Permit /t CITY OF TIGAR® • MASTER PERMIT
IN
.: F,..-- PERMIT #: MST2007 00066
COMMUNITY DEVELOPMENT DATE ISSUED: 4/13/2007
' TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S104CA -05100
SITE ADDRESS: 13668 SW MICHELLE CT ZONING: R -
SUBDIVISION: HILLSHIRE LOT: 051 JURISDICTION: TIG
PROJECT: SMITH
Project Description: Interior remodel
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE. sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD' St RIGHT:
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 75,000 00 REAR:
PLUMBING
SINKS: WATER CLOSETS: 2 WASHING MACH: , LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
i
LAVATORIES: 3 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
NAT FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 1
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 ADD'L 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: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # 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
MARK H. SMITH CHAMELEON CONSTRUCTION laws. All work will be done in accordance with approved plans. This
13668 SW MICHELLE CT 15993 SW KREICK PL permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 TIGARD, OR 97224 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 - 806 - 1594 Contact #: pRl 503 407 - 5630 questions to OUNC by calling 503.246 6699 or 1.800.332.2344.
Reg #: LIC 148735
TOTAL FEES: $ 1,305.46
REQUIRED ITEMS AND REPORTS
.ri A 1 �'
I ss ed B : fj �p � Permittee Signature : !�'E A �OW
_____-- Call 503.639.4175 by 7:00 a.m. for an inspection that business • ay. �/ li
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.
jut
Building Permit Application FOR OFFICE USE ONLY
lii City of Tigard Received nn 0 � Q / � O D �
- Date/By: O4� i Perm t No.: � (
13125 SW Hall Blvd., Ti OR 97223 Plan Review
.: Phone: 503.639.4171 Fax: 503.598.1960 Date/By: �� `• Other Permit:
TI GARD Inspection Line: 503.639.4175 Date Ready /By: Jur�is. H See Attached Checklist for
Internet: www.tigard or.gov Notified /Method: lr /6 Supplemental Information
_,_K:.... «mss, n, . >
F' ,OF W ORK.' A ::,
TY
.,,:,. , ..., a ,•::_. �.:.. "aREQL1IRED A . E I ,, .AND . 2- F
❑ New construction ® Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
® Addition /alteration/replacement . ❑ Other:
equipment, materials, labor, overhead, and the profit for the
i_ ' :, !' „ CATEGORY OF CONSTRUCTION. =;; 5. ,, t, ;: •, , =>=
work indicated on this application. '7 ( y
4 , _:,F •.. -, ...._ .�•,y, ..::...e.... _ ;a - ._ - . "r�,�,__�F,-; °s,: a:- t, F�y':< „9 �4?�'`,� : �;.', "4
® / I and 2- family dwelling ❑ Commercial /industrial Valuation: — 5b6d' .3L9- 1 eee
❑ Accessory building ❑ Multi- family • Number of bedrooms: 3 C ty y 5
❑ Master builder ❑ Other: Number of bathrooms: 2 a yi 5rn.)o)
1 ” " Total number of floors: 2
,• ION
..M,... �,. ..70 AND` ROGATION
B % >SITE' "INFORNfA-T ,:� " ✓ ' , '>>F�
Job site address: 13668 SW Michelle Ct New dwelling area: 0 square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: N/C square feet
Suite /bldg. /apt. no.: Project name: Smith Remodel Covered porch area: N/C square feet
Cross street/directions to job site: from SW Walnut Street southbound left on Deck area: N/C square feet
135th Ave., turn right onto SW Lauren Ln follow to SW Michelle Ct Left onto Other structure area: N/C square feet
Michelle Ct, east to 13668 SW Michelle Ct on the Right. k '" O • ,REQUIRED I)ATA:GOIVIIVIER'CIAL- USE =CHECKIIST
Subdivision: Hillshire Lot no.: Permit fees* are based on the value of the work performed.
■ Tax map /parcel no.: 2S104CA05100 / Va. - Indicate the value (rounded to the nearest dollar) of all
fi r., , i..v:, , ,
and the profit for the
•equipment, materials, labor, a e r
'�' ;.c 9p RIPT N F ' ; e - :t� ` ;i, i d s'' ` f work in di c ated on this application.
� " � 5C Q , 4 , W t ORK,.;,,,,, k , s•��:, i"='s', >,,�,;,�„ PP
remodel of existing kitchen/family room and master bath. Demo existing gas Valuation: $
wood stove, add new gas fireplace, remodel shower, remove tub, replace (2) Existing building area: square feet
•
sinks at master bath with new sinks New building area: square feet
® PROP WNER , _•' -' '43' ® -,TES ;„ . ' Number of stories:
- 2 E RTY °.O ,, NANT : ; ,
Name: Mark Smith Type of construction:
Address: Same as project Occupancy groups:
City /State /ZIP: Existing:
•
liPhone: (. P �1 - / 3 — 5- 3q3 ax: New: ■
, a.: ., .. ''
: • . �.:i. �'�` a_ ; x � , � , g i„ - ice,".": •." Y �k^ed" bI
� 7 ;-,.., ICAN . . =CONTACT P "' ... rt.;.
s,.,�,. ,rte ..�_.,.,.,,.,,<•• ,,.,.. „ ..,,. . : a,���:. = E i `s. NOTICE = ; , : . ��.
Business name: ORANGEWALLstudios All contractors and subcontractors are required to be t
Contact name: Gary R. Hartill licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 215 SE 9 Ave Suite 108 jurisdiction in which work is being performed. If the
City / State /ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 227 - 8100 x 1 Fax: : (503) 227 -5569
E - mail: garyh @ORANGEWALLstudios.com •
'IF::: N, g' ��s's�� ✓ , i , - »;.a .�:;t�.e,srtx =..�..�::... �,,,: - g a,:;,•: :��' � ° ^'
CONTRAGTORg <.,, : a ;, ,
a � `
t,
Business name: Chameleon Construction and Remodel Inc ; ': °; »; ` " ' BUILDINO.t. MI TFEES* ,$,F ``' ='` t '1'
,: =A Please r`e er•to: ee'sched le a a, 5; "'T a' "' +t
Address: 15993 SW KREICK PI
Structural plan review fee (or deposit): F il k i 4..6° City /State /ZIP: Tigard OR 97224 —,--
Phone: (503) 407 5630 Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: 148735 IS litil , Total fees due upon application: II imp / / / Amont received:
Authorized signat- -. `/ � ` �, V `mow This permit application expires if a permit is not obtained
t, �� within 180 days after it has been accepted as complete.
/Z � ` /� 01/ * Fee methodology set by Tri- County Building Industry ■ /
1 Service Board.
I.\ Building \Permits \BUP- PcrmitApp.doe 03/21/06 440- 46I3T(I I /(12 /COM /WhB)
r
i
Plumbing Permit Application 4, �' ` - I OIt O i F1E4 US 0 1 1 ` I h ' ,
II City of Tigard div ed Permit No.:
a 13 125 SW Hall Blvd., Tigard, OR 97223 • Date/By.
`� ��"
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By.
Permit No.:
Inspection Line: 503.639.4175
T I G , A li D Date ReadyBy Juns: et See Page 2 for
=_ „ ,z Internet: www.tigard or.gov Notified/Method: Supplemental Information
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m k Y,` Ra,,.:a .zr,a. .;; •�?"S?; ��lp r,'�z, ,Wa h,"'i,;:+n:??i�< L7:12 �..�'i:s r.° �r�..�." -, �:� §J� "•� ,,��..II
. u'i i94s<•:,.,waa�N�„� � µ_, , t. R «s".,v.��yiLh"w;'F
For special information use checklist.
❑ New construction ❑ Demolition
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
, , � �.�j� � �� x� .v: p.:�
: ^�� A• �¢{ I p Y .mot r ��
0A ` iy � wz'CAIEGORY F � TR UCfO N jg 7 `� a R � SFR (1) bath 249.20
yC � x, ���• +b "rPl� flhk Wf ' 46 n*mM , `AdJ � - NAi. `x � ., u4kF.ir \ )
❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
„i , -. k.�, h . tea „ , ON xg Fire sprinkler ( , sq. ft.) Page 2
Y' #
,% ;4 b sa * ., -?JOB ST L0 7 , TI s 5 , ,f Site utilities
Job site address: /3 , 6 g ,, J /� f � Catch basin or area drain 16.60
City/State/ZIP :, ,f On 7 z-/-3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: t Project name: C, , � Footing drain (no. linear ft.: ) Page 2
t"" Manufactured home utilities 110.00
Cross street/directions to job site: (JJLI. � yi, 4 / 3 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
/ I i Water service (no. linear ft.: ) Page 2
/
Subdivision: / S / I I Lot no.: 5_
11 ! VVVZZ2 Fixture or item
Tax map /parcel no.:
,cT E ss�.;":: , "°: ,��..�,�. vg:.^ar.s- �.srrr+�.�: 'n :�, *, 4_ ta � a �. " Absorption valve 16.60
,
�' f i`DE.SCRIPT10N OFWOft cIP a � „';r� Backflow preventer Page 2
veCW? . _ Yt•,..rz ` .x,s�•? n ., ..� - »-:_b �.;� . k ,•vas � ' ' , +
-,. )tL 044 4 - . Backwater valve 16.60
/-/ l ' Clothes washer 16.60
��' Dishwasher 16.60
�,_., . ., •,rtxs
s Q2PROPEti•CY' U it l +� "' ® ;
F � �, Dunking fountain 16.60
Ejectors/sump 16.60
Name: - l C '' v11, t Y�l� �
Expansion tank 16.60
Address: ) '3./.:(.4 C �,� f l4 / C , Fixture /sewer cap 16.60
City / State/ZIP: 0- •� / V Y ' 9 -72-Z- 7 CC C��� Floor drain/floor sink/hub 16.60
Phone: ( - a 3 pr 3 t Fax: ( ) Garbage disposal 16.60
i4r.a014T'" : - A ^ pc wr '
4 ' : * a^ �, .�,. ,wi . _,h: • .-'''' i'. e cl
';v� S '" *r,m:. .#` Hose bib 16.60
' ,rf
mot 4 O ®'APPLICANT '+'�, A x �h " h ®'
CO PERSON
x,:'_ _as _ :. -, , x__..�w�« .� r_ F�_x,.��� Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 3 16.60
( Phone: ( ) I Fax: ( ) i • Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
r. ¢ y t gPA AW: . etiN yy TRACT > O " i " i , �' -f tl' x :447 `/ Water closet 16.60
`Business n.. . -: „.( � .� Water heater 16.60
Address: I Other:
City /State/ZII
- Subtotal
- r Minimum permit fee: $72.50
Phone: (I I Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.:)' . (....6 - `I - bing'Lic. up.: Plan review (25% of permit fee)
� . State surcharge (8% of permit fee)
Authorized signature:
j "r:�rT/ /,/ Jr. TOTAL PERMIT FEE J`
Print � ��, Date: O W This permit application expires if a permit is not obtained within
i VI iv , 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building\Permits \PLM- PermitApp4oc 06/26/06 440- 4616TO0/02/COM/WEB)
R p-'
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
° i A fg R Q� ee: (eaM TOtaI_''. �" _c .,�. • e , os «"' 1, ° . 94 m - ,.,, x
Sate Utilitie .a � :.,.. � a Squar,.:0'-f take i' O e .e:, : " � a ,:, ,
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 '`7aluation. TVA z`tW 'X% *'
Storm & Rain Drain - 1st 100' 55.00
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
+' ' 01)1„,'`, ` Total additional $100.00 or fraction thereof to and
. `'' � a ��.•s - � 0 A k4~° ,liaA 0-.,. � �.t-�� including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device each additional $100.00 or fraction thereof; to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or
I specially requested inspections - per hour I 72.50 I I and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
sr {� x� .
Fixture Work: . , :�, iPlan ReviewLforrPlumbin Installataons;7 ;
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to -Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
: -r t - E: � �°• x . '`, a� :ix a Qian' city ,by. (Fi:anre) - Wor greater, except systems designed and stamped by licensed
t ° 'a�. : , gn , cs. an
engineer. Fatare yp , -tix;,t^' . :.x Pre ; s 6 iiti *i. ,0i.'a k dedr � Eiish
p a ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic f�;.„ '�" i,,:. � ds-��`,�p .. . ,- r , yd �,<.< ., �;�
Drinking Fountain'' CISO� nleta'ICQi?RiserDiagram�"� 4V4,
Eye Wash - ❑ Isometric or riser diagram is required for new buildings .
Floor Drain/sink -2" that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang -
- Stall *Note: If the fixtur work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes •
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures:
i:\ Building \Pennits\PLM- PennitApp.doc 0927/06
Mechanical Permit Application ' ' r� o f ; "' F ORiOFFICE U ONLY,".m ''�t, . , $ n, . I`
. a
'''..,',;:'-`:'7 Received ,
Ill ety of Tigard Date/By. Permit No.:'i 9 (2v 1 6D0 l
• 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review ��++"
' Phone: 503.639.4171 Fax: 503 598.1960 Date/By Other Permit:
T I G A R D- Inspection Line: 503.639.4175 Date Ready /By: lures. el See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
: -a,:• ,; � •o r :•. ''`:-....:', FSr =,- , : " ;„ ` '„TYPE OF WORK ,-:. -.... - COMMERCIAL FEEL, SCHEDULE '= USE CHECKLIST
Mechanical permit fees* are based on the value of the work
El 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.
' ' "'''f' „. ;.CATEGORY OF. CONSTRUCTION : l' N':, : ” ''' '4-."'.:: Value: $
�1 and 2-family dwelling ` •» RESIDENTIAL EQUIPMENT / SYSTEMS FEES *.
_-.. y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder
❑ Other: Description Qty. Ea. I Total
JOB SITE INFORMATION AND LA • tion
p Heating/cooling
Job. site address: _ a
3 Air conditioning or heat pump
/ , I I -- , 1 (requ s p s placement) 14.00
City /State /ZIP: o r Dot ° 7 .22— .22— Furnace 100,000 BTU (ducts /vents) 14.00
g p f� // A r • 7 eli Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bld /a t. no.: I Proect name: 1 t v n Gas heat pump 14.00
Cross street/directions to job site: 1 q � ( u �_ "` ' 3 r 'C � / � Duct work t 14.00
6/ V 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
( l Flue /vent for any of above 10.00
Subdivision: ,. IA I Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF „
WORK 7 • - Water heater
10.00
Gas fireplace i 10.00
- (7" 2 4 14 1 , L I JJ' Cl t„ .c i i U f 4-f/ Flue vent for water heater or gas
1 /� fireplace 10.00
J A' Log lighter (gas) . 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PRO ERTY WNER i ❑ TENANT`;. Chimney/liner /flue /vent 10.00
Other: 10 00
Name: •' (AA r I � Environmental exhaust and ventilation
/ Range hood/other kitchen
Address: a ♦ / _ . , equipment 10.00
City /State /ZI' . .4 l l/ ` q-22-a- Clothes dryer exhaust 10.00
,� Single -duct exhaust (bathrooms,
Phone: (-93) 13—s-3 9 3 Fax: ( ) toilet compartments, utility rooms) 6.80
[APPLICANT 1 . ❑ CONTACT PERSON ' Attic /crawlspace fans 10.00
Business name: 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 1
E -mail:
Range
, _.P , Cnvruer -nn Barbecue
Business na. _ — , - F Clothes dryer (gas)
Other:
'Address: : MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
---+ Minimum permit fee ($72.50)
Phone: (� r7 /5 Fax: ( ) Plan review (25% of permit fee)
CCB lie.: ' J V State surcharge (8% of permit fee)
P TOTAL PERMIT FEE
AuthOriZeB Signature: `/`� This permit application expires if a permit is not obtained within 180
1��.�f r days after it has been accepted as complete.
Print name. ,r r0 : Date: ,r • Fee methodology set by Tri- County Building Industry Service Board
i- w r war VW
I'1Building\Permits\MEC -Perms .,• :oc 04/06 I. 440 -4617T (I 1/02 /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
$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 12/30/05 2
Elect; leaf Permit Application FOR OFFICE USE ONLY
C- ,
T . Received
r City Of T1gard Date/By: Permit No.: 0 -7— Qd 0
0 v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
34
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
-
T I G ARD Inspection Line: 503.639 Date Ready /By: luris• ® See Page 2 for
Internet: www:tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction [1] Addition /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
❑ 1- and 2- family dwelling ❑ 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 ", "1 - ", "l - ",
Job no.: Job-site ^address: 3�G CO Six or or more. Recreational
Q , A , ❑ Six or more residential units. ❑ vehicle parks.
City /State /ZIP: / / / j; ,,�� 1 ]� 9 7 2_�? ❑ Health -care facilities. ❑ Supply voltage for more than
VV " r ( v im , ` / ❑ Hazardous locations. 600 volts nominal.
Suite bldg. /apt. no.: Project name: 771/4-.1/-0 I// ❑ Service or feeder 600 amps or more.
/ �
' Q FEE SCHEDULE, _
Cross street/directions to job site: W4 A L f / '3 S Description I Qty. I Fee. I Total i
f New residential single- or multi- family dwelling unit.
Includes attached garage.
/
Subdivision: a / / S / I ' Lot no.: I 1,000 sq. ft. or less 145.15 4
` 111 `! Ea. add'I 500'sq. ft. or portion . 33.40 1
Tax map /parcel no.: Limited energy, residential
• DESCRIPTION. OF WORK ? - (with above sq. ft.) 75.00 2
�)
� Limited energy, multi - family
i4/1 I 1 f'1/l.x 1i14.a S)-e- � residential (with above sq. ft.) 75.00 2
( / Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. • ❑ v4 PROPERTY OWNER ' ❑ TENANT 201 amps to 400 amps 106.85 2
Name:2 / f l ate ,- -1,_ c
t 401 amps to 600 amps 160.60 2
^ 601 amps to 1,000 amps. 240.60 2
Address: 134, L J 1 ( ( €- t C.4 /� , Over 1,000 amps or volts 454.65 2
City/State /ZIP: v ®® �V �l �i 1 Temporary services or feeders installation, alteration, and/or
c t relocation
Phone: (J G ) — slci 3 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-599 amps 133.75 2
Branch circuits – new, alteration, or extension, ter panel
Owner signature: Date: A. Fee for branch circuits tvith
AP ' ' ` lir CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit _
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 2
first branch circuit
Address: Each branch circuit - 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular•
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66:85 2
E - mail: Pump or irrigation circle, 53.40 2
C NTRACTOR _ _ _ - __ _ __ _ Sign or outline lighting' 53.40 2
j � Signal circuit(s) or.limited
Business > t. �, _ _ - -_ energy panel, alteration, or
Address: ` I extension. Describe: Page 2 2
City. /State /ZIP: Each additional inspection over allowable in any of the above
. , Per inspection 62.50
- Phone" - '"' )
Investigation per hour(] hr min) 62.50
COB Lic.: : 1 Electrical Lic.: Suprv: Lic.: - Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES :
Suprv: " Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee): •
State surcharge % of permit fee):
Authorized - signature: 4 TOTAL (8 PERMIT FEE:
Printname.
� , This permit application after expires if a permit is not obtained within 180
�- • L 1 d Date: Z `J , / � days after it has been n accepted as complete.
/ e/ v f Numberof inspections allowed -per permit. •
t:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 46I5T(t 1 /05 /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*
n Burglar Alarm
❑ Garage Door Opener*
n H eating, Ventilation and Air Conditioning System*
n V • acuum Systems*
❑ Other:
I COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
El Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls •
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
P \Building\Permits\ELC- PermitApp doc 03/23/06
Apr 16 07 03:28p PIPELINE PLUMBING (503) 624 -1926 p.1
MI! CITY OF TIGARD
owe COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
PIPELINE PLUMBING
PO BOX V -108
333 S STATE ST
LAKE OSWEGO, OR 97034
Permit #: MST2007 -00066
Date Issued: 4/13/2007
Parcel: 2S104CA -05100
Site Address: 13668 SW MICHELLE CT
Subdivision: HILLSHIRE
Lot: 051
Jurisdiction: R -7
Zoning: TIG
Project Name: SMITH
Description: Interior remodel
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
MARK H. SMITH PIPELINE PLUMBING
13668 SW MICHELLE CT PO BOX V -108
TIGARD, OR 97223 333 S STATE ST
LAKE OSWEGO, OR 97034
Phone #: 503 -806 -1594 Phone #: 503 - 624 -1906
Reg #: LIC 148735
LIC 158260
PLM 3 -510PB
LIC 165607
LIC 43084
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature Authorized Plumber Name (printed)
FROM :BARBPR'S&ROSEELEC" FAX NO. :5036488254 Apr. 18 2007 11:20AM P1
CITY OF TIGARD
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
HARVEY ROSE ELECTRIC SERVICES
PO BOX 128
NORTH PLAINS, OR 97133
Permit #: MST2007 -00066
Date Issued: 4/13/2007
Parcel: 2$104CA -05100
Site Address: 13668 SW MICHELLE CT
Subdivision: HILLSHIRE
Lot: 051
Jurisdiction: TIG
Zoning: R-7
Project Name: SMITH
Description: Interior remodel
Your company has been indicated as the electrical contractor for the permit referenced 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. Please mail the form to:
City of,Tigard, Building Division, 13125 SW Hal? Blvd., Tigard, OR 97223, or you may fax the form to: 5
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
MARK H. SMITH HARVEY ROSE ELECTRIC SERVICES
13668 SW MICHELLE CT PO BOX 128
TIGARD, OR 97223 NORTH PLAINS, OR 97133
Phone #: 503 -806 -1594 Phone #: 503-789-3284
Reg #: ELB 34-130C
LIC 43084
SUP 2767S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X •- /+ 144.4_051 12E5 z 7 5
Signature of ?r ervising Electrician Name (printed) • SUP LIC #
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2007 -00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639- 4171 d N��iiN�il
Inspection Requests (24 Hrs.): (503) 639 -4175 J
INSPECTION WORKSHEET FOR DATE: 5/15/2007 TIME: 7:00AM PAGE: 40 ;
SITE ADDRESS: 13666 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add ( branch circuits.
OWNER: SMITH, MARK PHONE #: 503.80&1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503.407 - 5630
Inspection Request Scheduled For: Date: 5/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 048305 -01 503 - 250.3164 Y
Corrections/Comments/Instructions: oz.
P.avlo C ,� #\/ ( ; � AA 549 56 CaZL -.
e l./- 4.-1Cr/ Gat C I5 u , .w rte€ c;.. r - ./I Si 4= 7
PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
ila
Inspector: Date: c..- Phone #: (503) 718 -
• '\-- "
. ,..
CITY OF TIGARD •.
•
BUILDING DIVISION PERMIT #: MST2007-00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639-4171 Ad
Inspection Requests (24 Hrs.): (503) 639 ,...„
-4175 54- II.
INSPECTION WORKSHEET FOR DATE: 5/14/2007 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH. MARK PHONE #: . 503-8061694
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503-407-5630
Inspection Request Scheduled For: Date: 5 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 048219-02 503-407-5630 Y
( Corrections/Comments/Instructions:
all 0. :..e.,/ 4 _ , , , , ). --- Fe .. - , _ I Ai • - ./.6.,
EL/PAS fl PARTIAL APPROVAL 7 CANCEL 7 NO ACCESS
I AIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector; .4
_../2 Date: 5 Phone #: (503) 718- __________
CITY OF TIGARD .y •
BUILDING DIVISION P ERMIT #: MST2007- 0006E
13125 SW Hall Blvd., Tigard, OR' 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639 -4171 ; /
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/1112007 TIME: 7:01AM PAGE: 69
SITE ADDRESS: 136€8 SFW1 MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503- 806-1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503.407 -5630
Inspection Request Scheduled For: Date: 5/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
6 Mechanical rough-in 048135 -02 503-407-5630 N
Corrections/Comments/Instructions:
ASS ❑ PARTIAL APPROVAL CANCEL NO ACCESS
FAIL I CALL FOR INSPECTION I 1 ADDITIONAL FEES ASSESSED
Inspector: Ill 1� . 'J Date:. ' 7 / I I 'P Phone #: (503) 718-
1 �
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: MST2007•00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639 -4171 a ii' ' ik
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/9/2007 TIME: 7:00AM PAGE: 39
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel
OWNER: SMITH, MARK PHONE #: 503.806 -1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503-407-5630
Inspection Request Scheduled For: Date: 5/9 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 047942-02 503 - 2503164 N
Corrections /Comments /Instructions:
Il 1 L ...i . .1 iti 4k Ai! + V'
it: ILL
/ 1
t LC ti 1 '' SAL t 1' 1.
1- ..:. FA'
IN PASS I I PARTIAL APPROVAL n CANCEL I NO ACCESS
sa AIL CALL ' OR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins ector: , A
: J l ` Phone #: p Date. Ph #. (503) 71 "
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/8/2007 TIME: 7:00AM PAGE: 43
SITE ADDRESS: 1366E SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/1012007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503 -806 -1584
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503- 407 -5630
Inspection Request Scheduled For: Date: 818/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 053581 -01 503250 -3164 N
Corrections /Comments /Instructions:
14A 111QT LU C i ���1 G t� �v ��. ,.
•
•
. PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I I FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector J 61 ''`"' - V � Date: ? / 6- 7 Phone #: (503) 718-
A
CITY OF TIGARD N
BUILDING DIVISION PERMIT #: MST2007 -00066
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639 -4171 # ii ��19i�I
Inspection Requests (24 Hrs.): (503) 6394175 - °_... '
INSPECTION WORKSHEET FOR DATE: 6/13/2007 TIME: 7:01AM PAGE: 85
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503.806 -1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503-407 -5630
Inspection Request Scheduled For: Date: 6/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 050105 -01 503 Y
Corrections /Comments /Instructions:
\`..---
V .
s , ASS I I PARTIAL APPROVAL I I CANCEL NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: / " Y )
Y Dater ( , 2 Phone #: (503) 718-
CITY OF TIGARD '
BUILDING DIVISION PERMIT #: MST2007 -00056
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639 -4171 . ) ,, ,41 1 1 1
Inspection Inspection Requests (24 Hrs.): (503) 639 -4175 ..�,
INSPECTION WORKSHEET FOR DATE: 6/11/2007 TIME: 7:01AM PAGE: 60
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503.805 - 1631
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503 - 407 -5630
Inspection Request Scheduled For: Date: 6/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 048135 -01 503. 407 -5630 N
Corrections /Comments /Instructions:
. _.
6 '•ig
AI-- -/ // f ../ / /
`/ _ AI% • - maw 4te i
- i
S ❑ PARTIAL APPROVAL n CANCEL I NO ACCESS
I I FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: al Date: / Phone #: (503) 718- )-.'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639 -4171 Ajm�ii�6 "�
Inspection Requests (24 Hrs.): (503) 639 -4175 ' i � ..
INSPECTION WORKSHEET FOR DATE: 5/9/2007 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel
OWNER: SMITH, MARK PHONE #: 503 - 806 - 1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503 - 407-5630
Inspection Request Scheduled For: Date: 5/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 047942 -01 503. 250 -3164 Y
Corrections /Comments /Instructions:
4 ,- , ./ - ''''.
J , • iyi--7 _ _ ...--
i
_
67 ?___.)
P (- " (2 _C__` 1 / 3
e 497, , , .
• PASS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
IL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector ,/ K Dater/ �/2") Phone #: (503) 718 -
•
CITY OF TIGARD. � r3.
BUILDING DIVISION / a � Q� ' / PERMIT #: MS 0066
13125 SW Hall Blvd., Tigard, OR 97223 C DATE ISSUED: 4/13/2007
Phone: (503) 639 -4171 1 1/CA4 a' 4PNyp l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/9/2007 TIME: 7:00AM PAGE: 38
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel
OWNER: SMITH, MARK PHONE #: 503 -806 -1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503 -407 -5630
Inspection Request Scheduled For: Date: 5/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 047942-03 503-250 -3164 Y
Corrections /Comments /Instructions: _/-ATM--4
ei/ ci, �' re4,41.pte).. � i, . & 4 a.
1
y
yfrofroi," / / / 15.
_!C, . ' , // , / /.?/ / / , / /
I:1 / 1 i AIL.: / J J , . ' .„,,,,,., lifilliiff" -
,,,A4. ,, , /
I i PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
1 FAIL X CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
''/
.Inspector: -„ , Date: �� Phone #: (503) 718 -i
•
CITY OF TIGARD • 4 -
BUILDING DIVISION PERMIT #: MST2O07-00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639-4171 Awito
Inspection Requests (24 Hrs.): (503) 639-4175 ..-41611■
INSPECTION WORKSHEET FOR DATE: 818/2007 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503-806-1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503-407-5630
Inspection Request Scheduled For: Date: 8/812007 Pour Time:
Code # Inspection Description - onfirm • Contact # • Message
199 Electrical final 053582-01 503-250-3164
Corrections/Comments/Instructions:
X ASS I I PARTIAL APPROVAL fl CANCEL fl NO ACCESS
I FAIL I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: / 1 4 ° I% Date: 1) '01 Phone #: (503) 718-
— ,
- -0 • .
CITY OF TIGARD '' .
.
BUILDING DIVISION
• iinAilt PERMIT #: M3T2007-00066
D ATE 13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: 4/13/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ..„......14- .....
INSPECTION WORKSHEET FOR DATE: 5/14/2007 TIME: 7:01AM PAGE: 41
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503-806-1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503-407-5630
Inspection Request Scheduled For: Date: 5/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 048219-01 503-407530— Y AV
fi( Corrections/Com ents/I structions:
.'
/get/7e_ 0...-14.z...0 v a v1/4---- L-/C1,0 - et. ! - , , _ 1 , ,
2 4,A-- (a_nie4/ h4 S'Af-e__- W-Let (-C /14- c k 04.--p.t , • e---
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Aly 057
g.4 "ASS n Pi" IAL APP • • ' L 0 CANCEL NO ACCESS
I I FAIL R c, , 0 g 91.97. - P - TION I ADDITIONAL FEES ASSESSED
/ •
c" - 0 /7 -? ----
Inspector: . DatA/
Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M ST2007 00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1312007
Phone: (503) 639 -4171 / �zaa dd Pu��ul�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ate' A IL.
INSPECTION WORKSHEET FOR DATE: 6/1112007 TIME: 7:01AM PAGE: 58
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMI TH
DESCRIPTION: Interior remodel 05/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503 - 806 -1594
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503 -407 -6630
Inspection Request Scheduled For: Date: 5/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 04813 03 - 503-407.5630 N
Corrections /Comments /Instr ctions:
-
N ® IN A s W A- U ()C)&. 0(L
41 6 Li 09 • S 6 30 .
1 PASS n PARTIAL APPROVAL I CANCEL XNO ACCESS
X FAIL XCALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: G 1466 Date:s II 0 Phone #: (503) 718 -
. .
CITY OF / . ,
BUILDING DIVISION PERMIT #: MST2007-00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503)
ido,„ I 4,
Inspection Retkiests (24 Hrs.): (503) 639-4175 „.4ir-
..,
INSPECTION WORKSHEET FOR DATE: 8/14/2007 TIME: 7:00AM PAGE: 29
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Interior remodel 06/10/2007 Add (6) branch circuits.
OWNER: SMITH, MARK PHONE #: 503-806-1591
CONTRACTOR: CHAMELEON CONSTRUCTION PHONE #: 503
Inspection Request Scheduled For: Date: 8/14/2007 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
------:_)
299 Final inspection 053941-02 /603-250-0316 Y
Corrections/Comments/ Instructions: '
i
I fl PARTIAL APPROVAL 0 CANCEL n NO ACCESS
I I FAIL pi CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
/
Inspector: ..
/A . Date: g 7 Phone #: (503) 718- 7-R-Aq-N
• .
, ,, •
CITY OF TIGARD . .
BUILDING DIVISION PERMIT #: MST2007 -00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2007
Phone: (503) 639 - 4171 >I uIt
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/14/2007 TIME: 7:00AM PAGE: 30
SITE ADDRESS: 13668 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 051 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: interior remodel 05/10/2007 Add (6j branch circuits.
OWNER: SMITH, MARK _ PHONE #: 503 - 806 -1594
CONTRACTOR: CHAMELEON CONSTRUCTION - PHONE #: 503 - 407 -5630
Inspection Request Scheduled For: Date: 8/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 053941 - 01 503.250.0316 N
Corrections /Comments /Instructions:
PASS n PARTIAL APPROVAL n CANCEL U NO ACCESS
1 l FAIL ❑' CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ' , Date: 9 l d7 Phone #: (503) 718- 2_44 7's"---