Permit 5 �� _, -7 Q. � ,�AL It: , , i a
C IT O F T I GA MAv ER PERMI
PERMIT #: MST2004 -00062
,,441- 12.I.. , � �� DEVELOPMENT SERVICES DATE ISSUED: 2/17/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13640 SW 124TH AVE PARCEL: 2S103CC -07200
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 019 JURISDICTION: TIG
REMARKS: Converting 640 sq. ft. of crawl space to storage space.
BUILDING
REISSUE: CUSTOM STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 640 sf BASEMENT: 640 sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: TNRD: sf RIGHT:
VALUE: 15,552.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 640 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: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE F - -..ii TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 20 . mp: 1 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 4 . ■ amp: 201 - 400 amp: 1st W/O SVOFDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1.00 SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000. amp /volt :
PLAN REVIEWS ECTION
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: $ 485.14
STEPHANIE KUNTZ SLINGLUFF CONSTRUCTION This permit is subject to the regulations contained in the
STEP
STEP AN E Tigard Municipal Code, State of OR. Specialty Codes
13640 S K AVE PO BOX 194 , OR 97223 WILSONVILLE, OR 97070 and all other applicable laws. 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 the
work is suspended for more than 180 days.
Phone: 503 - 521 - 8933 Phone: 503 - 574 - 2619 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 152141 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
Footing Insp Electrical Rough In Special insp. required Electrical Final
Footing lnsp Electrical Rough In Insulation lnsp Electrical Final
Foundation lnsp Electrical Rough In Insulation lnsp Final inspection
Post/Beam Structural Framing Insp Misc. Inspection Building Final
Post/Beam Structural Framing lnsp Misc. Inspection
Issued By : ,li4 ".f Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
, • •
Building Permit Application FOR OFFICE USE ONLY
g t' �� Received /� Building
g + � C' \ / Date/By:oti/ „1D`f , 0 Permit No. 'E vit, -' `f
C I of Ti ar C C V Planning A pr al Other
g Date/By: Permit No.:
13125 SW Hall Blvd. FEB £ I 200 Plan Review Other
Tigard, Oregon 97223 D Date/By: Permit No.:
Phone: 503 p 4/4,,, 4�p H.,' � A Post - Review Land Use
� P t t (� E . f J Date Case No.
.. Internet: www.ci.tig • 4' � - VISION -
C on t act t f Juris.: ® See Page 2 for
24 - hour Inspection R 1 4175 Name/Method: Supplemental Information
tru ' TYPE OF "L :. ,, _ '*Q t l ,,,
❑New constru ❑Demoli DW h G
Addition/alteration /re•lacement ❑ Other:
,JCAUGOR g • - ! Note: Permit fees* are based on the total value of the work performed. Indicate
1 & 2- Family dwelling • Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
DI overhead and profit for the work indicated on this application. / S g 5g. ,
1, ,
Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $ — a*
)10 hl = r g h g „
No of bedrooms: No of baths:
Job site address: / 34, O 570 / Lt f ' Ave . Total number of floors
Bld /A t. #: New dwelling area (sq. ft.)
Suite #:
�(/ //r I g P / Garage /carport area (sq. ft.)
Project Name: k U �JTZ Covered porch area (sq. ft.)
Cross street/Directions to job site:
Deck area (sq. ft.)
Other structure area (sq. ft.)
AE t } I 1 ns' Y�` 1 5. y $fig
Subdivision: I Lot #: `'.; ,;
Tax map/parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
y , t7„ ` tgCI It? ■ ' if 4 S i the value (rounded to the nearest dollar) of all equipment, materials, labor,
�� � ) --. e i = 1 /PA �• overhead and profit for the work indicated on this application.
" (1[ IC_l Z f '� Valuation $
/ .F ___ . Existing building area (sq. ft.)
New building area (sq. ft.)
1 -33 36 Number of stories
h °w .' e l l . e.:: Type of construction
Name: ku il'>r`Z 1 STe p k AL1 t z- Occupancy group(s): N ewing:
Address: /3( ZI,3 t2.1-1 c� 4ve -
City /State /Zip: - PoitTL/4•0 & i OR 47„,2?3
Phone: • • `Jo11 Q 3 Fax: NOTICE: All contractors and subcontractors are required to be
,. g r licensed with the Oregon Construction Contractors Board under
2 " ` :t, .. l ' tN . l provisions • of ORS 701 and may be required • to be licensed in the
: usiness Name: 5) pi.) c, t V FT Coke jurisdiction where work is being performed. If the applicant is exempt
Contact Name: JpS{ (_ ) from kou7 from licensing, the following reason applies:
Address: QO_ Roc 14
City /State /Zip: \,t 1 o,j vr' /Ie , O. 97070
Phone: 603 - '57w -abi RI Fax:,�[�3 -6711 - ,2595 , g . ,
E-mail: � l r 1 � . g:
� 6 s , _ . t r ¢ ,n t, t - ms %,a4,,,,,„-: _._ m
4 M,
Business Name: 51, iJ Ca t o R Co Fees due upon application $
Address: O. aqc I Q
City /State /Zip: \i 1St&ut'I (e 1 Oe 97 07'D Amount received $
Phone:503 41,q• alb(1j' 1 Fax: 5b3- 57'1 • ,a51'5 Date received:
CCB Lic. #: / 6 / 4 f /
Authorized
Signature: ite Date: / / t✓
d 1 cl b Li Notice: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
>•ti (l (ts *F methodology set by Tri- County Building Industry Service Board.
(Please print name) - —
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 f,1e r
TA
11■1
G rp H/ I , Plan Submittal Requirement Matrix
�� l A Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans. After
plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
is \dsts \forms \PlanSubMatrix.doc 2/27/03
E Permit Ap Il FOR OFFICE USE ONLY
City of Tigard � � v `' Received y
Date/By: Permit No.: IWO /I / 00C9
13125 SW Hall Blvd., 7223 Plan Review
Phone: 503.639.4171 ax: 503.598.1 Vit il l i Date/By: Other Permit:
Inspection Line: 503.639.4175 GE t?• Date Ready/By: Juris. ® See Page 2 for
Internet: www.Ci.tigard.or.us ` 1 11� w , Notified/Method: Supplemental Information
e-..‘17`4 �17`4 GP� `a c ORI� PLAN REVIEW
111 Ncw construction f i , d ditton /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other ['Service over 225 amps, comm'l ❑Hazardous location
ID Buildng over 10,000 sq. ft.,
Wi,,,,,,„..,44 e F CON5TRUCTION ❑Service of 1 -and over 2- family 320 amps dwellings - rating 4 or more new residential
❑ 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 [Weeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
s � a) 4. C s` " {` t , �..= fi , . ❑Egress/lightingplan RV park
Job no.: Job site address: /34) � /A � Submit 2 ❑Health - care sets facili of planty ['Other:
s with any of the above.
City / State/ZIP: The above are not applicable to temporary construction service.
FEE* SCHEDULE ;
Suite/bldg. /apt. no.: J Project name:
Description I Qty. I Fee. I Total I *•
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.: Ea. add'1500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ` ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 1.L- •'Z-,, 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I F ax: ( ) relocation
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, 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
'''''' 443. * ': i� m A � ON 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: without service or feeder fee, /
each branch circuit 46.85 2
Address: Each add'I branch circuit / 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E Signal circuit(s) or limited -
:: energy panel, alteration, or
a� i /^,
Business nam ' r) -/._(:t - extension. Describe: Page 2 2
Address: - p .0 .'a OX ( 1 1 Each additional inspection over allowable in any of the above
1 ` - Per inspection 62.50
City/ State/ZIP: r n /1 ( C. / 0 o yS Investigation per hour (1 hr min) 62.50
1 /
Phone: , V 3 6;5 7 ' 9/-13 I Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL :PERT 1[ ES* ,
CCB Lic.:/ 3 5:2 3 ii Electrical Lic.: + 3 --yo)C. Suprv. Lic.: `/`J 7 5 _ 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:\ BuildinglPermifs \ELC- PemtitApp. 2/03 M/
440- 4615T(10 /02 /COWEB
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
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
.. Q WO ONLY*
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n O utdoor Landscape Lighting*
n P rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pemits\ELC- PemutApp.doc 04/03
• CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PARKDALE ELECTRIC INC
PO BOX 309
PARKDALE, OR 97041
Electrical Signature Form
Permit #: MST2004 -00062
Date Issued: 2/17/2004
Parcel: 2S103CC -07200
Site Address: 13640 SW 124TH AVE
Subdivision: WHISTLER'S WALK
Block: Lot: 019
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Converting 640 sq. ft. of crawl space to storage 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 will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
STEPHANIE KUNTZ PARKDALE ELECTRIC INC
13640 SW 124TH AVE PO BOX 309
TIGARD, OR 97223 PARKDALE, OR 97041
Phone #: 503 -521 -8933 Phone #: 541 -354 -1992
Reg #: LIC 157198
ELE 14 -39C
SUP 4453S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
gnature of Supervising Electrician
If you have any questions, please call 503.718.2433.
i 00 fj ,LdHQ 9Q"IH (MOM, ID A,LID T89E6Z9E05 XV.3 9£ : ET 3H.L t0/90/170
•
05/19/04 WED 17:06 FAX 503 684 0954 CARLSON TESTING 0002
Main Office `alem Office Bend Office
• P.O. Box 23814 riudson Ave., NE P.O. Box 7918
Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708
Carlson Testing Inc ♦ Phone (503) 684 -3460 Phone (503) 89 -130 Phone (541) 330 -9155
FAX (503) 684 -0954 FAX (5D3) 589 1309 FAX (541) 330 -9163
Special Inspection
FINAL SUMMARY LETTER
May 19, 2004
T0405250. CTI
City of Tigard COPY
13125 SW Hall Blvd.,
Tigard, OR 97223 -8199
Attn: Building Department
Re: Kuntz Residence
13640 SW 124th Avenue - Tigard, OR
Permit No.: MST2004 -00062
Dear Sir or Madam:
This is to certify that in accordance with Section 1701 of the Uniform Building Code, Title 24, we have
performed special inspection of the following item(s) per our inspection reports only
Structural Steel — Shop, Includes verification of welder certifications, weld procedures, and material certifications
All inspections and tests were performed and reported according to the requirements of Project Documents
and, to the best of our knowledge, the work was in conformance with the approved plans and
specifications, approved change orders and applicable workmanship provisions of the State Building Code
and Standards, as well as the structural engineer's design changes, approvals and verbal instructions.
Our reports pertain to the material tested /inspected only. Information contained herein is not to be
reproduced, except in full, without prior authorization from this office.
If there are an further questions regarding this matter, please do not hesitate to contact this office.
Respectful) submitted,
CARLSON ESTING, INC.
Ja es E. Hietpas
Op r ions Manager
JH
cc: Slingluff Construction — Clint Parker
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 9- 75 -�c�
INSPECTION DIVISION - " Business Line: (5 71 MST
BUP
Received Date Requested t P (‘' \ 1 6 AM PM BUP
Location /3 4-0 1 a- Suite MEC
Contact Person c � t � Ph (' Z ) .,? --3 3 PLM
Contractor Ph ( ) SWR
UILDI Tenant/Owner ELC
Footing
Foundation R.A.
Ftg Drain Access: `/ f� ELR
Crawl Drain 7 �' / `
Slab Inspection Notes: /4 SIT
Post & Beam .‹._ i ,c o GLJ
Shear Anchors r ire_ ‘,./G it /(
Ext Sheath/Shear ,
Int Sheath/Shear A i�/ ) �� : � _ Pf VACC.
Framing
Insulation / V 64 J ( / Q� k , Q /
Drywall Nailing L -�-t� �C
Firewall M �j '
Fire Sprinkler
�G.�
Fire Alarm
Susp'd Ceiling
Roof
Other: J
PART FAIL
P I " BING
Post & Beam
Under Slab
Rough -In
elyi V VC! ,. e. - - -----; ) ). s — j'
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
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Ili Unable to inspect - no access
Fire Supply Line Q- 1/41\
ADA ch y Date 6. l�` 6 Inspector /L-' � v Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST -- C ( 0 D.
INSPECTION DIVISION Business Line: (503) 639 -4171
ll 3t1, PM 6/7 BUP
Received �/ Date Requested ` AM PM BUP
Location 3(0 't-0 Suite MEC
Contact Person Ph STO 2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner F7V3=P e 147 ELC
Footing
Foundation * ELC
Access: p
Ftg Drain G t . . �1 �'r"`_t ELR
Crawl Drain 017
Slab Inspection Notes: c 6,0)2<./ /, 1 ,
6 01.0 SIT
Post & Beam Anchrs
Ext Sr Sh ea t h /SSh ear — � e '
Ext eah/h 0� ��
Int Sheath/Shear
Framing
Insulation ® / J� , �� �l ¢�
( C(/'LVW/G F- i,- ,64 - £' - I. /5- / �
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
S �TRICAL
Rough -In
UG/Slab
Low Voltage
Fire Alarm
a- km PART FAIL fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
iiiikap 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA 14 p I�1 Q
Approach/Sidewalk Date Inspector G-` \� 1 v QU Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL