Permit CITY OF TIGARD MASTER PERMIT
1111 .. COMMUNITY DEVELOPMENT Permit#: MST2013-00243
T It;AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/26/2013
Parcel: 1 S134CD06000
Jurisdiction: Tigard
Site address: 11695 SW SUMMER CREST DR
Subdivision: BURLWOOD NO.3 Lot: 20
Project: Kopf
Project Description: Replace 40'of water service and regrounding of electrical panel.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement. 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Eront: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $0.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 40 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 1
Mid Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF 0
Owner: Contractor:
KOPF,RICHARD D CANBY PLUMBING&CONSTRUCTION LLC Required Items and Reports(Conditions)
11695 SW SUMMERCREST DR PO BOX 1051
TIGARD,OR 97223 CANBY,OR 97013
PHONE: 503-590-3000 PHONE: 503-266-1212
FAX: 503-266-4391
Total Fees: $144.12
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 the 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 952-001-0090. You may obt les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: G� �. Permittee Signature: ' - //2/��✓
f ir639.4175 by 7:00 a.m.for the next available inspection date.
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.
11/26/2013 11 :35AM FAX 5032661212 CANBY PLUMBING AND CONST f10001/0001
Plumbing Permit Application Fil tr Mb O a Gbh
Building Fixtures I FOR OFFICE USE ONLY
City of Tigard RDeee
tdiB v ed: aa( em, Permit N°-: NSTo10/3-6,0
III
13125 SW Hall Blvd.,Tigard,OR 97223 Plan RcLiow
Phone: 503.7182439 Fax: 503.598.1960 Other Permit No.!
Date/B :
.r i CiARD Inspet Lion I,inc; 503.639,1175 Date Ready/By; furls. RI' See Page 2 for
Internet: www.tigurd-or.gov Notified/Method: Suppternentallnformntion
'. TYPE:OF WORK u. ,FEE"' ScIIEDULP
❑ New construction ❑Demolition Fur s,eciul in nrmatian use checklist
----- - r)cscri'lion Qt . Fa Total
(81 Addition/alteration/replacement ❑Other New I-2-family dwellings(includes 100 ft.for each utility connection)
cA),,FcpRY;OE CON''.FR14CCTION .,;r,-.;4' . SFR(1)bath 312.70
® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath . 437.78
El Accessory building El Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
Q Master builder ❑Other;
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMA1ION'.AND;I,0CATION' Site utilities:
Job site address:11695 SW Summer Crest Drive Catch basin or area drain 18.76
City/State/ZIP;Tigard/08/97223 �- 1.)rywcll,leach line,or trench drain 18.76
Footing drain(no,linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: !Calif Water Service Manufactured home utilities_ 50.03
Cross street/directions to job site:SW 12P Avenue>SW Summer Crest Drives Manholes 18.76
follow SW Summer Crest Drive around past SW Summer Crest Place>SW Summer Rain drain connector 18.76
end of SW Summer Crest Drive Sanitary sewer(no.linear ft,; ) Page 2
- - Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft,;5a) Page 2 ,
Subdivision: 1 Lot no.: Fixture or Item: ,,_
Tax map/parcel no.: Buckflow preventer 31.27
DESCRITON[1 R 1( Backwater water valve 12.51
. , .
- -- --- Clothes washer 25.02
Replaceing Water Service-Boring line in w/Line Scpae Directional Boring Dishwasher 25.02
Drinking fountain 25.02
yEjectors/surnp 25.02
®.'PROPERTY OWNER 1 T'ErANT '' Expansion tank 1251
Name:Richard Kopf Fixture/sewer cap 25.02
^---•, - Fluor drain/floor sink/hub 25.02
Address: 11695 SW Summer Crest Drive
- Garbage disposal 25.02
City/State/ZIP:Tigard/OR/97223 _ Huse bib _25.02
Phone;(503)590-3000 Fax_( ) Ice maker 12.51
o:'?xPPr LCANT =0 j:CONT C°f.i•1t:RSO Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: --
Root drain(commercial) 12.51
Address: Sink/busin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone;( ) Fax;:( ) Tub/shower/shower pan 12.51
E-mail: Urinal - 25.02
+COIVTRACTOIZ Water closet 25.02
,
Water heater 37.52
Business name:Canby Plumbing&Construction,LL( Water 1 )W V 56.29
Address:PO Box 1051 Other: 25.02
City/State/ZIP:Canby/OR/97013 Subtotal
Phone:(503)266-1212 ii Fax:(503)266-4391 Minimum permit fee: $72.50 7a.60
CCB Lic.: 199591 Plumbing Lie.no.:1336 Plan review (25%of permit fee) ---
State surcharge(12%ofpermit fee) '34 7f7
Authorized signature: n JA4 4(4)h.-� TOTAL PERMIT FEE '3/ ,,g
Print name:Linda s ss, w r 9 Date:11/26/2013 This permit application expires if a permit Is not obtained within!till days
_- utter it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1'1 RUitding1 PermictOPI.M11-PMmliApp,dOC 10/01/00 440-4616T(1 0102ICOMAW48)
Nov 26 13 12:25p Advantage Electric 5032363913 p.1
°' I CEIVE t�j
Electrical Permit Applicat�tiNia
R Permit No..H57-2.6/5_069
City of Tigard 1/ G
IIi, 13125 SW Hall Blvd.,Tigard,OR 97 Y 2 6 2013 Place Review pricer Permit:
L . Phone: 503.718.2439 Fax: 503.598.1 Date/By:
ins ctinn 1,ine: 503.639.4175 Date Ready/By: )iris- 0 See Page 2 far
T'` ^R www.tr orpov
Internet: gard CITY OF TIGARD Notified/Method: Supplemental Information
TYPE diRldilliNG DIVISION PLAN REVIEW
❑New construction .4ddition/alteration;replacerneni Please check all that apply(submit 2 sets of plans u/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories
j ❑Demolition ❑Other. where the available fault cement ❑Marinas and boatyards. I
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exrrnds 14,000 0 Commercial-use agricultural
and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E',`l-2","l-3",
t (� C + ' is or or more. occupancy.
Job no.: I aQ Job site address: Jw occupauo,ctl vehicle parks.
Y11 ❑Sixwmoreresidentialunits. ❑ �'
y 0�a t o I ^ n /1, 1 ❑Supply voltage for mare than
City/Slate/ZIP: V K `+� �I ❑Hazadous facilities.
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apl.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 • ,
New residential single-or multi-family dwelling unit.
i Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map'parccl no.: Limited energy,residential- 75.00 2 ,
DESCRIPTION OF WORK (with above sq.IL)
Limited energy,multi-family 75.00 2
( )C) ,,A C r a ;01 residential(with above sq.ft.) I
t1_l (�1 Renewable Energy ❑ See Page 2 i
l c r 1l t.L Y Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 _ 2
201 amps to 400 amps 133.56 —27
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1.000 amps or volts 552.26 2
City/StateiZIP: Temporary services or feeders installation,alteration,and/or
( ) Fax:( )
relocation
Phone: 200 amps or less 59.36 1
Owner installation:This installation is being made on property that F own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449.670.and 701.
401 amps to 599 amps 166.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension, • r panel
X APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 .,
Business name. each branch circuit
V"f2--- B.ser for branch r fee.f rsttirovr
Contact name (� service or feeder fee,first }
56.1 6 2
branch circuit , (�
Address: Each add'I branch circuit 7.42 2
('i /Statc/7_IP: YCJ Miscellaneous(service or feeder nor included)
h Each manufactured or modular
67.64 2
dwelling,service and/or feeder
Phone:( ) Fax::( ) Reconnect only 67.84 2
E-mail: C 3 0 62.y'-4 nzae( P 1,claw '1111 i1 �lo 2lL I s Pump or irrigation circle 67.84 2
ONTRACTOR CON' Sign or outline lighting 67.94 2
c
Business name: f� /� ` Signal circuil(s)or limited-energy. See
1�Q�>J ` ( i� �� L � V panel,alteration.or extension. Page 2 _ 2
Address: 151 SCE L.4 t { Each additional inspection over allowable in any of the above
��� v Additional inspection(1 hr min) 66 251 hr
City/State/ZIP: D c - `(L�c4 n 12..__ "I--) 6--1 - . Investigation(I hr min) 6625/hr
Phone:(S[� ,D 3.s,5 "f Fax:("3/29 a'3 te_3 (j i 3 j Industrial plant(1 hr min) 78.181 hr
p / Inspections for Much no tee 1s
[D 90 00!hr
CCI3 Lie.: ICI 07 L Electrical Lie.:C,-Le c Suprv.Lie.:l-'� q S I specifically listed(f�hr min) ,
- ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ! Subtotal: ! 5-(:,4) i‘
Print name: }��If�t�1 ,V` v �-I-DA Date: L I i J ' 3 Plan review(25%of permit foe): (a.�]
��I1....h ` State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: _t71 .9 r
Print name: Date: This permit application expires if a permit is out obtained widtin 1811
T 1 I'1 t ; e)ks(1/���t If_` .licaG I f -j days after it has been accepted as complete.
JJ�""""" V J 11 • Number of inspections allowed per permit.
I:.Buitdind,PermitstELC PermitApp_ELR_EREdoe Rev 05/21122013 440-16151(1UO5;COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: rns pP'3�
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: a�
Phone: (503) 639 -4171 �'�I �
Inspection Requests (24 Hrs.): (503) 639 -4175 .'
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: H/2 25 5---,v Sc/ro (:2v C I CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: /02' c 2-13 Pour Time:
Code # Inspection Description w Confirm # Contact # Message
Corrections/Comments/Instructions:
/ - E C �; , u,. 0 f e • EP � ✓2 _
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❑ PASS I I PARTIAL APPROVAL fl CANCEL n NO ACCESS
IL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: " .rr� Date: /42 :► - 13 Phone #: (503) 718-
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11695 SW SUMMER CREST DR, TIGARD, OR, 2013 -12 -03 (null)
97223
Record Type: Record ID:
Residential - Master Permit MST2013 -00243
Inspection Type: Result:
399 Plumbing final PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11695 SW SUMMER CREST DR, TIGARD, OR, 2013 -12 -03 00:00:00
97223
Record Type: Record ID:
Residential - Master Permit MST2013 -00243
Inspection Type: Result:
199 Electrical final PASS
Comments:
Violation Summary:
Inspector Contractor