Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00375
� ��4, DEVELOPMENT SERVICES DATE ISSUED: 12/14/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15925 SW ALDERBROOK CIR PARCEL: 2S111 DC -01800
. SUBDIVISION: SUMMERFIELD NO.8 ZONING: R -7
BLOCK: LOT: 465 JURISDICTION: TIG
REMARKS: 80sf. patio enclosure.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 80 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5
VALUE: 11, 575.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 80 sf 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: .
EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 100 SIGNAL /PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEWS ECTION
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:
Owner: Contractor: TOTAL FEES: $ 331.99
This permit is subject to the regulations contained in the
AHERN, O.E. PAUL SCHULZ CONSTRUCTION Tigard Municipal Code, State of OR. Specialty Codes
15925 SW ALDERBROOK CIR. 15420 SW SPRINGBROOK RD and all other applicable laws. All work will be done in
TIGARD, OR 97223 NEWBERG, OR 97132 accordance with approved plans. This permit will expire
if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
Phone: 503 624 - 1127 Phone: 503 320 - 3149 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 160569 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Slab Insp Electrical Final
Electrical Rough In Final inspection
Framing Insp
Exterior Sheathing Insc
Insulatio• - - /
Issue. By : O _ 1.0 4 /4. .1 _.L._ Y Permittee Signature : . _ ■_
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day /
Buildin. Permit ✓ ioi;I� fm _ 0, n ® Foe_oFFLCE osE'oly v
Received q I
City of Tigard DateBy: / � • �`( , Permit No.: mST��n� /_ 26
13125 SW Hall Blvd., Tigard, 01023 ® 2UU4 Plan Review W
T !/ €y w Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 �.' i DDate/By: /' ( 5 - o V
Inspection Line: 503.639.4175^ ` iJ. Date Ready/By: Jurs" 0 See Attached Checklist for
Internet: www.ci.tigard.or.u�0 DING T GARD ' •t' �y,� ethodi, 7/// / 7 / Supplemental Information
VISION .:: u! �r+rC a :6 " _,�
w.1 < ;'? sl4`d z .< -,,, •,^ .:4 k-, r !'"T.tT - _ - ,1 ' , 1 , -.-3/.--, „ s. . :. vg , a •• i, 't,.t ,--,--. r .,: ; ,Kr:,� ., < Y:
={ . t - Aa• , FS �O` k- . .' :-:,- / :�^� a :.,. s RE. AT "AND2 FAlV II E YDWE LLI NG
? , C �+ f iii > ;:v i - t r � :, � �, �. O� x a�; 9�aT�,'.Y $�- .+C:,!��;�,,.,� -/ p !y� �:�< Q . `�.,,, . �„� .,=...z, > « ", ..r.�, a. ,. .., .
� .; >„ ✓..- �. >. ?` � � ,.. . ::2�a,, c y�' �A '�' �"'.$ ._,...... xis :. s'a'L'3s::� %�����i' •..,a.?,.��” � ?,s a' S.'k. . =.s...... .. n. ;.,.
❑ New 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, overhead, and the profit for the
M IX, - : " 4 . a , W �: VAZIV;..�:Rg.�,..4. u:., work indicated on this application
-i sa ..; 0 f�t< CATEGORYt O 1 4 ( ONSTRU,C ION `� ; it �*
• Valuation: $ t k' 1
►C/ 1- and 2- family dwelling 0 Commercial/industrial
),
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder • ❑ Other: Number of bathrooms:
y: e ` z .:- , r.s,,. .., °4,:�: d`at;,` a. "sra : ,
r, ^• : y ip ^ ^* °.�r 't; ka: : ;•:: +,•_ . . .
, J INFOItt A ION y A ,. L`OCATLON. Total number of floors: ■
Job site address: I Lj 5t.,3 0 New dwelling area: go square feet
City /State /ZIP: �" 5aC c\_ y(' 91 2,Z5 Garage /carport area: 4 S , square feet
Suite/bldg. /apt. no.: Project name: H €R1,3 - pi...5 i C1,6nC.S:. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
_ i` R'EQ D COMMER;C I AL; U S EtC HE CICL-"IS T
i:%,< „'$. ','a?". fJ:a# +wvo ,uvw.' S %'§::.r;c; °. : ' cif , ,. "... »,A:r ' .'�!" . is
Subdivision: S LA Vrllnti2 1 t._,A7 Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the
Tax map /parcel no.:
„, y � tea'
i ”; , 'S S OF �W9A i ,.
'4',Z"+ � .-. _.. ,. � -z ae,..� ��- ..C. ,. <�.,a�.��i as, . �- �€..,z �., :a3#..asi�.. u�i�w� work indicated on this application.
QTX t- `wt_. -1-L -- ■ n C \c34f.1 L \Y1�v2�( F,Klc,'f I n3 - P. sC t0 Valuation: $
f7
k Existing building area: square feet
New building area: square feet
s
S PROPERfW6WNERVVI' l'I ` ' ENN -fle , � 1;1 Number- of stories:
Name: d E, k „, Type of construction:
Address: kG9 ZC� 51,J A47i R..47_2 �OC7 0�v,C \Q Occupancy groups:
City/State/ZIP. Is ,2 A --, 0 ( C 1 22-5 Existing:
Phone: (eo5) 62i f I `'1 Fax: ( ) New:
x”'
;:37` . , :t". °RSON ` •'.as4 ': . 7, . : , " "x _,,; , .: fi r:,;
. .. , PELICAN.: .3, s" ,!s, COt�I {TACT .P -E « t, . . =; �: ° " w.. .
" 'i'.: <:= uxs -_.c .:a «"; ' . �'e abz �'. `t�+s,' "::,,�=s: n°��.. -.^�', a. ..;: �"' -r' °�' :.: ^f » , "et, li a`ti - AliL=c'y '<. t ii4 OTI�E d,+?� aatr 4 , .
Business name: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
W t In,R i
�\1 under ORS 701 and may be required to be licensed in the
Address: ' i 6 i.(E " G'1 I t v jurisdiction in which work is being performed. If the
City /State /ZIP: t\_ _[a�1C7 E2� O \/' �7 1 3 Z applicant is exempt from licensing; the following reasons
l apply: r I SES, SO
Phone: ( 603) 6 Z5 e / 9 l Fax: : ( ) . A Nl 6 /( 0 3 , o-5
E -mail:
.:. � - a 't ?'3"� y' `y`*;s••' » I, i .',: ' ^ e,' :i ^,:i« a`, $ '" ;ap g @a°E;`'?"a- =3 .� %-" .^ s . 5 ,� f; ` .; ^ ' : ^ . 7 - o ` /` .q( 4.(9--1
Business name: /� n,-15 i"- r: -, - ,, x� �.
l--C� x' <��'� BiJ]Tb1� G P�.ERMIT *`., , x
sn aasz'�,°,i`:� '.z`�`. Est"» � a».a' ., <y _:e'�.�...., -.,� '�re;: . ^ :,.:� �. -
Address:
�S� al of Ql A (���' Please refer to fee schedule.
City/State /ZIP: ..1,te..1.0 el ca, q '3 `y-
2 � �" Fees due upon application
Phone: ( S) go .. 3.1 Fax: (503) 55g "(C,7,3v
Amount received
. , CCB lie.: I 4066 9 7 / 340
I �,��\� ��,,.� Date received:
Authorized signature: C��,�`I` This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: t 1iy tl y \ (::; S Date: I '? oil * Fee methodology set by Tri Building Industry
I Service Board.
1:\ Building \Permits \BUP- PermitApp. doc 12/03 440- 4613T(1 l /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Ti and Received
Permit y g Date/By: Pert No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 / t iNlo \ t'
❑ Electrical ❑ Plumbing ❑ Mechanical
24- Hour Inspection Line: 503.639.4175, -.f
(
Internet: www.ci.tigard.or.us "' ❑ Other:
. THE FOLLOWING ITEMS ARE REQUIRED FOR.PLAN REVIEW • • , Yes, No ..,,N /A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat /lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. . • ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc. .
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and /or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑. ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the .roject.under review.
• JURISDICTIONAL SPECIFICS •
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must,meet criteria outlined in the Permit &' System Development Fees document. - , ❑ ❑ ❑
27 "Drawn to scale" indicates' standard architect or engineer scale. .. , ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree'plan (if applicable), arid of Tigard ❑ • ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ n ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑.' - ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to exist ; irig residential dwellings •
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One - Two - FamilyChecklist.doc 12/03
.
Electrical Permi .1,i :,o~ ' E 1;1.7 D FOR OFFICE USE ONLY
City of Tigard - - Received Permit No. , / 0037
Date/B . 5 >' �
13125 SW Hall Blvd., Tigard, OR 0 Q no Plan Review M
Phone: 503.639,4171 Fax: 503.5 960 (J / /a iii *P +r m �<< : � Date/g Other Permit:
Inspection Line: 503.639.4175 J ' � Date Ready/By: turfs: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
BUILIM bt>r PLAN REVIEW
❑ New construction A A ddition/alteration/replacement Please check all that apply:
El Demolition El Other: ❑Service over 225 amps, comm'I ['Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
l - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
El Multi El Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
❑Health -care facility ❑fie:
Job no.: Job site address:
59 75 s'(,..3 k m4 . K G r Submit 2 sets of plans with any of the above.
City/ State/ZIP: aR-17 Cr The above are not applicable to temporary construction service.
I_` - I FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: Pi ife V.-f `i
S 1 Z n cA Description I Qty. I Fee. I Total I "
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
�n ��� ' t t 4.7 Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
f'4' PROPERTY. OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: CD 6 A f2j 601 amps to 1,000 amps 240.60 2
Address: (,5 9 2_6 5 C,,) A `de. >rr b <ra e7 c, t ve Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: I ,Aio_ jc , ®V' Temporary services or feeders installation, alteration, and /or
relocation
Phone: (5n 3) t , Z (1 Z-7 Fax: ( ) 200 amps or less 66.85 1
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 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
. V APPLICANT CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name:----� B. Fee for branch circuits •
l d m 0 without service or feeder fee, P 46.85 2
Address: 35 / 5.5 IA ) f i I R e add' anch circuit
iC >C1C`j VII I !L Each add'1 branch circuit 6.65 2
City/ State/ZIP: �€N..s a-L, 0.,r Miscellaneous (service or feeder not included)
Fax: (
Phone: (,3) (! , 2, j '
� c� r (, C� L cam, �
Pump or irrigation l lighting 53.40 2
`1 � / f `� Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name:
��� _ extension. Describe: Page 2 2
Address: 5 a- �� ~D�be-a.4_0" Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: ;>I-t__1:) 00.1 CZ7 ( -t 3-Sc Investigation per hour (thrmin) 62.50
Phone:
� ) v , Industrial plant per hour • 73.75
Q . O / Fax ( ) ELECTRICAL PERMIT FEES*
CCB Lic.: lqs lob (Electrical Lic.:96 / 9 e Suprv. Lic.: 4 430 5 Subtotal
Suprv. Electrician signature, required: 1f' /0ll to(I (eV Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
\ c),SZ.,---a TOTAL PERMIT FEE
Authorized signatur This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: e, ir) =3 S 60 / f) h ,eit\t" Date: i Z Jt/ * Fee methodology set by Tri- County Building Industry Service Board
•' Number of inspections per permit allowed.
i:\Building\Permits\ELC-PennitApp.doc 12/03 4404615T0 0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other: •
rCOMMElRCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other `, - •
Total number of commercial systems:
*No licenses are required. Licenses are required •
for all other installations
is\ Building \ermits\ELC- PennitApp.doc 04/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ALL PRO ELECTRIC INC
5224 SW DOSCH ROAD
PORTLAND, OR 97201 -1255
Electrical Signature Form
Permit #: MST2004 -00375
Date Issued: 12!14/20004
Parcel: 2S111 DC -01800
Site Address: 15925 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8
Block: Lot: 465
Jurisdiction: TIG
Zoning: R -7
Remarks: 80sf. patio enclosure.
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:
AHERN, O.E. ALL PRO ELECTRIC INC
15925 SW ALDERBROOK CIR. 5224 SW DOSCH ROAD
TIGARD, OR 97223 PORTLAND, OR 97201 -1255
Phone #: 503 - 624 -1127 Phone #: 503 - 246 -0361
Reg #: LIC 148108
ELE 26 -1099C
SUP 4630S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X —.LE/ 0
Sig ature of Sup7rvising Electrician
•
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004- 00375
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/14/2004
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 '!J
INSPECTION WORKSHEET FOR DATE: 6/16/2005 TIME: 7:10AM PAGE: 48
SITE ADDRESS: 15925 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.8 LOT #: 465 TYPE OF USE:
'PROJECT NAME: AHERN
DESCRIPTION: 80sf. patio enclosure.
OWNER: AHERN, U.E., PHONE #: 503 - 6241127
CONTRACTOR: SCHULZ CONSTRUCTION, PAUL PHONE #: 503-320-3149
Inspection Request Scheduled For: Date: 6/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 009445.02 503 -320 -3149 Y
Corrections /Comments /Instructions:
M PASS ❑ P. r IAL APPRi t L • ❑ CANCEL ❑ NO ACCESS
❑ FAIL 1/,' ALL FVA"' ION ❑ ADDITIONAL FEES SSESSED
Inspector: X / `/ `� Date4 Phone #: (503) 718 7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00375
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12114/20044
Phone: (503) 639 -4171 � "' j
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' `
INSPECTION WORKSHEET FOR DATE: 6/16/2005 TIME: 7:10AM PAGE: 53
SITE ADDRESS: 15925 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.8 LOT #: 465 TYPE OF USE:
PROJECT NAME: AHERN
DESCRIPTION: 80sf. patio enclosure.
OWNER: AHERN, O.E., PHONE #: 503- 624 -1127
CONTRACTOR: R SCHULZ CONSTRUCTION, PAUL PHONE #: 503-320-3149
Inspection Request Scheduled For: Date: 6/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # - Message
199 Electrical final 009445-01 503 - 320.3149 Y a7
Corrections /Comments /Instructions:
. C V`rec54 p% '0-7 - --1-4 ---- ...----- 6 94 t
r -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL i ALL G TI c I El ADDITIONAL FEES ASSESSED
A ri , � 6 / o Inspector: Date: Phone #: (503) 718-c.,,-).-