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Permit IN �' CITY O F TIGARD MASTER PERMIT PERMIT #: MST2007 -00139 ° COMMUNITY DEVELOPMENT DATE ISSUED: 9/5/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 25111 CA - 02100 SITE ADDRESS: 15493 SW SUMMERFIELD LN ZONING: R -7 SUBDIVISION: SUMMERFIELD NO.7 LOT: 332 JURISDICTION: TIG PROJECT: CLARK Project Description: 94sf addition. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 94 sf BASEMENT: sf LEFT: 4 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: of FRONT: 10 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 4 VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 94 of 8.841.64 REAR: 8 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: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: 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 ALKYL 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 1 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: 0T11: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL U SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable NORM CLARK OWNER laws. All work will be done in accordance with approved plans. This 15493 SW SUMMERFIELD permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct Phone: 503 -239 -5440 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 420.17 REQUIRED ITEMS AND REPORTS Issued By : Permittee Signature : ,I ' i A ir- Call 503.639.4175 by 7:00 a.m. for an inspection that 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. B uiijaPermit Application • r r , Residential OFFICE USE ONLY / City of Tigard Ps, 4� 1 � Re�c�eived Permit No t 71 13125 SW Hall Blvd., Tigard, OR 97223 " d' 1 ;,Dal.: ��� %%I �a /39 C g _' I [ Ptj�m'7te,(ew Other Permit: ' Phone: 503.639.4171 Fax: 503.598.1960 �'atelB J �6' 3 ...c 7 T i G n K u Inspection Line: 503.639.4175 JUL n Date Ready /By: Jeri/ ® See Page 2 for Internet: www.tigard or.gov 100 rNotified /Method: ' � Supplemental Information TYPE OF °1'UIt , ... s � T... F,a R REQUIRED DATA: 1- AND 2-FAMILY DWELLING ❑ D emolition '7\ _ " ' —, ,` �"`� Permit fees* are based on the value of the work performed. ❑ New construction P ''. " ki Indicate the value (rounded to the nearest dollar) of all , Xr.A ddition/alteration/replacement ❑Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ' and 2- family dwelling ❑ Commercial/industrial Valuation: $ $ 8 41 ❑ 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: is— 4q:3 Sew So A4 kw/2 TJ [= L_ / ,M /`y�6/ w? New dwelling area: 9 C,/ square feet City /State /ZIPaTj 6 t: 2 ' ® Garage/carport area: J square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet . Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. ,\ Valuation: $ Wo DM )4,00/771e> 'V fsxi (/ Existing building area: square feet New building area: square feet VA PROPERTY OWNER ❑ TENANT Number of stories: Name: /J J t2 P- C--Z_ /I �,� Type of construction: r Address: / / 2 S W sc)/ C 1P4C ( g—` 0 Occupancy groups: City/State /ZIP: ( t l . q e_ Existing: . Phone: ( Z — T �c0 Fax: ( ) New: APPLICANT teCONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City /State /ZIP: apply: /1 L • Sd Phone: ( ) Fax:: ( ) R . /k E -mail: i0 CONTRACTOR Business name: ©w ,01). BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City /State /ZIP: Structural plan review fee (or deposit): FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB lic.: Total fees due upon application: — Amount received: .. 23 . ) o n. �t Authorized sig This permit application expires if a permi Is not obtained IZZFAIr within 180 days after it has been accepted as complete. i ` C„ Date: ■ • Fee methodology set by Tri-County Building Industry Service Board. I::uilding\Permits\BUP -RES 'etmitApp.doc 02/23/07 440- 4613T(1 /02 /CO EB) Building Permit Application Checklist , - ' One- and Two-Family Dwelling FOR OFFICE USE ONLY . City of Tigard Received Permit No.: 11 14 1 3125 SW Hall Blvd., Tigard, OR 97 223 Date/By: C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: TIGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I 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- ❑ ❑ ❑ • ..' • . rotection, etc. '-- 10. mplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ ding 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. 1 14. 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. r 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 Enginier'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 . 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\BUP- RES- PerrnitApp.doc 03/21/06 440.4613T(I1 /02/COM/WEB) r E1e trical Permit ApplicaRKrn q� 7, FOR OFFICE USE ONLY c k 1 ,' �'�;z :i " i Received �� II City of Tigard I veDate/By: Permit No-/ " �d .00/1 ° 13125 SW Hall Blvd., Tigard, OR 9d LkL 3 1 2007 Plan Review 11 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: Inspection Line: 503.639.4175 Cih U V c "CIUARD Date Ready/By: turfs: ® See Page 2 for T I G A It D Int rnet: www.tigard - or.gov BUPLL6NiC DIVISION Notified/Method: Supplemental Information ' E OF WORK PLAN REVIEW ICI New con ►: • r dition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition • Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural �LJ - and 2- family dwelling E3 Commercial/industrial ❑ Accessory building amps for all other installations. buildings. Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address /5 q go IOO or more. occupancy. 1 W /�(,�t .0 ) .1j' J❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: v , ❑ Health-care za d fcation ❑ Supply voltage for more than (( ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description ' I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. (1.) /7� � Limited energy, multi - family . 0 Al 4-f) 1 it) 4 ) 9 T / P residential (with above sq. ft.) 75.00 2 (X::;.7 Services or feeders installation, alteration, and/or relocatio 200 amps or less 80.30 • 2 ROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps • 160.60 2 C/ ��Q 601 amps to 1,000 amps 240.60 2 °• ' i. Address: i 5 -4 47 3 ` w if6re Q l-vt/ Over 1,000 amps or volts 454.65 2 City/State /ZIP: /� �,f/� � ' � Temporary services or feeders installation, alteration, and/or ` `'/ . a relocation • Phone: (QZ ) $q ���G- 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, leas - rent, or exchan• - a ording t., IRS 447, 449, 670, d 701. 401 amps to 599 amps 133.75 _ 2 Branch circuits — new, alteration, or extension, per panel Owner signature: i r /4,� i /� Date 7 A. Fee for branch circuits with ❑ APPLICANT I . CONTACT. PERSON ' above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, Contact name: 2`O ` ,per f irst branch circuit 1 46.85 2 Address: 41 36, � l _� ' c(3,_(....(71,1 1 f��rK1 , Each add'I bran(h circuit 6.)5 2 Co O/ Miscellaneous (service or feeder not included) .. ,r-t, / ,e G/I. ��� �_ Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: (? -� Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: ©i1 �� it J _ Signal circuit(s) er or limited- l i(/ energy panel, alteration, or • Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) I Fax: ( ) Investigation per hour (I hr min) 62.50 CCB Lic.: I Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: 14 (, . 5,5 Print name: Date: Plan review (25% of permit fee): ice /' State surcharge (8% of permit fee): 15 4 Authorized sign •S -, / 2Q ( TOTAL PERMIT FEE: 3. Print name: � T� permit application expires if a permit is not obtained within 180 � � !d / . / /p Date: / days after it has been accepted as complete. • Number of inspections allowed per permit. I:\ BuildingWermits \ELC- PermitApp.doc 05/23/06 4M/WEB Electrical Permit Application - City of Tigard i • 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: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (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 • To number of commercial systems: *No' licenses are required. Licenses are required for all other installations 1:\ Building 'Permits\ELC- PermitApp.doc 03/23/06 Me ianical Permit Application . , FOR OFFICE USE ONLY Sir Re ceived City of Tigard y t ='' a �, - M 1 1 Date/By: Permit No.f6� 7 , 00/2 13125 SW Hall Blvd., Tigar 972�23A j 4----"° .i .`•f j s ,. 4 Plan Review 7 : C Phone: 503.639.4171 Fax: 503'598`Y960' k ' Date/By: Other Permit: TI G A It D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov JUL 3 1 200' Notified/Method: Supplemental Information TYKE. )I N VOIRIC t' i JUN COMMERCIAL FEE* SCHEDULE - USE CHECKLIST "S T" ,-" '•• " I "'r °,,��-•� a Mechanical permit fees* are based on the value of the work ❑ New constructiond "Lion /alteratlon/repla�ement _ ;; �i �i performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition r 0 Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. eMulti-family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: /� Air conditioning or heat pump � .5, �/� �� (requires site plan showing placement) 14.00 City/State /ZIP: /f 6 6 O Furnace 100,000 BTU (ducts/vents) 14.00 (( Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: P /1 Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work I. 10.00 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. 14.00 Subdivision: I Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK ( Water heater 10.00 / Gas fireplace 10.00 �-S . Y ri /t) Flue vent for water heater or gas _..r / �,�� p �� � • � fireplace 10.00 r� • cif %_ : : ;.� Log lighter (gas) 10.00 '? Cr-N L .7 , i4 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00 Other: 10.00 Name: /J) 9 r /, « - L ./ y ' Environmental exhaust and ventilation v " `" „ � p 1 Range hood/other kitchen Address: 7 C 4(� 5 „k) �c' J �� �J v J lip equipment 10.00 • City/State /ZIP: `� / Ji � V t� / Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( )Z -pr t' f y� Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT XdyONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: v ec � 41� $5.40 for first four; $1.00 for each additional Address: > o � �I ? � � �'V � p_ Furnace, etc. G 2 . % 4 �(/Il ' Gas heat pump City/State /ZIP: <? r -{, • Q �¢ Wall /suspended/unit heater Phone: (sa3) € ,_3q - , 1.. Q Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: /, �jr Other Address: PV �/ Clothes dryer (gas) MECHANICAL PERMIT FEES* • City /State /ZIP: Subtotal Minimum permit fee ($72.50) id , 55 Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) Ft' • 150 ./ J r --.� uthorized signatur TOTAL PERMIT FEE F This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete rint name: Date: ' Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp.doc 01/19/07 440- 4617T (11/02/COM/WEB) 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 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 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 `' 1 $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. • 1:\Building\Permits\MEC- PermitApp.doc 01/19/07 2 . • Co Contractors Board Permit #: 1��Qo'7 139' 700 Summer St NE Suite 300 Address: I &_ - 5 SU ) S(.L rvl rn Fi L� J) f:'.'�c, PO Box 14140 ,-;` ":_ , Salem OR 97309 -5052 275' O7 + \ � Phone: 503- 378-4621 Issued by: Date: `„., IJ Web Address: www.ccb.state.or.us Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed 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 licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. • ill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: if f Er • I 1. I own, reside in, or will reside in the completed structure. i , tg 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. ❑ 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed 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. -.' 4 , ato 7 0 7 ...._____ - (Signature o permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06 -01 -04 • Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503- 378 -4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503- 947 -1488. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503- 945 -8091 or www .dor.state.or.us /formspay.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503- 947 -7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their web site at www.irs.gov. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503 - 378 -4621) or write the agency at PO Box 14140, Salem, OR 97309 -5052. Property_owner.doc 06 -01 -04 ,.. --: •i� I RECEIVED Vl���o oo 3� 3Vt , AUG1 G 2007 leanateService �Ro Our cuunmtmcnt b lama CITY jr i CWS FlbNumber B SW106 1i -Screening I 03- 0 0 1 , 7 0 / Site Assessment Jurisdiction: ' Property Information: (example 132301301400 Owner Information: Taxiot ID(s): aS I I fr am pp Name: Company: • Address: r .. ;: �r . , Site Address: I S'4-`1 3 a LAD , S" Me-I~ II 81--6 e * '4 n ..► t,.0 r --- , --(a- , _ m Q. 3 ,Z _� L_ _ Nearest Cross Street E -mail: Development Activity. Check all that apply Appllc Information: Addition to Single Family Residence (rooms, deck, garage) Name rye QOlt,/ J 9r ��J Lot Line Adjustment ❑ Minor Land Partition ❑ Company: d Residential Condominium ❑ Commercial Condominium El Add ress: �- C �- I Residential Subdivision ❑ Commercial Subdivision ❑ C t . , O 2 6 l t , 2! Single Lot Commercial ❑ Multi Lot Commercial ❑ Phone/Fax :$b3 -.7. 3 'id / Other E -mail: 6 1ctellq - 1 11). &4 ae Lt_ .C.xavld Will the project Involve any off -site work: YES ❑ NO) Unknown ❑ Location and description of off -site work; • Additional comments or information that may be needed to understand your project This application does NOT replace the need eed for Grading and Erosion Control Permits, Connection Permits, Building Permfte, Site Development Permits, DEQ 1200 -C Permit or other permits as Issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE All required permits and approvals must be obtained and completed under applicable local, state, and federal law. By signing this corm, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the Info a / ' on contained in this document, and to the beat of my knowledge and belief, this information Is true, complete, and accurate. Print/Type Name: / D 4 C L— --e , Print/Type Title: J♦ id I..) Signature: 4 . ice` _� Date:1 -71 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICA MUST PE RFORM A SI TE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. ❑ Sensitive areas do not appear to exist on site or within 200' of the site. This Sensitive Area 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 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, State, and federal law, I ► Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s) found near the site. This Sensitive Area Pre- Screening Site Assessment does NE eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. ❑ This Service Provider Letter Is not valid unless CWS approved alto plan(e) are attached. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS RE QUIR E D. � ✓ � Reviewed By: _ Date: O 2350 SW Hillsboro Highway . Hlllabero, Oregon 97123 M .1/ 4 Phone: (903) 661.4100 • Fax: (603)11914439. www eloimwecternervicom rot R.vbat rby t, X07 70'd abbS 6£Z £0S N3N I1dtiki>1 OWSO Wd 913:Z0 LAOZ— T £ --ifi CITY OF TIGARD - • . BUILDING DIVISION PERMIT #: MST2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9 /5/2007 Phone: (503) 639 -4171 Awky /Iii Inspection Requests (24 Hrs.): (503) 639 -4175 W IL. INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7 :01AM PAGE: 10 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: .332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 84g addition. OWNER: CLARK, NORM PHONE #: 503 - 239 - 6440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 286 Drywall nailing 059926 -01 503-239.5440 N Corrections /Comments /Instructions: 7'J �� a44.-(... , - x....64 4, C I1t - ,9z. =- - ❑ SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS El FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 1 -1 9 -U 7 Phone #: (503) 718- 7.41-4-/ CITY OF TIGARD - BUILDING DIVISION PERMIT #: MS 13125 SW Hall Blvd., Tigard, OR 97223 DA TE ISSUED: 9/5/2007 Phone: (503) 639 -4171 / ra Inspection Requests (24 Hrs.): (503) 639 -4175 -' A INSPECTION WORKSHEET FOR DATE: 11/14/2007 TIME: 7 :02AM PAGE: 19 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 9411 addition. OWNER: CLARK, NORM PHONE #: 503 - 239.5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/14/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 280 Insulation 059625-01 503- 239-5440 N 275 /4 4.4 `..15 Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED Inspector: Date: / / —L4 —a7 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/ 2007 Phone: (503) 639 -4171 ,ujiill Inspection Requests (24 Hrs.): (503) 639 -4175 F__.. INSPECTION WORKSHEET FOR DATE: 11/1/2007 TIME: 7 :02AM PAGE: 22 SITE ADDRESS: 15433 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM PHONE #: E03-239-5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/1/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 235 Shear wall,,,,,//anchors 058811 -01 503. 239.5440 Y 214 i t Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED /' Inspector: Date: /I — / —o 7 Phone #: (503) 718- ; CITY OF TIGARD . . BUILDING DIVISION PERMIT #: MST2007-00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/+,x,12007 Phone: (503) 639- 4171f Inspection Requests (24 Hrs.): (503) 639 -4175 F_ INSPECTION WORKSHEET FOR DATE: 10/31/2007 TIME: 7:0()AM PAGE: 43 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIE1D NO.7 LOT #: 932 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94 addition. OWNER: CLARK, NORM PHONE #: 503-239.5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/31/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 295 Misc. inspection 058731 -01 503. 239.5440 N Corrections /Comments /Instructions: Aio a aA.c sr7 . Aft —ra - S6 7 zF- y w y1 1— v- /4"/ V'Ei -7-,�it hi J ❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /6-3/— o 7 Phone #: (503) 718 - r- - ci. — 4 9 s -- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007- 00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9fJ2O07 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 . ' " '- 1 II INSPECTION WORKSHEET FOR DATE: 10/301200 TIME: 7 PAGE: 46 I SITE ADDRESS: 1193 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 940 addition. OWNER: CLARK, NORM PHONE #: 503 239 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/30/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 24 0 Exterior sheathing 058597 -01 503- 2395440 N Corrections/Comments/Instructions: JJ . 0 ) ,.f._ / 4�'G 7 / 47 --..i. r 2 ' _Li.--. sre.,. # 46.4_ . A _ • ❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED j ._. Inspector: k . Date: /6 :307 6'7 Phone #: (503) 718- -- F 1 CITY OF TIGARD • BUILDING DIVISION PERMIT #: MS72007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 915/2007. Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/16/2007 TIME: 7 :01AM PAGE: 19 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIE_LD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM I PHONE #: 603.239 -x40 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/16/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 230 Underfloor insulation 057697 -01 503-239-5440 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Z Inspector: Date: l � -(J� Phone #: (503) 718- .1_1-'9-'2 CITY OF TIGARD . I BUILDING DIVISION PERMIT #: M5T2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2007 Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 , �' ' I I .. INSPECTION WORKSHEET FOR DATE: 10/9/2007 TIME: 7:00AM PAGE: 15 SITE ADDRESS: 15493 SW SUMMERFIEI..I) LN CLASS OF WORK: SUBDIVISION: SUMMERI=fELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94st addition. OWNER: CLARK, NORM PHONE #: 503 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1A/9 /2Q07 Pour Time: 1:00 Code # Inspection Description Confirm # Contact # Message 210 Foundation walls 05722401 503.239-5440 N Corrections /Comments /Instructions: PASS ❑ PART L APPROVA ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ / L FOR I. PAAN ❑ ADDITIONA FEE ASSESSED Inspector: / L � ( Date: ` '9 0 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/W2007 Phone: (503) 639 -4171 i l l Inspection Requests (24 Hrs.): (503) 639 -4175 " _ INSPECTION WORKSHEET FOR DATE: 10/3/2007 TIME: 7 :02AM PAGE: 65 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM PHONE #: 503.239 -5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/3/2007 Pour Time: 12:00 Code # Inspection Description Confirm # ntact # Message 205 Footing 056803 -01 503 - 239.5440 N Corrections /Comments/ Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS ❑ F AIL ❑ , , • - TION ❑ ADDITIONAL FEES ASSESSED Inspector: r Date: l 3 A?" #: (503) 71?27/ CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2007 Phone: (503) 639 -4171 A i Inspection Requests (24 Hrs.): (503) 639 -4175 ..— INSPECTION WORKSHEET FOR DATE: 11/29/200 TIME: 7 :00AM PAGE: 19 SITE ADDRESS: 15493 SW SUMMERFIELD I..N CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM PHONE #: 503-239.5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/29/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 209 Final inspection 060491 -01 503239 -6410 N Corrections /Comments /Instructions: III , ri 4 ' • 1111 w r IMP' A / I / , 1 ck) .9 ,Pb a 4. ' , u4 ,i, tv_.or ___..---__,(. g ot4tiAA 1 j i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: il G /hone #: (503) 718- • CITY OF TIGARD • BUILDING DIVISION PERMIT #: f5T2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: cri�/20i)7 Phone: (503) 639 -4171 , u�9 iti Inspection Requests (24 Hrs.): (503) 639 -4175 ,,W ° `'' I .. INSPECTION WORKSHEET FOR DATE: 11/29/2007 TIME: 7:00AM PAGE: 20 SITE ADDRESS: 1.5193 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIEI.D NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM PHONE #: 603239 -6440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/29/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 060490.01 503 - 2403399 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FE S ASSESSED • Inspector: / Date: C l gA "hone #: (503) 718- CITY OF TIGARD BUILDING DIVISION #: MST2007- 001:9 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2007 Phone: (503) 639 -4171 i� Inspection Requests (24 Hrs.): (503) 639 -4175 .�' FLL. INSPECTION WORKSHEET FOR DATE: 11/13/2007 TIME: 7 :01AM PAGE: 65 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM PHONE #: 503. 239.5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/13/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 059500 -01 503 - 239.5440 N Corrections/Comments/Instructions: V i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CA A FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718- CITY OF TIGARD • ' ' BUILDING DIVISION PERMIT #: MST2007 -00139 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/512007 Phone: (503) 639- 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 gsgj�lh � INSPECTION WORKSHEET FOR DATE: 11/912007 TIME: 7:00AM PAGE: 8 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK DESCRIPTION: 94sf addition. OWNER: CLARK, NORM PHONE #: 503. 239.5440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11t912007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 059408.01 503- 239 -5440 N Corrections/Comments/Instructions: r .44A `'e 4..4 • ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS Dt FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: / l.- 1 /4 Phone #: (503) 718 -� 1 CITY OF TIGARD BUILDING DIVISION 5 , r PERMIT #: MST2007- 00139 I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9far2007 Phone: (503) 639 -4171 a Inspection Requests (24 Hrs.): (503) 639 -4175 .�' I �.. INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7 :00AM PAGE: 55 SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE: PROJECT NAME: CLARK . DESCRIPTION: S4cf addition. OWNER: CLARK, NORM PHONE #: 503- 239.6440 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1118/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 0592213.01 503 - 2315440 N Corrections /Comments /Instructions: / 7 / I r - - / - r e IFI % ,1,. ri. / 41 7 3 . 4I4._..t_. 49� / , . ' (4) - ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS KFAIL I►, CALL F R INSPECTION ❑ ADDITI FEES ASSESSED - MA-I Inspector: 11 Date: P . Phone #: (503) 718 -