Permit „-
CITY TIGARD r `• MASTER PERMIT
. PERMIT #: MST2006 -00243
e� DEVELOPMENT SERVICES o -639 -4171 DATE ISSUED: 10/13/2006
�"� PARCEL: 1S133AD-10300
SITE ADDRESS: 10659 SW 127TH CT ZONING: R -
SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT: 159 JURISDICTION: TIG
Project Description: (2) dormers.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE: 14 12100
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 14,121.00 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 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 SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FOR: 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:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
GREGG JACOBS JLM SERVICES INC applicable laws. All work will be done in accordance with approved
10659 SW 127TH CT 12220 SW WALNUT ST plans. This permit will expire if work is not started within 180 days
TIGARD, OR 97223 TIGARD, OR 97223 of issuance, or if the work is 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 952- 001 -0080. You may obtain copies
Phone: 503 330 - 4679 Contact #: PRI 590 - 2451 of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Reg #: LIC 70082
TOTAL FEES: $ 374.63
REQUIRED ITEMS AND REPORTS
•11
Iss ed By : /W�� � / l _C / _ Permittee Signature :
Nie
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that bus - - -ss day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applicatio_L1 FOR OFFICE USE ONLY •
I. E
4 �E kj Received D / t � � �� ,( q
City of Tigard �' — C� G �6jL Pet N \- \ J � , ytlt ��� vI
Dat /Bch
13123 SW Hall Blvd.- Tigard. OR 97223 Plan Revie
Phone: 303.639 f 171 Fax: 303.398.1960 S E P ® t * ! < Other Permit.
Inspection Line: 303.639.4175 Date Ready By fur H See Attached Checklist for
"'°
Internet: \v\c\\.cl u_ard.or us CITY OF TIGAI 'u Notified /Method: Supplemental Infurnwhun
'x
BUILDING
ff F R7viTgR. Cr'' REQUIRED DATA: I- AND 2-FAMILY DWELLING
❑ Ne\s construction ❑ Demolition
Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
® Addition /alteration /replacement ❑ Other: equipment. materials. labor. overh and the profit for the O
work indicated on this application.
CATEGORY OF CONSTRUCTION
Valuation: 814121.00
® I - and 2- family dwelling ❑ Commercial/industrial
❑ Accessory building
❑ Multi - family Number of bedrooms:
❑ Master builder
❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
lob site address: 10659 SW 127 Ct New dwelling area: 100 square feet ....
City /State /ZIP: Tigard, Oregon 97223 • Garage /carport area: square feet
Su ite /bldg. /apt. no.: Project name: Jacobs Upstairs Dormers Covered porch area: square feet
Cross street /directions to job site: SW 127 Ct and SW Springwood in the Summmerlake Deck area: square feet
neighborhood
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
L ot no.: Permit fees* are based on the value of the work performed.
Subdivision: Sununerlalce Indicate the value (rounded to the nearest dollar) of all
Tax map/parcel no.: equipment. materials. labor. overhead. and the profit for the
work indicated on this application.
DESCRIPTION OF WORK
Valuation: S •
Adding two dormers to the upstairs room .
Existing building area: square feet
New building area: square feet
•
® PROPERTY OWNER ❑
TENANT Number of stories:
Type of construction:
Name: Gregg Jacobs
Address: 10659 SW 127 Ct • Occupancy groups:
Cii ■/State /ZIP: Tigard, Oregon 97223 Existing:
Phone: (503)330 - 4679 e.P.V1 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE • .
All contractors and subcontractors are required to be
Business name: licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
jurisdiction in which work i s being performed. I f the
Address: applicant is exempt From licensing. the following reasons
City /State /ZIP: apply.
Phone: ( ) Fax: : ( )
E-mail:
I CONTRACTOR
Business name: JLIM Services, Inc BUILDING PERMIT FEES*
Address- 12220 SW' Walnut St Please refer to fee schedule.
City /State /ZI P: Tigard, Oregon 97223 Fees due upon application f,/ , / .y 5
Phone: (503) 590 - 2451 / Fax: ( ) Amount received
' CCB tic. 70082 i 0 Date received:
Authorized signature: a This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
' * Fee methodology set by Tn- County Building Indust■
Print nonce D ate
Service Board.
1 ,Huddme \Pei min\itLi PermitApp.de I' -/1t3 440- 4b13T(I1/02 /COI / \\'Ea)
Electrical Permit Application_ t FOR OFFICE USE,ONLY
City of Tigard Received •
Tigard Dale /By: Permit No:
13125 SW Hall Blvd.. Tigard. OR 97223 P ^^ Plan Revie s
Phone: 503.639.4171 Fax. 503 598.1960 ? -�I'?JO Date /By Other Permit:
Inspection Line: 503.639 4175 i +� �� of Date Ready /By: loos IO See Page 2 for
Internet. \vww.ci.tigard.or.us L,jI Y / '�.iIC 1 WA ;p 1.d Notified /Method' Supplemental Information
1� 1.' t ( P Y a (C / Y 1 : 1/ a r te REVIEW
6 �pIPE F OE• �10RK' ' { d PLAN REV IE�1
❑ New construction ® Add ition/alteration/replacement Please check all that apply.
D emolition
EService over 225 amps. comm ❑Flazardous location
E] El Other:
❑Service over 320 amps - rating ❑ Boddie over 10.000 sq ft..
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
® I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑S•stem over 600 volts nominal units in one structure
['Buildin over three stories ❑Feeders. 400 amps or more
❑ Nlulti -t unit El Master builder [11 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting_ plan RV park
lob no • Job site address: 10659 SW 127 Ct ❑Heahh -care facility ❑Other.
Su bmit 2 sets of plans with any of the above.
•
City /State /ZIP: Tigard, Oregon 97223 The above are not applicable to temporary construction service.
Suite /bldg /apt. no.: Project name: Jacobs Upstairs Dormers
FEE* SCHEDULE
Description Qq. Fee. l - orl '
Cross street /directions to job site: SW I 27 Ct and SW Springwood New residential single - or multi- fancily dwelling unit.
Includes attached garage.
1.000 sq. ft or less 145.15 4
Subdivision: Summerlake Lot no.: Es. addl 500 sq. ft. or portion 33 40 1
Limited energy. residential 75.00 2
Tax map /parcel no.: Limited energy. non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Relocating duplex receptacle
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less • 80.30 2
El PROPERTY OWNER 1=I TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160 60 2
Name: Gregg Jacobs 601 amps to 1.000 amps 240.60 2
Address: 10659 SW 127 Ct Over 1.000 amps or volts 434.65 2
Reconnect only 66.85 2
City/State/ZIP: Tigard, Oregon 97223 Temporary services or feeders installation, alteration, and /or
Phone: (503)579 -8035 Fax: ( ) relocation
200 amps or less 66 55 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale. lease. rent. or exchange. according to ORS 447. 449. 670. and 701. 401 amps to 600 amps 133 75
O\\ tier signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee_ each 6.65
Business name. branch circuit
• B. Fee liar branch circuits
Contact name: without service or feeder fee.
first branch circuit 46.5 2
Address: -
Each add'I branch circuit 6.6 2
City /Slate /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:( ) Fax: : ( )
Sian or outline lighting 53.40 2
• E -mail: Signal cu'cuit(s) or limited -
CONTRACTOR energy panel. alteration. or
j, extension. Describe. Page
Business name:
...
Address: 11220 ��Vstltrut St'' Each additional inspection over allowable in any of the above
Per inspection 62 30
Cit\ /State /ZIP: T Orego - 97223 Investigation per hour It hr min) 62 50
Phone: (503).5W-2454- p ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CC Lie.: 490 -- Electrical Lie.: Suprv. Lie : Subtotal
Sum . Electrician signature. required Plan review (25% of permit fee)
State surcharge (8% of permit tee)
Print name: Date:
TOTAL. PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name' Date: n Fee methodology set by Fri-County Building Inchisii ■ Science Board
-* Number of inspections per permit :illotsed.
i ABuiidin_AI'rim uiii_C PermitAiis J u t 1 -1- In -4t,I ST( I0 /02 /COiSt,AA'Gi
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
Electrical Signature Form
Permit #: MST2006 -00243
Date issued: 101 1 312006
Parcel: 1S133AD-10300
Site Address: 10659 SW 127TH CT
Subdivision: AMART SUMMER LAKE NO. 3
Block: Lot: 159
Jurisdiction: TIG
Zoning: R -7
Remarks: (2) dormers.
Your 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 the work to the address above,
ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
GREGG JACOBS WILLAMETTE ELECTRIC INC
10659 SW 127TH CT PO BOX 230547
TIGARD. OR 97223 TIGARD. OR 97281
Phone #: 503 - 330 -4679 Phone #: 503 - 624 -3631
Reg #: ELE 34 -283C
LI 5059
-
SUP 44135g ) yzz6 -s
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising` Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: MST2006.00243
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005
Phone: (503) 639- 4171 l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/1312007 TIME: 7 :02AM PAGE: 54
SITE ADDRESS: 10659 SW 127TH CT CLASS OF WORK:
SUBDIVISION: AIVMART SUMMER LAKE NO. 3 LOT #: 159 TYPE OF USE:
PROJECT NAME: JACOBS
DESCRIPTION: (2) dormers.
OWNER: JACOBS, GREGG PHONE #: 503 330 - 4679
CONTRACTOR: JLM SERVICES INC PHONE #: 590 - 2451
Inspection Request Scheduled For: Date: 2/1312007 Pour Time:
Code # Inspection Description Confirm # Contact # Me _ _ -
299 Final inspection 043275 -02 503-704-5742
Corrections /Comments /Instructions: .
61
*SS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: C.--4/ f Date: / % Phone #: (503) 718-
CITY OF TIGARD
1
BUILDING DIVISION PERMIT #: MST2006 00243
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13120116
Phone: (503) 639 - 4171 °�41a�i h
Inspection Requests (24 Hrs.): (503) 639 -4175 J °'I...
INSPECTION WORKSHEET FOR DATE: 2/13/2007 TIME: 7 :02AM PAGE: 55 ;
SITE ADDRESS: 10659 SW 127TH CT CLASS OF WORK:
SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT #: 159 TYPE OF USE:
PROJECT NAME: JACOBS
DESCRIPTION: (2) dormers. ,
OWNER: JACOBS, GREGG PHONE #: 503.330 -4673 ,
CONTRACTOR: JLM SERVICES INC PHONE #: 590 - 2451 ' -
Inspection Request Scheduled For: Date: 2/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 043275 -01 503-579-8035 N
Corrections /Comments /Instructions: -
IR PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
• I I FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: ( 7t-� Date: Z- I' 6 Phone #: (503) 718- A
CITY OF TIGARD
, 1. ,
BUILDING DIVISION PERMIT #: MST2006-00243
13125 SW Hall Blvd., Tigard, OR 97223
DATE ISSUED: 10/13/2006
Phone: (503) 639-4171 Vt
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: '11/2912006 TIME: 7:04AM PAGE: 43
SITE ADDRESS: 10659 SW 127TH CT CLASS OF WORK:
SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT #: 159 TYPE OF USE:
PROJECT NAME: JACOBS
DESCRIPTION: (2) dormers.
OWNER: JACOBS, GREGG PHONE #: 503-330.4679
CONTRACTOR: JLM SERVICES INC PHONE #: 590-2451
Inspection Request Scheduled For: Date: 11/29/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 040375-01 503-579-8035 N
CorLections/Comments/Instructions:
r■-kc .',
P (2.4:22V i r> (-_ --- z_c:-:- e--1 '
y ' fryiv Aq--e
•
I I PARTIAL APPROVAL pi CANCEL I I NO ACCESS
I I FAIL 7 CALL FOR INSPECTION I 1 ADDITIONAL FEES ASSESSED
Inspector: e•- • Date: 11/Z /0 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION , PERMIT #: MST2006 -00243
. A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/1312006
Phone: (503) 639 -4171 rit
Inspection Requests (24 Hrs.): (503) 639 -4175 '
INSPECTION WORKSHEET FOR DATE: /1/2912006 TIME: 7 :00AM PAGE: 42
SITE ADDRESS: 10669 SW 127TH CT CLASS OF WORK:
SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT #: 159 TYPE OF USE:
PROJECT NAME: JACOBS
DESCRIPTION: ( dormers
OWNER: JACOBS, GREGG PHONE #: 603- 330 -4679
CONTRACTOR: JLM SERVICES INC PHONE #: 590 -2451
• Inspection Request Scheduled For: Date: 11/29/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 040375.02 503 - 579.8035 N
Corrections /Comments /Instructions:
7J PASS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: (Mt 1� Date: t! 246 Phone #: (503) 718- 7(�y