Permit CITY OF TIGARD
MASTE R PERMIT
PERMIT # MST9G - -04Z1 Z
t COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED; 9f Gl /9
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: : 1 S 135AD- -0 1301
SITE ADDRESS...: 03840 SW SPRUCE ST
•
SUBDIVISION • GRAHAM ACRES ZONING: R-4.5
... . ..... LOT • 3
Remarks: Adding 3 branch circuits, SEE ELC96-0128, MST95 -0209
------------------------------------- _- _-- M - -.---
REISSUE: STORIES • 0 FLOOR AREAS--- - - ---- BASEMENT...: 0 sf REQUIRED SETBACKS - - -- REQUIRED------- ----
CLASS OF WORK.:ALT HEIGHT • 0 FIRST • 0 sf GARAGE • 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD 0 SECOND...: 0 sf FRONT : 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT • 0
OCCUPANCY GRP.:R3 BDPM: 0 BATH: 0 TOTAL 0 sf VALUE..$: 0 REAR • 0
- - - - -- ---------------- - - - - -- PLUMBING -- --- - -- — _ --__ -- --- - --- --
SINKS : 0 WATER CLOSETS.: 0 WASHING MACH..: 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS L
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: 2
MECHANICAL - - -- ----- - - - - -- - -- - - -- - -- ----
FUEL TYPES FURN { 100K ..: 0 BOIL /CMS ; 3HP: 0 VENT FANS • Q CLOTHES DRYERS: 0
FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS 8 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- -
1000 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: 0 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: k 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 3 SIGNAL /PANEL...: 0 IN PLANT • 2
MANF HM /SVC /FDR: 0 601 - 1000 amp.: 0 601 +amps -1000 v: 0 MINOR LABEL -10: 0
1000+ 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..: OTH: :: BOILER HVAC LANDSCAPE /IRRIG: PROTECTIVE S1GNL:
GARAGE OPENER..: CLOCK INSTRUMENTATION: MEDICAL OTHR: ..
HVAC DATA /TELE COMM.: NURSE CALLS • TOTAL 0 SYSTEMS: 0
Owner: --------------------- - Contractor: - - - - -- TOTAL FEES:$ 42.00
TOD KINSLEY CONTRACTOR NOT ON FILE
8840 SW SPRUCE ST
TIGARD OR 97223
Phone 8: 503- 977 -0327 Phone 8:
Reg 8..:
This permit is issued subject to the regulations contained in the Tigard Municipal C de, State :f Ore. Specialty Codas and all :t`e:
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started withi- 1E8
days of issuance, or if work is suspended for more than 188 days.
- - -- --------- - - - - -- REQUIRED INSPECTIONS - -- ----------------
Crawl Drain Insulation Insp Mechanical Final
PLM /Underfloor Gyp Board Insp Plumb Final
Plumb Top Opt Water Line Insp Building Final
Electrical Rough Water Service In
Framing Insp Electrical Final
Permi.ttee Siynature: Issues! By: d
Cal for inspect 639 - 4175
Plan Check # N ►
CITY OF TIGARD Residential Building Permit Application Recd By 1 446.
13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd 3 0
TIGARD, OR 97223 Single Family Detached or Attached Date to P.E. q 3a
(503) 639 -4171 Date to DST q 30
Print or Type Permit # //1,ST9� �
Incomplete or illegible applications will not be accepted Called 317
Name of Subdivision Lot # Name
Job M ailin Address
Address Site Address �� Architect g
Name City/State Zip Phone
'" a > ../L_ _ / _ Name
Owner Mailing Address
`
Engineer Mailing Address
City/State Zip Phone g
Name
6117-032:7 City/State Zip Phone
General IJ Vlrn,l//l At 05'0 )0q Describe work new 0 addition 0 alteration 0 repair 0
Contractor Mailing Address to be done: PL„ V� t^
Additional Description of Work: (, Z p � + \
City/State Zip Phone � 'P(CAL CA
Oregon Const. Cont. Board Lic.# Exp. Date Cf E€ 0/ 4,616 - a ) m I � 1 I. o��
Attach Copy of Project 15.75 ° - "' —
Current COT Business Tax or Metro # Exp. Date Valuation 26
Licenses
:-Name NEW CONSTRUCTION ONLY:
Mechanical Sq.Ft. House: Sq.Ft.Garage:
Sub- Mailing Address
Contractor Corner Lot Yes No Flag Lot Yes No
City/State Zip Phone (check one) (check one)
Restricted Audio /Stereo Burglar
i Oregon Const. Cont. Board Lic.# Exp. Date Energy System Alarm
Attach Copy of
Current COT Business Tax or Metro # Exp. Date Installation Garage Door HVAC
Licenses Opener Systems
Name (check all that Other:
Plumbing apply)
I Sub Mailing Address Will the electrical subcontractor wire for all Yes No
Contractor restricted energy installations?
City/State Zip Phone Has the Subdivision Plat recorded? N/A Yes No
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
' Attach Copy of (Calculation Attached)
Current Plumbing Lic. # Exp. Date I hereby acknowledge that I have read this application, that the
Licenses information given is correct, that I am the owner or authorized agent of
COT Business Tax or Metro # Exp. Date the owner, and that plans submitted are in compliance with Oregon
State laws.
Name Signet re of Owner/ ent Date
Electrical A. 4 ?o--,49 76'
Contact Person Name Phone
Sub- Mailing Address 7 a6NS/ .177
Contractor FOR OFFICE US ONLY:
. City/State Zip • Phone Plat # Map/TL #:
Oregon Const. Cont. Board Lic.# Exp. Date
Attach Copy of Setbacks Zone: Solar:
Current Electrical Lic. # Exp. Date
Licenses
COT Business Tax or Metro # Exp. Date Engineering Approval: Planning Approval: TIF:
;. dsts\rnstapp.doc
Permit # Account Description Amount Amt, Pd. Bal. Due
MST. Permit (BUILD) cJ
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT) __W
State Tax (TAX) 1
Bldg:
Plumb:
Mech:
ELC /ELR:
Plan Check
MST: (BUPPLN)
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS)
Sewer Connection (SWUSA)
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:\dstslrnstapp.doc
Rev. 7/96
5/16/99 Activities for Case #: MST96 -00460
9:09:25 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA005 Application received 9/30/96 JMH RECD DST 9/30/96
MSTA008 Permit Created 9/30/96 JMH APPR DST 9/30/96
. MSTA010 Check for prcl. restrict. 9/30/96 DST 9/30/96 •
MSTA012 Plans routed to Plans Examiner 9/30/96 RT APPR DST 9/30/96
MSTA026 Plans approved by Plans Exmr 9/30/96 RT APPR DST 9/30/96
MSTA030 Reviewed plans routed to DSTS 9/30/96 RT APPR DST 9/30/96
MSTA713 Crawl Drain DST 9/30/96
•
MSTA717 PLM /Underfloor 1/27/97 NMS PASS MRS 1/28/97 .
MSTA722 Plumb Top Out 1/27/97 MS PASS MRS 1/28/97
MSTA724 Electrical Rough In DST 9/30/96
MSTA725 Framing Insp DST 9/30/96
MSTA740 Insulation Insp DST 9/30/96
MSTA745 Gyp Board Insp DST 9/30/96
MSTA760 Water Line Insp DST 9/30/96
MSTA761 Water Service Insp DST 9/30/96 -
MSTA790 Electrical Final DST 9/30/96 .
MSTA795 Mechanical Final • DST 9/30/96
MSTA797 Plumb Final DST 9/30/96
MSTA799 Building Final 6/22/98 KS PASS J *H 6/23/98 Per Ken's report: "Building -
. , finaled on 110597 by TLP.
• Addition, not sure if any
plumbing was installed."
MSTA080 (F) Ready to issue 9/30/96 JMH APPR DST 9/30/96 APPLICANT ADDING WORK
NOT INCLUDED IN ORIGINAL
MST95 -0209, SO FEES ARE
ADJUSTED IN MST96 -0460 .
TOM P. AND BOB T. BOTH
• REVIEWED AND
. INSTRUCTED DST TO
ASSIGN FEES AS SHOWN.
MSTA092 (F) Issue combination permit 9/30/96 JMH PAID DST 9/30/96
MSTA097 Issue plumbing signature form 9/30/96 JMH DST 9/30/96
MSTA098 Issue electric signature form 9/30/96 JMH DST 9/30/96
MSTA040 Hold for Code Enforcement 8/1/97 3/14/99 GS STOP JT 3/14/99 Placing fill without a permit plus
fill in drainage ditch.
Page 1 of 2
•
5/16/99 Activities for Case #: MST96 -00460
9:09:25 PM -
•
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTAl27 Stop Work order Placed 8/1/97 GS STOP J`H 8/1/97 1. Placing fill without a permit
and placing fill in a drainage
ditch.
MSTA055 Hold Release 11/5/97 TLP NOTE JT • 11/23/97 tom approved final on
mst95 -0209 and noted drainage
ditch has been restored.
MSTA055 Hold Release to Issued 3/14/99 JT 3/14/99
MSTA970 Case Finaled 3/14/99 JT 3/14/99
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•
•
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Page 2 of 2