Permit .•
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00217
11�; DEVELOPMENT SERVICES DATE ISSUED: 7/22/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10905 SW SUMMER LAKE DR PARCEL: 1S133AD-06500
SUBDIVISION: AMART SUMMERLAKE ZONING: R -
BLOCK: LOT: 109 JURISDICTION: TIG
REMARKS: Partial garage converted to habitable space. Other mechanical is duct work and combustion air
openings.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THRo- sf RIGHT:
VALUE: 2
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 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: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS 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 /OSVC!FDR: 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 REVIEWSECTION
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 8 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: $ 237.03
This permit is subject to the regulations contained in the
JAQUITH, KERRY B + DIANA D BRIAN DUTTON Tigard Municipal Code, State of OR. Specialty Codes
10905 SW SUMMER LAKE DR 16775 SW LAKE FOREST BLVD and all other applicable laws. All work will be done in
TIGARD, OR 97223 LAKE OSWEGO, OR 97035 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 - 579 - 5268 Phone: 503 407 - 1627 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Re • LIC 111999 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
Insulation Insp
Electrical Final
Final inspection
/
Issued By . / 4..,...._-_,—;_-_ _. / �, Permittee Signatu - . i c n A
Li _
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
.... �5r 'f
Building Permit Application FOR OFFICE USE ONLY
City of Tigard Re eiv / a te / Permit No.:u • u , -. CV
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
{�
Phone: 503.639.4171 Fax: 503.598.1960 '�i� Date/By: Other Permit:
Inspection Line: 503.639.4175 a Date Ready/By: saris: ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: .T /C‘ 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
A Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
al- and 2- family dwelling El Commercial/industrial Valuation: $ • gQ e.
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 0ixe..
Job site address: / D /vs" SO S0w1wterlak2 D . New dwelling area: square feet
City/State/ZIP: / {P4 i D >€ . 9' 7 yZ Garage/carport area: /6.5 /6.5 square feet
Suite/bldg. /apt. no.: Project name: A 4 ir-r J ',.' 44. Covered porch area: square feet
Cross street/directions to job siitte: r � Deck area: square feet
SoMmu'f4 r). S
6 ., "4 o ....Q1414 ....Q1414 F . ZJ Other structure area: square feet
&AA 1.41-4") ks , r / e.a REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: j *I tvt4lehike. I Lot no.: 10 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: S r ea� b B 6 Sao 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.
t'J f 14-. w wad Q GfrtO • _ � Je .fib` /I Valuation: $
`A ` P�� • � (tia�' ✓ Existing building area: square feet
,,t,1,r,Q c .e..).- v- un.o04.e0--
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: kei t../ , y 6 Type of construction:
Address: 1P qQ SO s'V / AD?.. Occupancy groups:
City /State /ZIP: !'qt , 05" 4 /7r X—; Existing:
Phone: ( Shp 5 747 , s t Z ( Fax: ( ) New: '
1 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: e All contractors and subcontractors are required to be
Contact name: ✓ a'� 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
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: igiZEM &PI") h (, 7-7"dIJ BUILDING PERMIT FEES*
Address: 1 6 7? 3' S W (. AA lc F61C,Gf'sv' B LA.
Please refer to fee schedule.
City/ State/ZIP: L ik lc k, d S y is-4 j OK 6 S ? a 3S"
Fees due upon application
Phone: (543 3) S71 7 3 Z I Fax: ( ) Amount received
CCB lic.: /it 855
/ • Date received:
Authorized signature: V .1 v > i This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: I�C�11%1 . D t : 7 - ( Z - 0‘ • Fee methodology set by Tri -County Building Industry
Service Board.
i:\ Building \Permits\BUP•PermitApp.doc 12103 gejj Zi f0V 1714 440- 4613T01 /02ICOM/WEB)
944/1424"
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
Date/By: Permit
No.:
r
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 / r acvt . .`� Date
Inspection Line: 503.639.4175 AA M_' I Date Ready/By: Juns: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK . ,
. • ., COMMERCIAL FEE* .SCHEDULE — USE CHECKLIST
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.
CATEGORY OF CONSTRUCTION Value: $
• RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
l and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address:
0 ( 105 $ So r.. htiWC • Q (requires site plan showing placement) 14.00
City/State/ZIP: — r i c rikiet p Q 5 722 3 Furnace 100,000 BTU ( ducts/vents) 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work Z - 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.: a Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: is i 33 SAD 0 65o (t] Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
PiarCr * )C TWA Duccoen2K Coe- Flue vent for water heater or gas
Ito /' fireplace 10.00
eK / 1. 6VPrt2 k Cr E Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue/vent 10.00
Other: 10.00
Name: ,K FRRY SkiU tTI4 Environmental exhaust and ventilation
Range hood /other kitchen
Address:
(O 't O 5 S W 5 U fh al 61.. k.../ 6 tb< equipment 10.00
City/State/ZIP: -- n G p A b, Q K IS 9 7 Zz 3 Clothes dryer exhaust 10.00
[ Single -duct exhaust (bathrooms,
Phone: (503) g7 S - 5 zcs Fax: ( ) toilet compartments, utility rooms) 6.80
. ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: 5 h� lC 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
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: O 6 d (tea N Other:
Address: MECHANICAL PERMIT FEES.
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 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
i :U Building \Pem,iu\MEC- PennitApp.doc 12/03 440-46177 (I 1 /02/COM/VEB)
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 •
$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
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
/ Received Permit No.:
Date/By: SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ', t�1 i " Date/By: Other Permit:
Inspection Line: 503.639.4175 _' -.ii"
Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK . . - • . PLAN REVIEW : -
❑ New construction IYAddition/alteration/replacement Please check all that apply:
❑ Demolition ❑ 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
Cg(1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi family ❑ Master butlder ❑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 ['Other:
Job no.: Job site address: i 0505 SW SUMnet < 6 Submit 2 sets of plans with any of the above.
City/State/ZIP: . 'j•\ (. A 0 0 Q 6" c 7 Z Z 3 The above are not applicable to temporary construction service.
f
Suite/bldg. /apt. no.: Project name:
FEE* SCHEDULE
Description I Qty. I Fee. I 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.: )6 Ea. add'l 500 sq. ft. or portion 33.40 1
�` Limited energy, residential 75.00 2
Tax map /parcel no.:
i S 13 3a� 04. s" �/ Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
• { f�� .e1 � ' dwelling, service and /or feeder 90.90 2
l Tt61 ln7 QZ+(, l io lSer�/` Services or feeders installation, alteration, and/or relocation
(1 200 amps or less 80.30 2
PROPERTY OWNER ❑TENANT 201 amps to 400 amps 106.85 2
we--, 401 amps to 600 amps 160.60 2
Name: K elt a.y Ai V t T rt 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
t05o s S 4J 5 O M,twt�lu /kKl� �It Reconnect only 66.85 2
City/State/ZIP: m6,A.Ab O g 7 -i3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503) s79 .. S Z 6 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, 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 I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: S-.40••••6.. branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 1
each branch circuit ) 46.85 2
Address:
Each add'I branch circuit 6.65 _ 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: extension. Describe: Page 2 2
OM OI.J0
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* .. ' • _
CCB Lic.: Electrical Lic.: Suprv. Lic.: 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 \Permits\ELC- PemdtApp.doc 12/03 440- 4615T(10 /02/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:
COMMERCIAL 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 \ BuildingTemti ts\ELC- PennitApp.doc 04/03
FROM :WESTGATE BAPTIST CHURCH FAX NO. :503- 524 -4560 Jul. 30 2004 11:43AM P2
•
CITY OF TIGARD `` '' c O
13125 S.W. HALL BLVD. ``�v
TIGARD, OR 97223 �CjG
IMPORTANT PERMIT NOTICE N\\- F -TO° N
01 0 \� \S
. OWNER g �\\ -a \
Electrical Signature Form
Permit #: M6T2004 -00217
Date Issued:
Parcel: 1 S133AD -06500
Site Address: 10905 SW SUMMER LAKE DR
Subdivision: AMART SUMMERLAKE
Block: Lot: 109
Jurisdiction: TIG
Zoning: 'R -7
Remarks: Partial garage converted to habitable space. Other mechanical is duct work and
combustion air openings.
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:
JAQUITH, KERRY B + DIANA D OWNER
10905 SW SUMMER LAKE DR
TIGARD, OR 97223
Phone #: 503 - 579 -5268 " Phone #:
Reg #: -
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Si nature u ervisin
g 2P 9 Electrician
If you have any questions, please call 503.718.2433.
FROM :WESTGATE BAPTIST CHURCH FAX NO. :503- 524 -4560 Jul. 30 2004 11:42AM P1
`' C ® Permit #: P'15T aoc, y , boa 17
17----7 CEIVG
%1_� <- Address: /096S 5 (..t.; Su.ti h L,4I< ' 1"; .
� VII IPI jy JUL ' 004
;; .•; , Issued by 8$ Date: 7-aa ,o Y
Ise CITY OF TIGAR
BUILDING DIVISION
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:
DE 1. I own, reside in, or will reside in the completed structure.
�—
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
_____
before or upon completion.
0 3A. My general contractor is
(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.
012
--- ri �� 3B. I will be my own general contractor.
I
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.
'moo
� �y
(Sign a of permit applicant) .. (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00217
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/22/2004
Phone: (503) 639 -4171 /t , t\
Inspection Requests (24 Hrs.): (503) 639 -4175 -__
INSPECTION WORKSHEET FOR DATE: 4/1/2005 TIME: 7:10AM PAGE: 59
SITE ADDRESS: 10905 SW SUMMER LAKE DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 109 TYPE OF USE:
PROJECT NAME: JAQUITH
DESCRIPTION: Partial garage converted to habitable space. Other mechanical is duct work and combustion air
openings.
OWNER: JAQUITH, KERRY B + DIANA D, PHONE #: 503-579-5268
CONTRACTOR: DUTTON, BRIAN PHONE #: 503.407 -1627
1 Inspection Request Scheduled For: Date: 4/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 003522 -01 503.572 -7392 N
•
Corrections /Comments /Instructions: 1
I
/ .
PASS ❑ PARTIAL APPROV ❑ CANCEL ❑ NO ACCESS
❑ FAIL A ., IN I TION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 jr4 Date: Phone #: (503) 718- i".7‘
1
CITY OF TIGARD
1 BUILDING DIVISION PERMIT #: MST2004 -00217
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/22/2004
Phone: (503) 639 -4171 „a „ , I I
Inspection Requests (24 Hrs.): (503) 639 -4175 - �'I I..
INSPECTION WORKSHEET FOR DATE: 4/1/2005 TIME: 7:10AM PAGE: 57
SITE ADDRESS: 10905 SW SUMMER LAKE DR CLASS OF WORK:
1 SUBDIVISION: AMART SUMMERLAKE LOT #: 109 TYPE OF USE:
PROJECT NAME: JAQUITH
DESCRIPTION: Partial garage converted to habitable space. Other mechanical is duct work and combustion air
openings.
OWNER: JAQUITH, KERRY B + DIANA D, PHONE #: 503-579 -5268
CONTRACTOR: DUTTON, BRIAN PHONE #: 503.407 - 1627
Inspection Request Scheduled For: Date: 4/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 003522 -02 503572 -7392 N
Corrections /Comments /Instructions:
j
PASS ❑ PA TIAL APPROVAL ❑CANCEL ❑ NO ACCESS
FAIL ❑ LL • R iP P' TION ❑ ADDITION F ES ASSESSED
Inspector: Date: / v C Phone #: (503) 718 -2