # Exp. Date Installation Garage Door HVAC
Licenses
Opener _ Systems
Name
- (check all that Other. - . .
Plumbing apply)
Sub Mailing Address Will the electrical subcontractor wire for all YES NO
ontractor
restricted energy installations?
CIty /State Zip Phone Has the Subdivision Plat recorded? N/A YES NO
Oregon Const. Cont. Board Lic.# I Exp. Date Reissue of MST#: Solar Compliance
.ttach Copy of
Uc _ (Calculation Attached)
Current Plumbing Exp. Date I heart pp
Licenses y acknowledge that I have read this application, that the
COT Business Tax or Metro # Exp_ Date information given is correct, that I am the owner or authorized
agent of the owner, and that plans submitted are in compliance
Name with Oregon State laws.
3 eCtrical J �` Sig ature of Owne Agent Date
ec e(c X /� -1. ..=..2 (° r0
Sub- Mailing Address x c'Persor ame Phone # k
contractor a .2. �i'- C ii i v,.. - t o t c ti,ti ,e CAS OR
F.�}}tY /S FOR OFFICE
Vc9l'. -: � cr /I Zip Phone USE ONLY:
:2 ;VZ - 644%1 Pl at #: , Map/TL#:
Oregon Const. Cont. Board Uc.# Exp. Date k 0/ 4 C / �y r J a2 SI- /dc 4 -- /44r P U
4 t:ach Copy of
b ' Setbacks:
Zone: Solar.
- Current c? cal Lc. # Exp. Dat _.--- cal
Licenses lb - I � I RI-1—T) En g in eering Approval: Planning a
OT3u in or tr Exp. Date/ g • pproval: TIF:
`� ess Tax 1 � i:lsfapp.doc (dst) 1/97
• �+ t't/( 7 Z�J 9S - 10 -011 .
I
•
Permit # Account Description Amount Amt. Pd. Bal. Due ' I -
/hsf9, ^t 1it'l MST. Permit (BUILD) a4, ®►
Plumb. Permit • (PLUMB)
Mech. Permit _ (MECH) _
•
ELC /ELR Permit (ELPRMT) -- - - - -"
State Tax (TAX) Q 4,03
_ .. Bldg: - .c G 3
Plumb: _.. - _
•
Mech:
.
ELC /ELR:
Plan Check •
MST: • • (BUPPLN) 52, V 3 S2, .
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: / / ( 6 1 4,5 7 d
i:\ fapp.doc (dst) 1/97 •
CITY OF TIGARD BUILDING INSPECTION DIVISION • MST 7-00 (g/
24 -Hour Inspection Line: 639 -4175 ' Business Line: 639 -4171
^^ � _/ BUP
//
Date Requested) � ct AM PM BLD
Location 13.2-(L/3- ( 4 • > • Suite P-A-___J MEC
Contact Person k1 < <�T J o Ph °--_ PLM
Contractor Ph SWR
BUILDIN ` < -_` Tenant/Owner
ELC
airnn Wall g ELR
Footing r+
Foundation Access: h Y e r p p� FPS
Ftg Drain l �
Crawl Drain Inspe(
, SGN
Slab n o t Ke quested
Post & Beam I \ Found During Rese SIT
Ext Sheath/Shear No Insnectoo ■4s) In File 1
Int Sheath /Shear
Framing YV) - t S 4, r •r S --Q r p
p 1 r A frJ --
Insulation A.
Drywall Nailing C r /011W / L '7 Fire wall f i 4 _ `-
Fire Sprinkler ; •
Fire Alarm
Susp'd Ceiling L _s._Ii iff _ / .44111 _ � ` ' —� �I
Roof Atr i4" r mi.
a nal , rAr / r
S PART FAIL
U NG
Post & Beam �
Under Slab l / ,e � � , j 0 - S 7 --) A■tg( .).___S
Top Out
Water Service `n t n f
Sanitary Sewer � A �..Z� 1,.�Q \ A L 5 'L
Rain Drains �,� ..___(s,./`.
Final •
PASS PART FAIL
MECHANICAL
Post & Beam -
Gas Line
I I I
Smoke Dampers -
ni PASS PART FAIL 1k, IR.ti- ® ,,—e A.�,1-_
ELECTRICAL C
Service CIJVI.N_ C `-sC-/ (� .
Rough In
UG /Slab e
Low Voltage
9 S� „ rn ' ' \ w Fire Alarm
Final "/ `'� �J 1Lc�J
`�
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer I I , 1 0
Storm Drain [ ] Reinspection fee of $ required before of section. 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 n�
C � V �� l G (
Other Date !� Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.