Permit 'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2000 -00177
11i4c DEVELOPMENT SERVICES DATE ISSUED: 05/30/2000.
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134CB-01300
SITE ADDRESS: 12280 SW SUMMER ST
SUBDIVISION: SUMMER HILLS PARK ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ACS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:'
OCCUPANCY GRP: R3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: 5 ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: 15 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: .
VALUE: $ 9,863.04
Remarks: 528 SQ FT POLE BARN
•
Owner: Contractor:
BURKE, MARIE C /RICHARD D OWNER
12280 SW SUMMER ST
TIGARD, OR 97223
Phone: • Phone:
Reg #:
• FEES REQUIRED INSPECTIONS .
Type By Date Amount Receipt Footing Insp
PLCK BT2 05/11 /200C $38.51 0002101 Framing Insp
Rain Drain Insp
PLC2 GEO 05/30/200C $42.09 0002519 Final Inspection
PRMT GEO 05/30/200C $124.00 0002519 OG1NAL
5PCT GEO 05/30/200C $9.92 0002519
(additional fees not listed here)
Total $254.52
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permitee I / / 4 /Z_Eje .
Signature:
Issued By: /_
Call 639 -4175 by 7 p.m. for an inspection the next business day
CI T Y OF TIGARD Residential Building Permit Application Plan Check # - ?/ 1�
13125 SW HALL BLVD. Additions or Alterations Recd By g- E7
Date Rec'd 5-t ( - CO
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. S - /s - ti
V 503 - 639 -4171 Date to DST S -1 6
F 503 - 684 -7297 Permit# u &GOO•00 / 7 7
Print or Type Called 361%
Incomplete or illegible applications will not be accepted �:/ .
Name of Project Name
Job ®W 10 I,---k Architect Mailing Address
Address S i l te Address r t
1 2a- D S V) S Ur4}-t -irR City /State Zip Phone
Nispet cm- -o R 0... Name
Owner Mailing Address
1 •0 -2?o S do So m.4-44;71L
City/State rn, ` Zip P Engineer Mailing Address
! ' ‘i.1•� 97 5 -SUS'
City /State Zip Phone
General Name
Contractor 0 t/. ..1 fZ Describe work Ne Addition 0 Alteration 0 Repair 0
Mailing Address to be done:
Prior to permit Additi�al Descriptipyt oS�W9r�C: � 4
issuance, a copy City /State Zip . Phone 0e E._ �� �V
of all licenses
are required if Oregon Const. Cont. Board Exp. Date PROJECT
expired in COT Lic.# VALUATION ` 43. — d (..- :__-
database
Mechanical Name NEW CONSTRU TION ONLY:
Sub- Sq. Ft. House: Sq. Ft. Garage
Contractor Mailin• • ddress
Prior to permit � - Indicate the restricted energy installation by the electrical .
issuance, a copy City /State Zip-' Phone subcontractor in the following areas
of all licenses Restricted Audio /Stereo
are required if Oregon Const - Cont. =•ard Exp. Date Energy System Alarms
expired in COT Lic.# j Installations Vacuum Irrigation
database System System
Plumbing Name (check all that Other:
Sub- apply)
Contractor Mailing A ress Corner Lot YES NO Flag Lot YES NO
// (check one) (check one)
Has the Subdivision Plat recorded? N/A YES NO
Prior to permit City/Stat Zip Phone
issuance, a copy
of all licenses are Oregon Const. C nt. and Exp. Date
required if Lic.#
expired in COT 7 I hearby acknowledge that I have read this application, that the
database Plumbing "L'ic. # Exp. Date information given is correct, that I am the owner or authorized agent
of the owner, and that plans submitted are in compliance with
Oregon State laws. ! . - -
Name i • - re of Owner!' • e��-� —i(_ 4v
Electrical
M a ilin• • ddress C. • - t Person Name Phone #
Sub- t. (i�..1� R)uuz rtz 596 -3
Contractor .
City/State Zip Phone
Prior to permit /"
issuance, a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const. •nt =bard Exp. Date
Plat #: ,� Ma �TL #:
required if Lic.# 5ant/41.4 - f - '/ I y - �pe6'a13 O 6
expired in COT
database Electrical Li . # Exp. Date Setbacks: Zone:
R - y. 5 g.
Electrical Supervisor Lic. # Exp. Date Engineering Approval: Planning Approval: TIF,
Q r, efi is \dsts \forms\sfaddalt.doc 11/20/98
• Permit #: 23 g P oZ OCO — 6 d/ 7F
• F
4 /,.0 . 4.; - e : - . .F So ,.O 5v 6 / ��
f.. c..�, Address: a
Issued by:6'7fU Date: '> ( DC)
1 5
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required '
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
0 . 1. I own, reside in, or will reside in the completed structure.
n I ` 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
I \ before or upon completion.
n 3A. My general contractor is
I 1 (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I 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.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
1- ‘4 11 (ie '''. C" .5 —3 (-)
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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PLAN CHECK FEE
Plan check # S -341 tk Permit la4P201 OU / I Date `f /
Address /A a irtl 3 w �/�/ Su h� M N 3 7 Tax Map # / 5/3 ../ C B - O(.3 G v •
Sub. ( 1 '11M dl �lill Lot # . / Z- Land Use R y• ;—
Valuation .9 963. - Set back fro Back 1 ) Left 5 Right
•
Work class A X v. Height / Z Total Area
Use Type S F Floor load 1 Floor •
Const Type 3 N Heat type 2 Floor
•
Occupy Group 12. -3 Dwell Group • 3 Floor
Stories / Bed Rooms Basement •
Deck Bath rooms Garage S. 8
Permit # Description Amount Amount paid Bal Due • ■
Building Permit /2 y• / L 7 •
Plumbing Permit •
Mechanical Permit
Electrical Permit
•
State Building Tax
Building 9.4 t
Plumbing
Mechanical •
Electrical
Total ' 9. 4 • 9 f
Plan Check Fees
Building B O 3$? S 412 9 •
CDC t/a 4 1 v, by
Parks
Residentical Tiff
Mass Triffic
Water Quality
Water Quantity
. • Erosion Control Plans
Erosion Control USA •
• Erosion Control COT
Sewer Inspection
Sewer Permit
TOTAL c? 5 Z 3 e rl o2/& G/
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Customer Receipt
CITY OF TIGARD Printed: 05/11/2000 14:40
User: front
Station: 02
Operator: KIP
Rcpt No: 0002101 Date: 05/11/2000
Customer No: 000000 Amount Due: 38.51
Name: RICHARD BURKE Cash: • 0.00
Address: 12280 SW SUMMER ST Check: 38.51
TIGARD, OR 972233231 • N/A 0.00
Change: 0.00
Type Description Amount
BUPPLN Building Plan Check 38.51
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fla,„ 4 5-3t(K
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