Permit I Q ��
�
y r - ct ii „ d 6 1 MASTER PERMIT
CITY F TIGARD PERMIT #: MST2004 -00192
f �I�+,� DEVELOPMENT SERVICES DATE ISSUED: 7/9/2004
°.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14560 SW CATALINA DR PARCEL: 2S105DA -17500
SUBDIVISION: PACIFIC CREST ZONING: R -7
BLOCK: LOT: 063 JURISDICTION: TIG
REMARKS: Convert 20x12 crawl space to storage.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: AOS HEIGHT: FIRST: sf BASEMENT: 240 sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 0 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 7,656.00
OCCUPANCY GRP: BDRM: BATH: TOTAL: 0 sf REAR: 15
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: 1 0 - 200 amp: W /SVC OR FOR: 00 PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC!FDR: co 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 TOTAL FEES: $ 344.78
This permit is subject to the regulations contained in the
BUNKOFSKE, RAYMOND & MARY RIVER CITY BUILDING COMPANY Tigard Municipal Code, State of OR. Specialty Codes
14560 SW CATALINA 2251 NE 33RD AVE and all other applicable laws. All work will be done in
TIGARD, OR 97223 PORTLAND, OR 97212 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 - 590 - 2649 Phone: 503 460 - 2579 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: L1C 119645 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
Electrical Rough In
Framing Insp .
Electrical Final
Final inspection
Issued By : / ' _. Permittee Signature : �� �, s , /��
Call (503) -4175 by 7:00 p.m. for an inspection needed t next business day
,.
Building Permit Application a ��� FOR USE ONLY
City of Tigard
ReceiveDate/By: /� d ,�
Permit No.: , /J'l / dG
6it9� dU
;) D /q 7 �
13125 SW Hall Blvd., Tigard, OR 97223 I' , I d 2O Plan Review
Pho 503.639.4171 Fax: 503.598.1960 urt I Date/By: P� A v 7 1- °(.1 Other Permit:
Inspection Line: 503.639.4175 OF TIGAF.�
CI Juris: ® See Attached Checklist for
. � a� �'' 't „ Date Ready/By: �° Notified/Method: 1 6I I Supplemental Information
Internet: www.ci.tigazd.or.us BUILDING DIVISION Pp
.. REQUIRED DATA:,1- AND 2 -FAMI LY.DW.ELLING .
❑ 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
- . a CATEGORY OF CONSTRUCTION - _ work indicated on this application.
® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $7656
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
• - - • - JOB SITE INFORMATION AND LOCATION. - - - - - Total number of floors:
Job site address: 14560 SW Catalina Drive New dwelling area: square feet
City/State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
_ Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Barrows to Melnor to Fern to Catalina, 2 house from Deck area: square feet
top of hill
Other structure area: 240 storage square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Pacific Crest Lot no.: 63 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.: Property ID from Portlandmaps.com = W395989 equipment, materials, labor, overhead, and the profit for the
_ = . ' 'DESCRIPTION OF WORK- . , r _ ' work indicated on this application.
Valuation: $
Build storage room approximately 20 x 12 in existing crawl space
Existing building area: square feet
Add sub -panel and outlets to existing basement
New building area: square feet
frvi N) SUS CA-` AQ S 1 ( a � -C�C.< �U 1 C' Number of stories:
. . ® PROPERTY .OWNER _ ❑ TENANT
Name: Raymond Bunkofske & Mary Brooks - Bunkofske Type of construction:
Address: 14560 SW Catalina Dr Occupancy groups:
City/State /ZIP: Tigard, OR 97223 Existing:
Phone: (503)590-2649 Fax: ( ) New:
-
. - ® APPLICANT — 7 . . _ . _ . 0 .CONTACT PERSON _ - _,_ �. . __ .. _ .—No—TICE -
Business name: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: Ray Bunkofske under ORS 701 and may be required to be licensed in the
Address: 14560 SW Catalina Dr jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: Tigard, OR 97223 apply: P / . 1 d
Phone: (503) 590-2649 Fax: : ( ) / (.0 7
E-mail: vt_sailor @earthlink.net 1---- �p/
_ _ • _ . . -- CONTRACTOR - - - - —1...D 7. 77
Business name: River City Building Company BUILDING- PERMIT FEES *_ - -
Address: 2251 NE 33 Ave Please refer to fee schedule.
City/State /ZIP: Portland, OR 97212 Fees due upon application
Phone: (503) 460 -2579 Fax: (503) 460 -2579 Amount received
CCB lic_,;1] A64&- / c / t / �
n � Date received:
Authorized signature: P:/ , This permit application expires if a permit is not obtained
/ ��� .,. r � / � within 180 days after it has been accepted as complete.
Print name: Mary M rooks - Bunkofske Date: 6/28/04 * Fee methodology set by Tri- County Building Industry
Service Board
Electrical Permit Ap.p,lication5D ,. .. FOR OFFICE USE ONLY
..:: .,. , ...
. .. - '. , • ''. • ' -
htL 1 -=- 1
City of Tigard
A„„„,,,,a,A D R e c e e m i v e d
Permit No.* s _ ....,
13125 SW Hall Blvd., Tigard, OR 97223 t ., 0 VII Plan Review ,
Phone: 503.639.4171 Fax: 503.598.1960A 4, 0 L i d. itivi Date/B : Other Permit:
..9-)"
Inspection Line: 503.639.4175 n -Lial.. e l' . Date Ready/By Juris: RI See Page 2 for
Internet: www.ci.tigard.or.us nc TIGIVIu- — ' Notified/Method:
GM N ''' ....„11C1C1N1 Supplemental Information
ntttrrtRZSISIAM:trWARM741PfIMSNEarM 10-gig,3Min*INKL100#:;::::":.' -.- . ..
0 New construction [ j Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l E Hazardous location
Ej Demolition EJ Other:
_ EService over 320 amps - rating EBuildng over 10,000 sq. ft.,
:
4:MarAk V' I N 5 P of 1- and 2-family dwellings 4 or more new residential
:: z,i4.,-,,r, .,; -,11,,, 'A,.,:k4
1- and 2-family dwelling 11 CommerciaUindustrial 0 Accessory building
['
Multi-family 0 Master builder 0 Other: System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
Li DOccupant load over 99 persons 0 Manufactured structures or
lita.11941010141:40W- 0Egressnighting plan RV park
IDHealth-care facility ['Other:
Job no.: Job site address:
Submit 2 sets of plans with any of the above.
City/State/ZIP: A 4 6 0 .,-.) v j 0.,2,...e,J , The above are not applicable to temporary construction service.
liik4 " • - '
Suite/bldg./apt. no.: Project name: , ::'
Description Qty. Fee. Total "*
Cross street/directions to job site: 0, 'L
..._ New residential single- or multi-family dwelling unit.
\M-._D '''' \ -C) - 5----- Includes attached garage.
0 0,&,k,, 9.- s\-e_.,-p 1,000 sq. ft. or less 145.15 4
Subdivision: Pag_ --.. „- e,,,,,----- Lot no.: ( -3 Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.: .
,, _ ,_ ,,, _ Limited energy, non-residential 75.00 • 2
ggY.ati''2:;SaNar?44;gR-V4iqiMfiia:*ti:" 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
3tffkWVISf.rtfAikf,Vro4Tsfffei<;Srde ASIVO,,::;.ciTiegM'ip:; i711m:Z;ya,mi 201 amps to 400 amps 106.85 2
T% 24,„.7.+Ag'.;;' x Ait NiVI.k.d.g44V '!', 7'!'41, .s.,j4. 401 amps to 600 amps 160.60 2
Name:
^c”) Inck- (6, .. Ne. `N.- ‘1\44 4 , 4 .LI amps to 1,000 amps
?` 240.60 2
Over 1,000 amps 454.65 2
Address: ILA (00 - \),) 02, o.,.. or volts
Reconnect only 66.85 2
City/State/ZIP: 77 cic)..r..,9k 0 ) (Z Q‘7 a ._3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( 5'0) 5 - ..-. a 6 , ,. 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: ..tt/' .7" , Z e -144; ) --4...- Date: 6 -,, - .6)4/ Branch circuits - new, alteration, or extension, per panel
a i:•'irn:ir'riaeAtfi:A=WVV;Al itri*MPrOf-651,,ialagigari:-* A. Fee for branch circuits with
t6 watt: y4 r,gi,6,:''.V4Nliilk.,:,,:,e,.....,:.i4;t,,„„t„.,.,,,,,Q.:i.-.4jy .,'
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name:
L
")- ke)
without service or feeder fee,
each branch circuit 46.85 2
0
Address: 14 54 c , ..e 0 (
: - 1 ,--.. 6:: • Each add'l branch circuit 6.65 2
City/State/ZIP: -- 7"' j ga._ c?"-? a__---S Miscellaneous (service or feeder not included)
/ Pump or irrigation circle 53.40 , 2
Phone: ( 50 ) . - t 9e,, q 9 Fax: : ( ) Sign or outline lighting 53.40 2
E \J , , 1 ,, 3 :- 1 \-- Signal circuit(s) or limited-
a' adVSMOe4FREM,WWit4:14.2k energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 4
- 1.7.
"N .t. Each additional inspection over allowable in any of the above
Address: ag --) n . 0 aak ...2.- v . \) ,._ . „ ( i . „ ...1 -1/4 Ro3
Per inspection 62.50
City/State/ZIP: 6 \■■,0,29,..,0 / 012..... Or CD-3 Investigation per hour (I hr min) 62.50
/ Industrial plant per hour 73.75
Phone: ( 57)3) (act a l bc Fax: (5V3) t 4 _ ,-. ‘ 3
fMtTnagin
CCB Lie.: Electrical Lie.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
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.
iABuilding \Pernits \ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAti,WORK. ().NAY:`,
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ Burglar Alarm
Opener*
G arage Door O
❑ g P
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
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
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Building\Pemtits\ELC- PermitApp doc 04/03
08/30/2004 14:04 5036425815 ROSS ELECTRIC INC PAGE 01
08/30/2004 13:51 FAX 5035981960 CITY OF TIGARD 1
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
RECEWED
IMPORTANT PERMIT NOTICE AUG 3 U 2004
ROSS ELECTRIC INC CITY OF TIGARD
2870 SW 221ST AVE #203 BUILDING DIVISION
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2004- -00192
Date Issued: 7/9/2004
Parcel: 2S105DA -17500
Site Address: 14560 SW CATALINA DR
Subdivision: PACIFIC CREST
Block; Lot; 063
Jurisdiction: TIG
Zoning: R -7
Remarks; Convert 20x12 crawl spare to storage.
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:
BUNKOFSKE, RAYMOND & MARY ROSS ELECTRIC INC
14560 SW CATALINA 2870 SW 221ST AVE #203
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone #; 603 - 590 - 2649 Phone #: 503.642.2800
Reg #: LIC 157891
ELE 34 -436C
SUP 42325
AN INC SIGNATURE IS REQUIRED ON THIS FORM
X rb
Signature of Supervising Electrician
If you have any questions, please call 503/18.2433.
A7, 5o3 591- )9/00
CITY OF TI_CARD 24 -Hour
BUILDING ` Inspection Line: (503) 639 -4175 MST ,;760 y bOl 9D
INSPECTION DIVISION ' Business Line: (503) 639 -4171 - - -
BUP
Received / Date R uested ( AM PM BUP
Location / 7 �4p Suite MEC
Contact Person a-7 a 4 Ph ( ) s ! ` a �' c1-5 PLM
Contractor Ph ( ) 7 7 l 7.7 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Insp ction Notes: Y— L �� - SIT
Post & Beam � J �, J�
Ext Shear Sheath/Shear th / ear 9 DG -C
Ext eah/h �� --Q-Q
Intlnt Sheath/Shear
Insulation
Drywall Na ing
Firewall
Fire Sprinkle
Fire Alarm
Susp'd Ceilin.
Roof
other
, PASS *ART FAIL
L L MBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
Ai(j
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ff
Approach/Sidewalk Dat l� ~l �1 —v 7""^ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL