Permit C OF T IGARD MASTER PERMIT
PERMIT #: MST2004 - 00006
trlov, DEVELOPMENT SERVICES DATE ISSUED: 3/26/04
4 ' - ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15657 SW SUMMERFIELD LN PARCEL: 2S111 DC - 04900
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 349 JURISDICTION: TIG
REMARKS: Add 176 sf addition living space.
BUILDING
REISSUE: CUSTOM STORIES: 0 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 176 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 16.262.40
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 176 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: 2 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/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 . 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. 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: $ 526.15
DUNLAP, WILLIAM J + MARIAN BRUCE ABRAHAMSON CONSTRUCTa Ti9 d u
M n is subject to the regulations contained C o i the
FIELD LN 12735 SW MARIE CT all other r applicable Municipal Code, State work k w Specialty Codes and
15657 SW SUMMER all other applicable l rov All work will be done i
TIGARD, OR 97224 TIGARD, OR 97223 t
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 adopted by the
Phone: Phone: 539 - 6790 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952- 001 -0080. You
Reg #: LIC 102637 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Crawl Drain /Backwater Insulation Insp
Foundation Insp Mechanical Insp Rain drain Insp
Post/Beam Structural Electrical Rough In Electrical Final
Post/Beam Mechanical Framing Insp Mechanical Final
Underfloor insulation Shear Wall Insp Building Final
Oa
Iss ed By : � !..�_.� OP Per mittee Signature : . ld /.. _ J.ti,.... _ /.
Call (503) 639 - 4175 by 7:00 p.m. for an inspect needed the next ■ ' s day
RECEIVED
I uil Pcrmit`ApplidANoi4 . . FOR OFFICE USE ONLY
Received Permit No.:
City of Tigard Date/By: / / — ' 8A ,6T�00 ODOD 6
13125 SW Hall Blvd., Tigard, OR 9720ITY Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598VEp1NG DIVISION ,td y� h � Ilil- Date/By: / '
Inspection Line: 503.639.4175 4iy. P' Date Ready/B . ) 33 2. Jn� ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: 01, Supplemental Information
— I- / /
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
Permit fees* are based on the value of the work performed.
❑ New construction ❑ Demolition 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. lb a(_,
Valuation: $ 4
151,1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi - family
Number of bedrooms: a
El builder ❑ Other: Number of bathrooms: a
JOB SITE INFORMATION AND LOCATION Total number of floors:
2C
/ 5 New dwelling area: 7 s Leer
Job site address: / s(p s7 5 /V Vl, ►�►,'r✓16 rg/ C.l1 L ei.
City/State/Z1P: 176 A f2- t] 4 7 2-244 Garage/carport area: square feet
0 Suite/bldg. /apt. no.: Project name: Covered porch area: 1 Z square feet
J Cross street/directions to job site: 4-Lb /3 e -LOOK t 0 rl b l..R►4AM Deck area: square feet
Q Other structure area: square feet
4 4 REQUIRED DATA: COMMERCIAL -USE CHECKLIST
w �
Subdivision: S u _ vn t r e 1 - - 7 I Lot no.: 3 44- q 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.: A5 / ( I DC, - o4Cj 00 equipment, materials, labor, overhead, and the profit for the
Q DESCRIPTION OF WORK work indicated on this application.
�!! Valuation: $
�.l s it ti o ws - Pro-141 - o wl- -fo , vac rrea��
Existing building area: 1 3 b square feet
A St K. o C ii V/ !2 VI) 71 GK .
New building arep:76_4, `: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
- Name: I k , J � -� ' Type of construction:
73 � y `t / ✓I
C Address: i 5-1 5 W 54 A rh. e 11 , • Occupancy groups: I -Pt, vl.. F t
W City/State/ZIP: / L 6,A /Z D 1 Ok Gf -7ZZa-1 Existing: I -r G� Vt.LL
�� Phone: ( j 3) 12 3 9 -G] 70 141 167 2-- New: r t
APPLICANT I CONTACT PERSON NOTICE •
Business name: ' C. f.. 4 AA , 44 -4-M -C D f\/ / All contractors and subcontractors are required to be
C+ licensed with the Oregon Construction Contractors Board
Contact name:
�(,{ L under ORS 701 and may be required to be licensed in the
Address: ) 2-7 3 S �
s etv °e C-r . jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: CG A- r (c)fz, q- - apply:
Phone: (S'b3 SCi — O Fax: : (S� S`r 41n r'
E -mail: _
CONTRACTOR
f Business name: --- eive t o f- ,/V / / /� / 6 ( 6 4/ 1 4 . 4 , 10/ \)
,� / 4..0 o� BUILDING PERMIT FEES*
Address: i�7 s 3 s�l /v[a e__/- s- 0 74. Please refer to fee schedule.
City /State/ZIP �G A t° D , P ie g 7 Z Z Fees due upon application
Z Phone: (5-03 t ✓`-0 q4..0 Fax: (� s71 _ q7O Amount received —
CCB lic.:
0,2._ & 37 4/116 a tf i all r- 5S 9-47 /6
Date received:
(-
Authorized signature: / This permit application expires if a permit is not obtained
mot— within 180 days after it has been accepted as complete.
Print name: ,/V7 4 R i t c} N s tr () A,/ 1 _ 1 4_ p Date: / _0 4 - 01 * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building 'Permits\BUP- PemtitApp.doc 17/03 440- 4613T(l1 /02/COM/WEB)
•
One- and Two -Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
Cl of Tigard Received. Permit No.:
City g an Datetty:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 �� "�N '�� ❑ Electrical ❑Plumbing ❑ Mechanical
24- Hour Inspection Line: 503.639.4175 6..... �
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 Ore:on and shall be shown to be applicable to the .ro'ect 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), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
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 existing residential dwellings
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03
_E1e trical Permit ApplicatplE
FOR OFFICE USE ONLY
City Tigard Received
Ci of Ti an CMa!' n
oQ �V� Y . .
Date/B Permit No.: �� V ----I /1
13125 SW Hall Blvd., Tigard, OR 97223 I Plan Review 1
Phone: 503.639.4171 Fax: 503.598.1960 'JAN 14 .. 'H 'MA
, i ' � Other Permit:
t r $,.' ,
Inspection Line: 503.639.4175 a J� r P!/ _, I Date/B Date Ready /By: tuns: ® See Page 2 for
Internet: www.ci.tigard.or.us c rryO .� F17aggp Notified/Method: Supplemental Information
TYPE IM MO D1VISfON PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply:
❑ Demolition Other:
['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps — rating EIBuildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
RI 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑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 DOther:
Job no.: Job site address: ) 5 ' S7 5 j� £L 14.4.4cLe r d1 ""� _ _ _ bmit 2 sets of plans with any of the above.
City/State/ZIP: G,' �> / 1 - C _ "" T h t e above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: FEE* SCHEDULE
� Description I Qty. I Fee. I Total I '"
Cross street/directions to job site: Awe 13eipo. 0 -e )0 2+i �e. New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: *v. wt. 2 I Pte.—W- 1 Lot no.: 34c 34cl Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: a') j j a) G _ 6 44 DD Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
�J
dwelling, service and /or feeder 90.90 2
n I t et Q& E- ( l Hit vi G� rtDO Services or feeders installation, alteration, and/or relocation
v 200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: a I j y Mt Z4 Ant OA) I P 601 amps to 1,000 amps 240.60 2
Address: j s1 5 tiv f L L , Over 1,000 amps or volts 454.65 2
�d q Reconnect only 66.85 2
City/State/ZIP: ` D ( -7/24 Temporary services or feeders installation, alteration, and/or
lam• 'j relocation
Phone: ( 2,) � _Ca 0 3 1 Imo{ (9:53) I _ 7(0/ .- 200 amps or less 66.85 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, tkcording to ORS 447, 449, 670, and 701.
� 401 amps to 600 amps 133.75 2
Owner signature: / .. .. �,_ L I Date: ? `if t-{ —041'
ot Branch circuits — new, alteration, or extension, per panel
APPLICANT I ❑ 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: /14, �� N C_il P without service or feeder fee, / 46.85 2
7 each branch circuit
Address: ( 7 g S VV RX.Q� L. Ea ch add'I branch circuit I I 6.65 I I 2
City/State/ZIP: 1' Miscellaneous (service or feeder not included)
` � O
( 5b3 ) ( Pump irrigation
tl itline I 53.40 I I 2
Phone: _ J /. C:) z ,� ( .5D3 .5D3 3o1 - 7 2 Sign or r o ne lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
‘ Business name: 01--1C/ePt'YC% -
0 Address: 1 " S sr • A n w n c
T o, a a3 -3o Each additional inspection over allowable in any of the above
1 Per inspection 62.50
e g City/ State/ZIP: � A � b / D '7 a % I Investigation per hour (I hr min) 62.50
Phone: (S Fax: y3) r 7g - If ?o Industrial plan per hour 73.75
f ELECTRICAL PERMIT FEES*
CCB Lic.: � Electrical Lic.:3 -1}�c Suprv. Lic.:� $b5 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.
is\ Building \Permits\ELC•PermitApp.doe 17/03 440- 461Sr(10 /07/COM/WEB
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
I COMIIfERCIAL 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 \Permits\ELC- PemtitApp.doc 04/03
Mechanical Permit Apt ` ion FOR OFFICE USE ONLY
City Of Tigard /EIVE® Date/By: Permit No.: jf c �2� d� 1j ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review v
Phone: 503.639.4171 Fax: 503.598.196 4,0 \ Date/B y Other Permit: Ins
Inspection Line: 503.639.4175 1 � 1 . ,L _
p JAN •� 0 04 �, J Date Ready/By: Juris: VI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY OF TIGARD
EULDBIGOVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction tisi Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
g] 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I S c 1 S VU Su vu vik r k e `c( 1-1 •
Air conditioning
fires s to plan ng or i gip pump
t (requires site I showing placement) 14.00
City/State/ZIP: 1 G 4}/ , Ore co 724 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: -h ,p Gas heat pump 14.00
Cross street/directions to job site: A (-D ER R R ,- � I v a, Uh i-t 4 M 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
Flue/vent for any of above 10.00
Subdivision5aN 144e3rpiejri le 7 Lot no.: 3 1 f Other: 10.00
J
Tax map /parcel no.: , 2 . 5 - 111 R� C.. p (7 0 Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
En lQ Ir 111(14 ro p IDt o-P h 0 U-Se . 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
14, PROPERTY OWNER I ❑ TENANT
Chimney/liner/flue/vent 10.00
A Other: 10.00
Name: B 1 ( 1 / M Al21 A IV iJ /V `A P Environmental exhaust and ventilation
Address: , . / S14_144.144. Range hood /other kitchen
S(p s7 W �� equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
�� - )�' �� Z Zz� Single -duct exhaust (bathrooms,
Phone: (So3) ( 0 3G ) _ � i O 3 4 05 - it '3 p7 -7 biz_ toilet compartments, utility rooms) 6.80
' APPLICANT 0 CONTACT PERSON Attic /crawlspace fans 10.00
Business name: nn Other: 10.00
�1`u CF. �Q I� ��S 0 S 7 Fuel piping
Contact name: `A (e f l2 C144-4 111-g t7.N. $5.40 for first four; $1.00 for each additional
s - ), / q /� /► Gas h ea t p
Address: u
171 � � l v , A I' 1.._ l.�T • Gas heat pump
City/ State/ZIP: (1 6 ,4pj) t 0A 411 - Wall/suspended/unit heater
Phone: ( 3 ) 69'0 .- cdi 11-0 0 Fax: : ( 2 5-7 1 -- t -7 o Q Water heater
Fireplace
E -mail: Range
CONTRACTOR ' _ I Barbecue
Business name: tau `e A 8kpl N A 0441,1,.) IV Clothes dryer (gas)
Other:
Address: 1 �,7 3 s Nit- A et £, C MECHANICAL PERMIT FEES*
City/ State/ZIP: C / 6, A 21, , 1 " 0 g ?'); 3 • Subtotal
Minimum permit fee ($72.50)
Phone: ( .-b3 5-9 _ Gj t 1 Fax: (5153 s' g -410G Plan review (25% of permit fee)
CCB lic.: i 0 2631 State surcharge (8% of permit fee)
\ TOTAL PERMIT FEE
Authorized signature: , / , / T his permit application expires if a permit is not obtained within 180
!'� t♦ days after it has been accepted as complete.
Print name: /VIA iz 1 A - D o A _m__A . -e Date: / -- J 4 -- • Fee methodology set by Tri County Building Industry Service Board
i:\ Building \PermitsUMEC- PennitApp.doc 12/03 440-46171(11 /02/COM/WEE)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the fast $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 first $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 4:61-01
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE RECEIVED
CHEROKEE ELECTRIC CO 'APR 0 8 2004
PO BOX 230230
TIGARD, OR 97281 CITY OF TIGARD
BUILDING DIVISION
Electrical Signature Form
Permit #: MST2004 -00006
Date Issued: 3/26/04
— Parcel: 2 11 04900 - - — - - — — — Site Address: 15657 SW SUMMERFIELD LN
Subdivision: SUMMERFIELD NO.7
Block: Lot: 349
Jurisdiction: TIG
Zoning: R -7
Remarks: Add 176 sf addition living space.
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 until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
DUNLAP, WILLIAM J + MARIAN CHEROKEE ELECTRIC CO
15657 SW SUMMERFIELD LN PO BOX 230230
TIGARD, OR 97224 TIGARD, OR 97281
Phone #: Phone #: 638 - 1515
Reg #: LIC 35681
SUP 2616S
ELE 3 -127C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X /
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection L' . (503) 639 -4175 MST °to `� , L
-60646
INSPECTION DIVISION ' "Business e: (503) 639 -4171
BUP
Received Date Requested 7 AM PM BUP
Location / ,S.(p-S C pl Suite CrY1 MEC
Contact Person Ph ( 3 — (0 7 'Fe) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: _
Ftg Drain ELR
Crawl Drain �,,
Slab Inspection = s: - t' /� SIT
Post & Beam : ` '
Shear Anchors -
Ext Sheath/Shear i11 -
Int Sheath/Shear
Framing .�� �x.A - - -
Insulation
fAga
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm P.M=
Susp'd Ceiling
Roof
Other: : dr FAIL
P .:ING
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 FAI
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection R . • ❑ Unable to inspect - no access
Fire Supply Line
ADA -
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection recor rom the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175 MST o 4 1---0600(o
INSPECTION DIVISION - • Business Line: (503) 639 -4171
BUP
Received Date Re ested -'/ AM PM BUP
Location S22 m' Suite MEC
Contact Person � Ph ( )3 — PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain /�
Slab Inspection Notes: /1 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
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
F : larm
'N Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date — l eik Ext
((\[
Approach/Sidewalk ` Inspector . 1
Other:
Final DO NOT REMOVE this inspection rece d from the job site.
PASS PART FAIL