Permit A - CITY OF TIG A RD MASTER PERMIT
PERMIT #: MST2005 -00065
� , . l��l� DEVELOPMENT SERVICES DATE ISSUED: 3/3/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 CC -05600
SITE ADDRESS: 10040 SW CENTURY OAK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD LOT: 079 JURISDICTION: TIG
REMARKS: Addition of 14' x 15' den. Other mechanical is duct work. Fee included in BUP - MAV
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 11 FIRST: 210 sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT:
VALUE: 25,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 210 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: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
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/FOR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 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:
Owner: Contractor: This permit is subject to the regulations contained in the
GUNZENHAUSER, ROBERT G + MARI PRO LINE CONSTRUCTION INC Tigard Municipal Code, State of OR. Specialty Codes
10040 SW CENTURY OAK DR PO BOX 87 and all other applicable laws. All work will be done in
TIGARD, OR 97224 BANKS, OR 97106 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.
ATTENTION: Oregon law requires you to follow rules
Phone_: 503 968 - 7180 Phone: 503 324 - 3400 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
Reg #: LIC 105694 952 - 001 -0080. You may obtain copies of these rules or
TOTAL FEES: $ 588.71 direct questions to OUNC by calling (503) 246 -6699.
REQUIRED ITEMS AND REPORTS
Issu d By : Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business 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 Application '' FOR OFFICE USE ONLY. .
City of Tigard Received Permit No �� / /
City Date/By: 5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. //J OJ
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 ° Date Ready/By »�� +C] See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: l /� Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ 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
CATEGORY OF CONSTRUCTION work indicated on this application.
@ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $25,000
Number of bedrooms:
❑ Accessory building ❑ Multi - family
❑ Master builder ❑ Other: Number of bathrooms:
. JOB SITE- INFORMATION' AND LOCATION Total number of floors: 1
Job site address: 10040 SW Century Oak drive New dwelling area: 210 square feet
City/State/ZIP: Tigard Oregon Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Den Covered porch area: , square feet
Cross street/directions to job site: SW Summerfield / Century Oak dr Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST'
Subdivision: Summerfield Retirement Village Lot no.: 05600 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: ISI -1CC equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Addition of 14' x 15' Den Valuation: $
Existing building area: square feet
New building area: square feet
' El PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Bob Gunzenhauser Type of construction:
Address: 10040 Sw Century Oak Dr. Occupancy groups:
City/State/ZIP: Tigard Or. 97224 Existing:
Phone: (503 -)968 -7180 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Pro -line Construction Inc. All contractors and subcontractors are required to be
Contact name: Vincent Reichow licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: Po Box 87 jurisdiction in which work is being performed. If the
City / State/ZIP: Banks Or. 97106
applicant is exempt from licensing, the following reasons
apply:
y
Phone: (503-324-3400) Fax: : (503) 324-2042
E -mail:
• CONTRACTOR. .
Business name: Pro-line Construction Inc.
BUILDING PERMIT FEES*
Address: Po Box 87
Please refer to fee schedule
City/State/ZIP: Banks Or. 97106
Fees due upon application
Phone: (503) 324 =3400 Fax: (503) 3242042
Amount received
CCB lie.: 105694 ii I I OS
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , Date: 2-24-05 * Fee methodology set by Tri -County Building Industry
Spry; PP I2narrl
Electrical Permit Application ;y FOR OFFICE USE ONLY.
F
City , of Tigard
•
Received
r/ Date Date/13 PermitNo.: `, fir 4014 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 77
Phone: 503.639.4171 Fax: 503.598.1960 / uidl V I Date/By: Other Permit:
Inspection Line: 503.639.4175 u'�'' Date Ready /By: �Jurts: a See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK . PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition In Other: ❑Service over 225 amps, comm'I ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
1=1 Multi ❑ Master builder ❑ Other:
['Occupant load over 99 persons El Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
�j,, ^, ❑Health -care facility ❑ Other:
Job no.: Job site address: 1® S IR) Ce�1 J (, Q K pc... Submit 2 sets of plans with any of the above.
City/State /ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE **
Description Qty. Fee. Total
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'l 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
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 1=1 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: k) ackAze.) 7\c(vse c- 601 amps to 1,000 amps 240.60 2
Address: 1 004 b W NL r - ■_c; Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: 1 - Z t? L 7 22A Temporary services or feeders installation, alteration, and /or
Phone: (5b ) 1 I Fax ( ) relocation 00 amps 7 200 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
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, l
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
C extension. Describe: Page 2 2
Business name: ,Ql•� 1 (2...t.3 G t.3 L
Address: i17:7 e �/ l l g r Each additional inspection over allowable in any of the above
/� Per inspection 62.50
City/State /ZIP: Po _T L t4 es1 D2 ql 7 'a? Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: i 65g5
- 6 Electrical Lic.: - Y'O /C Suprv. Lic.:4,11,15 Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
i:\Building\Petmits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COMIWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
I I Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
U Audio and Stereo Systems
n Boiler Controls
Clock Systems
❑ Data Telecommunication Installation
PI F ire Alarm Installation
n H VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n N urse Calls
Outdoor Landscape Lighting*
❑
•
Protective Signaling
❑ Other
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
c\ Building \Pennits\ELC- PertmtApp.doc 04/03
Mechanical Permit Application ' 1 ° .- ' FOR OFFICEUSE ONLY ''t' " •
City of Tigard Received permit No.: ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 it 1Nt k DateB Other Permit:
Inspection Line: 503.639.4175 fi ll e
c. � D ate ReadyBy: 8 See Page 2 for
�
Internet: www.ci.tigard.or.us "''"
g Notified/Method: 6 Supplemental Information
tr a _... _,�., -.. e
�.`.- z;-- �' r . Vim ":u^ "hilt ,L b' r : , r r �. .- : -.= . :a-,,z... - 3
4,:t :. >. T PT ; OFkWOR K *t y �T G ,- :- -- C : ,;,: �R EE * SC `'T
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,:�" .'sg qz�." : Y"-ya �, .-� x ^, +,as'a 'S';:ifit�� :. _
"..�, sue+#- m>r�sat�,,:.'vx :�::.;. � , y am* "'*�, 'k ° ± �. Value: $
. .
. w � CATEGOXfi13_F' COPIST$ilCi'IO _
a ,, ,, ".. ` :.,. �r
q :'s ,;. .,.e..... ;:, .,,"..r h . . ,.,<- .v;re" k..az a,' ..c. ° ." xa . .'rt .,- . ' c; ,Pd i ::: rt u. lYIE x.',, ,:z ::,
f * ;. *
111 1- and 2-family dwelling Commercial /industrial pi i1; - DEN A
A,, p . , , = , P. iVTi / FEES
y g ❑ ❑Accessory building
Master builder For special information use checklist.
Mulri - famil
❑ Multi ❑ ❑Other: Description Qty. Ea. Total
3 •4 �:. ,,;''''` x �'§ tr N1®RMATIO ;.D TON i ` 'v i � i• ag d g/ g
� 4A..asL.trt � ; . °" °�sw..�'�w r�e-fftx� . -.� - =�� Heatln COOhn
Job site address: / �� oc� eg } JLj y Q ` -D 2 . Air conditioning or heat pump
l '_ r (requires site plan showing placement) 14.00
City/State /ZIP: Furnace 100,000 BTU (ducts /vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts /vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00 •
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
111,1 DESCM•ifOI , OF WORKi M ?`§ 0: l Water heater 10.00
�, ' _ Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
' Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
F ,. ,, . ,, r, £ 4; . 4,i +,. ,_'. -�::_ > ;f;; : Chimney /liner /flue /vent 10.00
' �,t ',m � ,ER' i ; . :t ;fit - r €,'. sTeE1\NANT . '... ,
�h...a �- Other: 10.00
Name: � u N `> , C,�. Environmental exhaust and ventilation
Address: /� Range hood /other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) - toilet compartments, utility rooms) 6.80
:;.,; , , ,s x? �. � ; .; 'r .!�.,.t`�;�e� ;am .' ". ..:tl.s W: ",�-..> sv - r° oft4 :r �;.mi , , .�aq,,, , ,mv, ; ;.;, .- 10.00
�x
�S�r � - A pRC � f Attic /c rawls p acefans
� ._�.�'` s ,�.: y _, , ,, CONTA — TE R ON` • r- >.
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump •
City/State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: • Range
.,s° _ • j a xtgm � .M , t CO TRACTOR a ° ° i S ' ' ? . Barbecue
s~ a"��'��'"�� �SSz .�i�z� te ��,u �,_ �,�.��
11 O — I , /--v " ( Clothes dryer (gas)
Business name: IG Gam-- 1V
Other:
Address: ; t: ,.I-T a ,;, ,;,�- w', -ir >
��;aw'" E.CHANTGAI)PER1yTPT,RE'ES*'x .
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete,
Print name: e 3 C�Y`A� L I. Akeojk Date: * Fee methodology set by Tr - County Building Industry Service Board
i.\ Building \Permits \MEC- PermitApp.doe 12/03 440 -4617T (I1 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information
Commercial Fee Schedule:
ota1 Va=luaion ';`r; ,q Permit Fees ; "; . ..�.
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the fast $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including' • • •
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including .
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof
Note: All new commercial buildings require 2 sets of plans.
•
•
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
Electrical Signature Form
Permit #: MST2005 -00065
Date issued: 3/3/2005
Parcel: 2S111 CC -05600
Site Address: 10040 SW CENTURY OAK DR
Subdivision: SUMMERFIELD
Block: Lot: 079
Jurisdiction: TIG
Zoning: R -7
Remarks: Addition of 14' x 15' den. Other mechanical is duct work. Fee included in BUP -
MAV
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
GUNZENHAUSER, ROBERT G + MARIA E SQUIRES ELECTRIC
10040 SW CENTURY OAK DR PO BOX 16851
TIGARD, OR 97224 PORTLAND, OR 97292
Phone #: 503 - 968 -7180 Phone #: 503 - 252 -1609
Reg #: LIC 135085
ELE 26 -1101C
SUP 4882S
AN INK SIGNATURE IS REQUIR , = ON THIS FORM
X .// -
Sign. re • Supervising Electrician
If you have any questions, please call 503.718.2433.
t
Mar. 2. 2005 9:05AM CLEAN WATER SERVICES 503 6814439 No.5564 P. 1
(
i File Number FS-00063e FER242005
ClcanWatc.r \ Sc.rvicES
our cm
u,nitment is clear. Sensitive Are Pre- Screening Site Assessment
Jurisdiction 74 - Date 2-24-0q Map & Tax Lot 1 5 .. cot_ t � Owner lib_ Cwirl, hause.P - -
_ & 4 4 a- o 1..,00 Contact Atir c6 ®w Site Address O eage, st�o ter ai f Ogg, _ Company 0 Cake C a° euc }etM ‘
licfl 2. ell2Zg( Address ga gait an
Proposed Activity Agije$i53 of- at® City State Zip
SeteftYJ. eitt 71t0'6
tqktr Dahl. Phone St03 -S 3
Fax M.3. -2
Official use only below this One
Y N NA Y N NA
LJ
n st l H ❑ Sensitive Area Composite Map ❑ n ® Stormwater Infrastructure maps
M # �d I f OS # '/6/?
❑ n Fp Locally studies or maps i ❑ Other
. J Specify Specify rctrZ ...
Based on a review of the above information and the requirements of Clean Water
Services Design and Construction Standards Resolution and Order No. 04 -9:
❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT
MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE
PROVIDER. If Sensitive Areas exist on the site or within 200 feet on adjacent
properties, a Natural Resources Assessment Report may also be required.
a Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect
water quality sensitive areas if they are subsequently discovered. This document
will serve as your Service Provider letter as required by Resolution and Order
04 -9, Section 3.02.1. All required permits and approvals must be obtained and
completed under applicable local, state, and federal law.
❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
P;Trhrla f/y 1en /,r,ve arm, Q./ yrcool To 4e /41,ta1rd
Reviewed By: _ . G'l. i (-4,e, 0 --- Date: 3/A/
Post -it" Fax Note 7671 oar° 3/ / S Ipag / Returned to Applicant
To From d4. k ackatxv Mail Fax y Counter
coJoe � 4 a [,ovt9T co. u).5 Date 3/2///1 ; Ry_
Pnonc a /' Pinola a $ - 6g/ 36io-
Fax LZit - ZGy 7. Fax 1
F .,
SU MERFIELD . ARCHITECTURAL CHANGE
C�v�C
AS SOCIATION REQUEST
* * * * * * * * ** PLEASE PREPARE IN DUPLICATE * ** * * * * * **
MANGE REQUESTED BY:
j E Date: t t 0— 5
Name: Ro r + L: t1 VV ' I sr ci ¢-' r !
_ Phone: C �- . j s
Address: , 1 ', 7 .+ :¢ ±° ' 3) i _ - ~'
I DESCRIPTION OF CHANGE
R .c .. f �rdr ad "'k o •ws .0 c-,,% -= ? , '-'7 -' ?.c, (..�'.1tI '. :_
CJ �'� f ` ' .y+ f t r
trl c1 . .• r ! I , - e : i r gyp. } i
c. � „ t , l: � 1 E ic I.� x i i .s .° ' -�- lt.., 1 l r '
T 1 of i l Cpl Y?, ! Ct .. �_ ,`'”) : f.11 P 1' P`' - r f 4 "" :_, .0 . / • .� :
4 ) f'*0 -.. Cc:) S C.a. C.a. a t' V7 c1i Fsf
':' . _I Lot i t .6 e C)F f O ° CJ ` °far)s in i . • : ! .;- , . ,:,., -_ r •
f
-" l .
PAINT: HOUSE: page # Column: • Color #
TRIM: page # Column: Color #
REQUIRENIEr TS
I . The homeowner must obtain approval. Contractors cannot do it for you
2. For structural changes, include a detailed sketch or drawing with dimensions.
3. For roofs or siding, include a sample of the actual produc t
4. For painting, include chip for each color you are applying.
5. For windows, include a sample of the frame color.
6. The homeowner and their contractor are responsible for obtaining required building permits.
7. Adjacent property owners may be interviewed by the Architectural Committee regarding the requested change and
they will be given a chance to voice objections.
S. This project must be completed within 120 days of date of approval. If not completed, a time extension giving
reasons must be requested from the Architectural Committee.
LEGAL CONDITIONS
Although the Board of Directors for Summerfield may review any and all aspects of a proposed Modification t
a residential unit in Summerfield pursuant to the Restated Declaration of Conditions and Restrictions for Summerfiel
Civic Association (the "Declaration "), no approval of the Board of Directors is intended or should be construed t
provide any representation or certification that the proposed plans, specifications, design, construction, engineering
modification or alteration is structurally sound, properly engineered, geophysically appropriate, legally or safel
constructed or built according to the applicable building code or land use laws and regulations. Neither the Board c
Directors, any member thereof, or the Association shall be liable to any owner, occupant, or other person for an
damage or loss suffered or claimed as a result of the construction, existence or failure of the Modification, or for an
other claim, demand, suit or action attributable to or associated with the Modification.
I agree to the above requirements and conditions. ALLOW 14 DAYS FOR APPROVAL
Properties abutting the golf course may take longer
Owner's Signature :
Date:
APPROVED REJECTED . BOARD OR COMMITTEE SIGNATURE DATE
Townhouse or
Condo Association
Architectural , / /�
Committee 1 OIL _' ,0,-.7 "._ D / //c/a- ,s
`" project completed Name: Phone
/TIFY:
Project signed Off: _- Date:
SEE REVERSE SIDE OF FORM FOR APPROVAL CONDITIONS AND LIST OF COMMITTEE MEMBERS
dAME & LOCATION ZONING LOTS PLAT SPECIAL NOTES
these lots. An esmt allowing the septic system for lot 7 on that portion of lot 8 lying east
of the easterly line of the 10' util esmt as depicted on plat.
Starling's Crossing R -12 11 86 -2,3 SUB92-0009. 8' PUE along all lots abutting public streets. Lots 5,6 & 7 have no access
onto Hall Blvd. Lots 7,8,9,10 & 11 have no access onto Bonita Rd. 10' priv storm drain
esmt on rear lot lines of lots 2 -5. 8' slope esmt along Tract "A", 15' storm drain esmt
between lots 6 & 7. All lots must access 83 Ct. only. 8' slope esmt along the west p.1. of
lots 5,6 & 7. 10' waterline esmt along the north side of lot 5. 10' priv SDE along the rear
p.l. of lots 2,3, 4 and a portion of lot 5. STREET OPENING PERMIT.
Steve & Hughie's Place R -4.5 37 35- 09,09A
Stratford R -4.5 71 41- 08,08A A 5' PUE on all side lot lines. 10' PUE on all front & rear lot lines.
Studio Estates R -7 4 49 -18 Lot 1 - 20' esmt for ingress & egress & utilities for lots 1 -4. Lot 3 - 10' storm sewer
esmt.
Summer Hill Park R -4.5 36 21 -41
Summer Lake R -7 (PD) 40 67 -23,24 Non- access 1' on lots 1 -4 and 37-40 onto SW North Dakota. Non - access 1' on lots 1 & 40
onto Springwood Dr. 15' public san sewer esmt between lots 5 & 6, 20 & 21. 8' PUE
along public streets. 20' public storm drain and san sewer esmt between lots 25 & 26. 15'
public san sewer esmt between lots 35 & 36. 10' storm drain and power line esmt at
rear /east prop line of lots 34 -38.
Summer Lake No. 3 R -7 1
Summerfield R -7 93 32- 50,50A Setbacks: For 50' x 80' lots - 10' front; 4' side; 8' rear.
Summerfield No. 2 R -12 94 -140 33- 39,39A All front & back lines of each lot or tract are to have an 8' PUE. The front lines are
subject to a 8' sidewalk esmt.
Summerfield No. 3 R -7 (PD) 141 -151 33 -44 All front & back lines of each lot or tract are to have an 4' PUE.
Summerfield No. 4 R -7 (PD) 152 -233 34- 05,05A All front & back lines of each lot have a 4' esmt & all side lines of each lot have a 2.5'
PUE.
Summerfield No. 5 R -7 (PD) 234 -294 34- 47,47A All front & back lines of each lot have an 8' PUE.
Summerfield No. 6 R -7 (PD) 295 -325 35- 19,19A All front & back lot lines have a 5' PUE,
Summerfield No. 7 R -7 326 -417 37 -1,1A All front & rear lot lines are subject to a 5' esmt & all side lot lines are subject to a 2.5'
PUB.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2006-00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/3/2006
Phone: (503) 639 -4171 �m�� %'J i t it.
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/19/2005 TIME: 7 :12AM PAGE: 98
SITE ADDRESS: 10040 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 079 TYPE OF USE:
PROJECT NAME: GUNZENHAUSER
DESCRIPTION: Addition of 14' x 16' den. Other mechanical is duct work. Fee included in BUR - MAV
OWNER: GUNZENHAUSER, ROBERT G + MARIA E, PHONE #: 503 - 968 -7180
CONTRACTOR: PRO LINE CONSTRUCTION INC PHONE #: 503 - 324 -3400
Inspection Request Scheduled For: Date: 5/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 007218 -01 971 - 663-8067 N
Corrections /Comments /Instructions:
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1
•
•
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (' Date/ Phone #: (503) 718 -
CITY OF TIGARD
. ,
1 BUILDING DIVISION PERMIT #: MST200S-00065
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/3/2005
Phone: (503) 639 -4171 /n ,�>r�i�p„��
Inspection Requests (24 Hrs.): (503) 639 -4175 .-_-_,61
INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE:
SITE ADDRESS: 10040 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 079 TYPE OF USE:
PROJECT NAME: GUNZENHAUSER
DESCRIPTION: Addition of 14' x 15' den. Other mechanical is duct work Fee included in BUP - MAV
OWNER: GUNZENHAUSER, ROBERT G + MARIA E, PHONE #: 503- 968 -7180
CONTRACTOR: PRO LINE CONSTRUCTION INC PHONE #: 503 - 324 -3400 p,
Inspection Request Scheduled For: Date: 6/13/2005 Pour Time: r,,yr
ice`
Code # Inspection Description Confirm # Contact # Message ,
299 Final inspection 009100.01 503-320 -1295 V
Corrections /Comments /Instructions:
IMP o �� wd -7 � G ZirL l D L -.
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►1 -ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL • / ALL FO' SPECTION [1] ADDITION L FEE SSESSED
Inspector: / ' L I/ Date �C . Phone #: (503) 718