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12375 SW KING RICHARD DRIVE N -00 Q I N r rt 1, i0o � -I'`AZ 5/• 25 ' `0 WCA 1! Noj:E, I � � O � l A / i f� C ;r1G; VIA � Gl 15 VJ rook ���� ��, t � ,�Lirtil SG✓1 V(.X ►� �; � � rT l r I III I I III I11111111 -111-1111111IIi T T1�1 T I rl T r l fI i T`1� I I I I 1 I I I f -I I ► I II frN TICE: IF THE PRINT OR TYPE ON ANY r l I I I I 1 T 1 f � I �i 1 I �1 I l i 1 1 I I 1 C l 11 I 1 IMAGE IS NOTA L ` I I ' S CLEAR AS THIS NOTICE, 1 2 3 I , IT IS DUE TO T I +E QUALITY OF THE _ --�Jo.36 � __ •4� {4 ORIGINAL DOCUMENT E 6Z SZ LZ 9Z Z fiZ EZ Z TZ UZ 6i gi +-- LT 9T 9T � i ET ZT it i 6 R L e Iilllllllllllllllllllililllllllll1111IIIIII111111 .11111111.-1.11 L1� .111III1illl Illillllllllllll llllllll llllllllllllllll :1111 � ' I IIII .IIS IIII IIII 1111 .1111 IIII l lig Llll ll� IIII LI_Il lJl� 1 � lll,�lll�1�11 � N w V t7� CN C X Z G) X 0 2 D M D Q X m 1 1 12375 SW KING RICHARD DRIVE CITY OF TIGARD M C"}A A N"1, j DEVELOPMENT SERVICES P E"R M T, C,[Z RM T T 4. ME, 13125 SW HBO Blvd.,7798rd,OR 97223 (603)6394171 1,n 7 PnP"El- 251 1 r5B[,' 18-3,75 SW KTNG RTI,HARD DR (3N NG. f1r WORK,, . -ALT Yr-"r-, or USF. . . . ;VJF UNIT HEATERS. . tt 0 VE"NT' rr4mn. o "'CIJPANC' 'URP, a R3 VENTS It APPL; 0 ')011!r !�V-77r.'.M'32 I rj P,,F%G. . . . . . . . . 0 BnTLEQS/C:0MPRE9G0RS - 0 HP. 0 0 1171- TYP17C-, VX I NPtJT,. 0 S T(J 1115 "'Al t4p. 0 1 R 'JN TRE DAMPEFZ5". Q" I 4P. . . . 0 ,,I(l, OF I WITS— F) 1. f I A N U I-I N'S L W 17 S' OT111AIR UNITS'. 0 !RN ) =100X, STU: 0 1.0000 0 Tivztl-ks ; Add boiler or coo. heat pusp, air ccpd to 3 HP, absorp unit to W STU air handling unit 1P-jW CFM and vent'latic� not included in appl i 8-ic F ;erlit for an existing singlf family dwell. L I fW90N L.-) dak L '37'- f-1 P M'r 1 00 GE-0 I I /10 PT7 K 7 19G 1 Y DCI)( 1 0941111 40 T(-ITPI PT-QUI IN T'I 0PIG ";s permit is irs4ad subuect to the ;ins rantainpd in the Irl%p ", ,-,rd nuniripal Code, S-atF of Gre. _salty Codes and all other HPs:AiT'1g U11t TrlSf) 'icoblf laws,, All wr* will, be dor.e it accDrdarre with C,oj ci 1, iyii4 UrJ; Trisj�i tvpd plans, `his pfriit #64'1 expire if wo-k is not started Di.tc-'V- Trit4i:ir,(A; ir.)r1 in 180 days of iss,.ancej or if wcrt is suspended for more IV days. ATTENTION: I-egon law requites you to follow rules f=:i ITISf.le(At fan oted by tbt Oregon Utility Notification Ce^.Iker- 'hone rulis art fort- in SAR M-NI-0010 through DAN 97_M-M. You say in -opiri 0� those rulfs or dieoct oestiotsi to �x by cill liT,-i ?.3 i t a-4 1 4 +-I- i-4- 4 4 4 4 }.4,.A-4 i i 4..i +-i + 4- i- 4 {-.p..-, 4 p 1 1.f CITY dF TIGARD Mr-rHnN T D'11- DEVELOPMENT SERVICES PE.PmT-1 #. . . . . * * ; L 13125 SW HSU Blvd.,77g8rd,OR OW3 (503)U94171 0 97 ADDPE.W. . . ., 1237'-1 SW KING RTI"IHARD DR T ON, . . , . ZONING,. . . . . . . . . . JL)PT1,3DICrT()N. 11ITN L" MP- WORK, AL T r i.. r r u f-1 N. o rVF4P- COOLA FU:t 0 T'r'r"r t J-r" 1.1 rk r:. . , SF UNIT 1-117ATEPS. Qt VENT FANS. . . . 0 3rX!JPANC'v' ORP, P13 VCk)V"a W/0 APC"'Lc 0 VE P41,;' `iT[1P,',1EG. . . . . . . . .� 0 BOTLERS/COMPRE:SGORS HOODES. . . . . . . q? —UEL VXT'.7) 0 HP. 0 INIMEB). I �TN 3—.J. � 0 00MMLTNW. r,-.TNs 0 MAX INPUT,. 0 BTU 15-130 HP. . . 0 NEPAVR 'UNIT's. 0 I M7 1)A i 1r,E PS ,m,0._!;0 11P. . Q1 WWIDSTOVUB. . g 0 150.1 11P, 41 CLU DR` UJI�;. . 0 '11,1. OF AIR HONDL.ING LIN I TS OTHER UNITS. x 0 ( 11-UlK 1,0000 c-fro : I GAS 0UTL;,1J1,3. C 4.1 ) =100K nTU: 0 D 1.0000 U..-fm . 0 k% ; Add boiler or cos, heal pulp, air cand to 3 HPI absorp unit to W BTU and 6;r handling unit IC,W CrR and ventilation systes not ircl;jdfd in app!iancf Permit for an existing sirigie falily dwelling, t y y V,e C 75 SW H�TN[i rZU'HAR- D DRIVE'. PPIMI $ 1!!O. 00 GEO 11 /10/r37 1-1,A'NO C'1.7 ,T,Nf� CTTV Ort 972'224 3XT T I 1w 14.0 0GO t I /10/97 11N I NO C. 01L t,(1mrr)N,e T1,41, `,',1ZTj NW :315TH -C.) 11L OP8 219. 41A TOTAL 1094 'his pewit is issold subject to the rojulativis r(intained in thf MLchatlical Illrip :Vrd 4nicipal Cods, State of Ort, Specialty Codes one all other 1-1e 44t i v;6 Wit I ri s g q -Wsw flaws, All k will be done it accordance with tr I in 1.)T1 t I ri f.1 :-.Pd plans. This pvoit 6;—, expire if w4 is not started D1..1ct ,it 181 days of iwance$ v if work is suspended for We Misr--. 111%[1PcAiall days. AMNTIOQ; Orquit list reqkiret you to follow rule, r- frial Inspectjcill ttd bV the Orqoti Utility Notification Center. Those roles are `ort'. in OAA through MR 97-NI-W. You vey ;n copies of t4tf rules ar direct ;utstivrq to 7C by calling 1, i- i.d t 4 t i, 1-4, q, 4...1_4+-4- i i,+f ++ 4-1 1..4 4+++4-4- ++4-1.4.f 4-4 1 4 1 + -4 4 1 t i I f. + 1 4-41 9 1 THI 114:')0 I D: FA;' NI1: 4601 F0,71 i Nov 06 -97 11 : 33A Carson Oil Company 1 - 503--227--8521 P - 03 ;',TY Cc TIGARD Mocnanicai vermix fapNncaatver Roca ay 3•i 23 3W HALL BLVD. Commercial and Residential Deis Rodd _ 1GARD. OR 97223 Date to P . 503) 6394171, x304 Data to r3sY ,e Print or Type Permit-0 3 Incomplete or illegible supplications will not be accepted called ___._..._,. wart of 00.111111io 0e5v+paon 1411 � l_C I r Table to Mechankj1 CCde aTT PAICt AMT Job %. 4eerwrr Sur�n A) Permit— 4 7.00 Addreso Z37S 'f��% KfAI(� �fa? eapatrre LIP 6) supplement Viet 5.00 KlAlk Cr q:; ". a.r.•r(r Mart.0 Of buraiiiiiisl 1.) Furnace to 100,000 9TU 6.00 C7wrt.r Et.boN Ltlf L rJ inch dual a writs Malas Af"M1111 .) Fumeca 1W'000 STU r 7 10 '5A MF ind duds b vernal cnvr taft zip R%Ww 3,) Floor Furnace 600 6P#nr7E ol2 InU,vent -...� nam•lar nrnw d b„ar.wrr •.) Suapent7ea heater,.call hetater 0.00 E_ or floor mounted heater OccupantPoint;°OO1 M 51 Vent not incl.in 3 pp 40 hence porme carraw• Zle ~0 61 boder or comp,neat pump,alr Gond. to 3 HP:absom and in 100K BTU f OC7 oiler or cartlp,flop%pump,alr Md. 11, r K`.�W C7)C. (bMP Nva c 3-15 HP:eb•_ory unU to SW 5TL Contractor Marne"•art" T� e.) Solver or mrnp,host Pump,air Gond. 15.00 -v S AAL' 3e` vo g �09g6I 15.30 HP:absorp unit-5.1 and M Afta[rh C40Y of cpw3trr• D Phoft 9) Boiler or camp,heat pump,art Gond. 22.50 Current Licensee AwtAoib 4 je, Z'Zq-r 5sl(,, 30-50 HP:absorp unit 1-1.19 mi)BTL 01`8es+CMXL Coni OMFO LAir-1 Ba 0} 10.) boder or camp,heat Pump,it cond.~ 0 60 HP,absorp unit 1.75 and BTU CO Burnrue Tarr arMwv a 61•.aSte 11 ) Air hand"and to 4.50 - L. 1t c- "` r] 10.000 CFM Architect •^" 12> Air handUrrg Unit 7.50 y 10.000 CTM o 'f.` or Mmiine A4*%" - 13.) Non oomlble a 50 -- @�sperate cooler EngineNr ONVIOGNZ ^• 14.) vent fancannou" _T 3.00 to a s 4 dud 0",trlDe work New O Addltien OAlleraden O Repair O 15') voritilatim system not / 4, In he done identnl 111111L Nonnesidendst O included in applience para* n.lnRrnnal Dolwtptlon of WON 16.) flood sumo by mechanical exhaust 4.50 17)'Uornestic Inpntratora yR 7.50 Fiindng use of Is.) caffolemol ori ors 0.00 malding Ofpf000ftY_�_1N4�E G9Mr tt� Di,;Er_Vh!6— incinerator 19) C::othas dryers,arc. I 4 50 _... r,opoaad use of 20) Other uruls 450 building or preprrty Type of fuel-of n� - aturet gee ct LPG O elaZ;;�_ 21) Cas pf"one to flour out4ta 2.00 i rereby ecotn Mo9e deet I have rand this appikwtion,that the 22) Men than A-per outlet (aech) gp -formatlen giver,to corteet Mat I am the owner or euthoried agent of the evrner.that tlsns subrnftW arc In compliance w1h Oragen State CATV.SUGTOTAL -�f1 la" [A, §gnatsira o1 orfAgentBe" SU O AL. 4%SURCHARCE _-.._____ter - f4-- - - contact Perao,M Wame Phone 1315iN REVIEW 25k OF 9UOT*TAL TOTAL .3 � �1�`IV a't,r+mac/tpmtdde 'Mlnimum p•rtnit W—%25++S%nrmlwga �v 7f% 0 V? W ro C) Cc') n 7 cd, C) / in -T X ro (D m rn nrn > C) :Tl IT, Ln Ll rn 13 u F1 0 m u71 > > < �J z 0 (w) M < n > in t I 11 > in L-) 0 C- 103 in 0 co rn C) in > -TJ r J3 > I- (j m r) in 'n 0In cl !n n ro > Inw -1 T- I > LAI In C) m < ri 0 r, C.) F-1 > A (i < > -n > -, r) In w coll X in 0 > Ca rn 7 U w in Z n in 71 V0 IT, rn In u T > 0 Z (I- m m A M > v) n > CO Z m u x u0 in In J, > -4 m z IV J) cn Ln r- tn 0 in 0 > > m -4 in 0bt > JD 0 in n m D > In a1 7 m v) in U In I > 0 0 M JX3 JJIn u r Fn un in 0-o in --4 in > 0 m r- in -n 00 L,n 0 1- v III C) -n > > -A 0 t7l z in n a T m > .,jin z 0 in in (Al IT: Jr- m 0 0* r > 0 M -n in C 3 0 iD n m X < rn :x J m 3i T > > cm 0 in (") U III LO 0 z m < -C T 0 In -u Ln lu M > tilt" > .13 M I X cc < 'a n 7' - > > T c r- I(,-1 0 m 0 m n I- rn in <00 ri rn 0 0 > m 71 in m I.Al Lo in 0 m c) z > VO "A rn 0 z o T-'NU o V) n > m fli T I r. C)< Zo in NV V L'i a• CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 6394171 Date Requested: _� ''� -( _ A.M. P.M. _ MST: Location: _—� �S LC G ' 1/ BTJP: "I enant— Suite:__ Bldg: MFC: 7 Contractor ' Phone: _ _ PLM: Owner:_-- 11��7-----` —d'f�'°i �t 1 _Phone: — --- ELC: Sri,: BUILDING Bf DG(can't) PLUMBING MECHA N LCA e SITE Site Post/Beam Post/Beamost scam .erviec Sewer/Slonn Footing Roof UndPUSlab Rough-In Ceiling Water Line Slab Framing Top Out Gas Line Rough-In `v UG Sprinkler Foundation Insulation Sewer Ilood/Duct Reconnect Vault Iismt Damp Drywall Stonn Iumacc Tetnp Service MISC. Masonry Ceiling Rain I)rain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found Dra um�� Low Volt Approved Approved pprove Approved Appr/Sdwlk Not Approved Not Approved oved roved Not Approved FINAL FINAL f FINAL n Call Gir reinsp-wclion C7 Reinspection fee of$ required IeRtte next inspection O 1 Inahlc to inspect Inspxclor: - -- — Datc haRe--- --- of' ----.� u o U u 00 00 00 00 (21 go >, o0 uj .a Z = r= 00Z r 40 rA v c O =°F d ate, z ° pz CA 00 ON OC a 1 c c O C C C C C C C C M L W u � � � a 00 00 tA Gr M T O 0o m oo N 49 r R w 0 1� C 7 C y CL I N OO C C U. U L1. 1 Q� �• � L UJ •n N rJ � C 'V .'r_' CCy� r1 3 �• r I 'T �i � M LU d °° m0 Q wlu u p w zx a y, v00 o po�C r U w -e a: o ate' ¢ o �u � z z_Do 00 00 00 3 � 00 00 00 00 00 00 00 CL a � Ca �` p Z CL 00 00 C7 00 V 00 V 00 C7 , LLQ i .� 3 rl) 3 z S7, rl r r- 00 00 00 00 00 c �• un LU ww U o d C Q\ y U 1 � O © LLJ J O r1 v v v a a a a a a a a Y' o C O U O O O O O O O w z z z z z z z y � �o �o a o0 00 �,o o0 00 00 'w OL (71 w OL 17 t- o0 00 0 0 N a A a era A Y n CA av c1 u nn cr CL h ° o c v o v o f y u 0n c ro m 55 G -a s v ca y c o v W rt oa U H: w c ° D U u° �i a° w U. n 00 r1 ^ f I o ? v1 n cn vi cn cn CA va (A V N CITY OF TIGARD MASTER F,ERMIT PERMIT #. . . . . . . : M5T96-0292 DEVELOPMENT SERVICES DATE: ISSUED: 07/23/98 *N& 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 F,ARCEI_: ES 1 1`;13C-16100 ' I 'TE ADDRESS. . . : 12375 SW !S I Nv RICHARD DR !_AUBD I V IS I ON. . . . : ZONING: bi_OCK. . . . . . . . . . t-OT. . . . . . . . . . . . . . JURISDICTION: KIM Remarks: Enlarge an existing bedroom. 6' X 141 ------------------------------------------------------------ BUILDING --------------------------------------------------------- REISSUE: STORIES.......: 1 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED------------- CLASS OF WORK.:ADD HEIGHT........: 12 FIRST....: 84 if GARAGE.....; 0 sf LEFT..........: 4 SMOKE DETECTRS: Y TYPE OF' USE...:9F FLOOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0 TYPE OF CONST.:5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT.........: 4 OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL------: 84 if VALUE..$: 5000 REAR..........: 0 ------------------------------------------------------------------ PLUMBING -------------------------------------- —---------------- SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 2 TRAPS.........: 0 LAVAT091ES....: 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 TUB/SIOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 --------------------------------------------------------------- MECHANICAL. ---__- ---------------------------------------------------- FUEL TYPES-----------• FURN ( LOOK ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: 0 FURN )=100K ..: 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-- 1000 SF OR LESS: 0 0 200 amp..: 0 0 200 alp..: 0 W/SVC OR FDR..: 0 PUMIP/IRRIGATION: 0 PER INSPECTION: 0 1A ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 400 asp..: 0 1st W/O SVC/FDR: 1 SIGN/OUT LIN LT: 0 PER HOUR......: 0 LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 asp..: 0 EA ADDL BR LIR: 1 SIGNAL/PANEL...: 0 IN PLANT......: 0 MANE HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+asps-1000 v: 0 MINOR LABEL -10: 0 1000+ asp/volt.: 0 ----------------------------------- PLAN REVIEW SE:TION ---------------------------------- Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=cS A.: i 600 V NOMINAL: CLS AREA/SPC OCC: ---------------------------------------------------- ELECTRICAI_ -- RESTRICTED ENERGY ------------------------------------------------------ A. --------- -- A. SF RESIDENTIAL.--------------------------- B. COMMERCIAL------------------------------------------------------------------------------- AUDIO X STEREO.: VACUUM SYSTEM..: AUDIO 6 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 A SYSTEMS: 0 Owner: -----------------------------------Contractor: ---------------------------•--- TOTAL FEES:t 154.11 ELDON L WILLIAM50N OWNER This permit is subject to the regulations contained in the 12375 SW KING RICHARD DRIVE Tigard Municipal Code, State of Ore. Specialty Codes and all KING CITY OR 97224 other applicable laws. All work will be done in accordance with approved plans. This permit will eypire if work is Phone A: Phone N: not started within 180 days of issuance, or if the work is Reg C.: 000000 suspended for more than IN days. ATTENTION: Oregon law ------------------------------------------------------------------- requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 932-0014010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. ----------------------------------------------------------- REQUIRED INSPECTIONS ------------------------------------------------------------ Footing Insp Shear Wall Insp Foundation Insp Insulation Insp Post/Beam Struct Rain drain Insp — Electrical Rough Electrical Final Framing Insp Building Final I ssi.:ed By:_ Permittee 5ignat L:re : _ '.�- _- + +++++++++++++ +++++++++++++++++++++++++++ +++4-+++++++++++-++++++++-+-++++++ 4-+ + 1 + Call 639--4175 by 7:00 p. m. fat- an insper-i; ion needed the next hi-iciness day Plan Check# C5 r" ..:TY OF TIGARD Residential Building Permit Application Recd By 13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd G o GARD, OR 97223 Single Family Detached or Attached Date to P.E. 03) 639-4171 Date to DST it Print or Type Permit# s -+0,,Z Incomplete or illegible applications will not be accepted Called c U 39I '3c,��- Name of Subdivision Lot# Name Job y-' Address Site Addreaa Architect Mailing Address Name City/State Zip Phone Owner Mailing Address Name City#-tote Ip Phone Engineer Mailing Address Name City/State Zip Phone General _ Describe work new O —addition alteration O repair O Contractor Mailing Address to be done: Additional Description of Work: City/state Zip Phone Oregon Const.Cont.Board Lic.# Exp. Date Attach Copy of Project ,, ' Current COT Business Tax or Metro# Ex Date }'i Licenses p' Name NEW CONSTRUCTION ONLY: Mechanical Sq.Ft. HQuse, Sq.Ft.Garage: Sub_ Mailing Address -4`!�D Contractor Comer Lot Yes No Flag Lot Yes No City/State Zip Phone (check one) (check one) Restricted Audio/Stereo Burglar Attach Copy of Oregon Const.Cont.Board Lic.# Exp. Date Energy System Alarm Current GOT Business Tax or Metro is Exp.Date Installation Garage Door HVAC Licenses Opener Systems Ir Name (check all that Other: Plumbing apply) Sub. i Mailing Address Will the electrical subcontractor wire for all Yes No Contractor restricted energy installations? Citylstate 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 h,:reby 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 r Signature of D to/ Electrical Sub- Mailing Address �gptact e J G`•� �1110041 Contractor FOR b ICE USE ONLY: -� :ity/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: Manning Approval//: TIF ,4tslrnstapp.doc -- •, �� t.. Permit # Account Description Bpoun 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) 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 ldsts\mstapp doc Rev. 7196 Permit #: Aet cS,% hAl ISSUCd hy: ': .• L Date: _ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, OILS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors hoard to sign the following statement hefore a building permit cart be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt front registrations tinder ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Dill in the appropriate blanks and initial boxes I and 2, and either box 3A or 313: 1. 1 own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, E-1 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must he registered with the Construction Contractors Board. OR 191; 3B. 1 will be my own general contractor. If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If 1 change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. hereby certify that the above in!'.►rntation is correct and that I have read and do understand the 11"forniation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. licant )Sr nature of ermtaPP ( - ate (White copy to issuing agency permit filc. pink copy to applicant) I n€ormation Notice to Property Owners Ab,cut Construction Responsibilities I tra nt�lance it it OkS 70e.(7)5(9�jj aC'tin,! ;i'a qI,, i) t'tl; lltfat:l(tr to coot Mind;l)lt.'��1 hrimt1-or improvement t0 all+existirig StruCtltre, t'l',"I.: . '!II CC..�tt"�p1� �� . :�'f0�ti`tE,�C►II ••lilt ..': fi .l� ',':!f�1.t L" :litU 41i4'iL% l .fE11r, j�pt * j EMPLOYER f-O«SPONSIBI L.I TiEa: 'i II tit Iltii' 11t! wlly iltil rg tt'rod %,-lilt the Coil'"trut Ilvll Q i ,1Ir,4 lu7 lio,IJ to 4I1jahtlllit t. tl ,ii'icniw,yr al'siming 111 the 1r1F,1'I11Ctu.111 ui tlll) t11t In[klr :i,r �lClf t 1 p p ;:� j:1It.Y 4 t� 1 + �li�... 11tTM Ctll�"(I !f� 'i , � $:r and thk I)l`o1114 s t y6, �'Ctll I"7li(° te,�idl 1"IC'(tit �nV T \ CWC' t.ltl ItJYt t. V i=�i lli.�,.•:<i�Jill"�i�.��t1i11 'fll �i lltit!;Ilii, 0lLr1l""1ton'ti�� .,1 Pm4 irl"1tt\,ithlllf'tt(1i110114" Itlxi$flfZ­hlitll'olmlt41'(r111\ti:bIt"tltll' th0ti1't10mi"il,vinpioC< 91, C * For IIil fYld 'll tltq.f4.'14'll' f(, 15;kiwl't it`dollmitioll, call the 0'.e Civ )erw'`o'itR!~,entio it I 91.llempltly'mcilt it"tmir'&iNice t.ox: As Ill Cr,'lllloyer, y'tlil art_' I1'tlutrt`d itl f`Mi a UMX 14 it lint'U11,h tilent imsilralicc i111ri1t ses Ctrl the, t"�^i r.r,t,7f;fll 1'i'!;i'��':1� ht�s'llta`1L Iillt ttittn tri,tac I�'tllf tt rr r1o.vitlelit I)k-i"i(111 tlt ihU Llepal!me.tll YI i lYll)l m lel`9iliIrol" Workers'd,,omfliviliquifim i l-a;Is 'anl' ! .10,111 o1111,y1(tyt 1"'11 Ht.'. � lil}It;'t'',I 6n 1}1.,'(lli fi�tli'I �'�1t(t+1:i'i t��`nlilt'Utiatittli I :m, laust i ll;t;.rif) �.wo't t{'I CCM:hif lh�l"tl'i:lt It it iilsurl lllt., i0, Oil, ltluilot,et:,. .1t,You Iad tt t.!I`i.1VI A!!YLCI,, t!N tl�t.'!I'yLitlnf; ?11:;1IE�Ii1Ci. �!J11 li lil j, _.yt {v , I .�.I r i:, hE"Itt"jEti't tt Pt'1t��111� �.i'lf.� v,i(1'�1c'ilal'lt Pir a!I t il=fillt,?ntit��if i>lYe 01�j`�tltY "tii>It1�,'�'� k i111111'"I"ll ilitnl`i1'liitlt?!1 dic Workci',' 06 i••il.ltl of lllc I)cprlrtu°Ic*nt of Collr.iiltu t Ilius `i€l vl� ", ai ►115�.7t�'ttt� >I�'„S, lntCl�rrral ixi�tveNaurV;�i•r t-ii:�:: i'A..an c;ut111c'lyt.�r,wt,,li rtn.i�t �,ithli<,IJ C�:Jeral in�ttillc•tst� l`trtiili carltllt��t��'�'�vti�r��. 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F+)t",flt`tr ttli�'flYti�rWYe>Vt e�t'rl '1 �w1trY�ti(In't �1t tll,llly tx'ithhold ncc u'N For rllt',r,.' kiliotlll.iliun.t X01 thr iwornal Roventic Servic t- OTHER 4E:SPONSIBILITIE S AND AREAS CSE CONCERN: ('1)ill' Ii1C i t'tmil ;11i1lallln. 1�1'I1't•I rtntt ';"tlUli 'Iia ill`+ 1111.11 illtl,' he' hlouvhi iIt Y(ttlr IUlClltll's1' i.11r'l",i;i!h 1L''1tf' lurll< l.is�i,ility�rr+1 I1ltliaw,rty ilarta;► r inrut arict: ('tall;+>t y'c�w in uran�c`a enl to.,et' it VIM 1a0,1: OdekILMIC.imsur�ultx elir c rs'11,.' li'lr :it(k,ldt fits iwd tso-r'It1;.11�i'.,b"Ilk 11 ,1', I'�<ilTlt uvcrspl'ity, h'61t1'i"aaalllil[e!t Itc?rTl I1ille I)lli1C'IL11C., Iii-C, t)I tdl?i'k that IIIII I he re t1• nc. .Littre to supervise cmplllyt,vs: Makc %lire }'tali '41MCICTI 111111 to suP0t­ViSC yilttr I•(" L'A:11Cr"Cita,• :I%`.t,''�'tifh.'':trilh :t"'.l1(':" i�C'1'l) lr,lltt,,l;}';•,(il't'; r'I'�"11r,"ill:, IIIIriC'tor,io(: dirt,titin oibt,w0C'kofri'igh in}IidI' id, tracic',,'. and t'+nt7t!'1' t`tlllCl.t'f 14i '1tYi; 11 !11!! 1{PPI'•1)r411r i, ti" iiiC�'Cull P1-rholli III,,f(-gIIIrl-d iTI50,dtIAW ti`You have additional�liwsllol1I 11t: ill tall the Construrllon t tintrac•tort, I;uartt(PO Box 1.1140, Snivin,OR 97.' ll 503l378.46211 The Board i4, located at'700 Sumner St. NF. Suite Wit in Salem. pi Ott-t ICV ii prn t i/l)d KING CITY 15300 S.W, 116th Avenue.King City,Oregnn 97°.24.2693 - Phone:(503)&99.4082•FAX(5103)6.19-377 1 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard. many building related permits For projects in King City are issued and inspected by the City of Tigard. l If your permit application DOES NOT REQUIRE PLAN REVIEW. simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will collect all fees and fax the application to the Cite of Tigard. City of Tigard staff will then create the permit. issue the permit. and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will he returned to King City staff for correction and no processing will occur until a complete. legible application is received. If your permit application DOES REQUIRE PLAN REVIEW. this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard DevelopmL..t Services Counter located at 13125 SW Hall Blvd. Tigard. to submit applications and plans. Development Services Technicians are available at 639-4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of Kine City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: located at: �a375-�5W K t_G�1Gt-e.a� Kine "I'1% iZe presentati4 1 1 DSTS KCiNST POC i CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 ; IMPORTANT PERMIT NOTICE ELDON WILIIAMSON 12375 SW KING RICHARD DR TIGARD OR Electrical Signature Form Permit # . . . . : MST98-0292 Date Issued. : 07/23/98 Parcel . . . . . . : 2S115BC-16100 Site Address : 12375 SW KING RICHARD DR Subdivision. : Block. . . . . . . . Lot : Jurisdiction: KIN Zoning. . . . . . Remarks : Enlarge an existing bedroom. 6 ' X 14 ' Vour company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of work to the address above, ATTN: Building Dept. I No electrical inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNER : ELECTRICAL CONTRACTOR: ELDON L WILLIAMSON ELDON WILLIAMSON 12375 SW KING RICHARD DRIVE 12375 SW KING RICHARD DR KING CITY OR 97224 TIGARD OR Hione # : 624-8609 Phone # : 624-8609 Reg # . . Signature o upervisingect icer an If you have any questions, please call 639-4171 , ext. #310