Permit fk
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00078
Zo Ali DEVELOPMENT SERVICES DATE ISSUED: 5/3/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12580 SW KAREN ST PARCEL: 2S104A■
SUBDIVISION: BELLWOOD ZONING: R -4.5
BLOCK: LOT: 028 JURISDICTION: TIG
REMARKS: Replace existing covered patio with new sunroom.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 8 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 36,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: 15
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:
MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/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 & 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: $ 723.43
This permit is subject to the regulations contained in the
STEVE SUTTON PATIO INNOVATIONS, INC. Tigard Municipal Code, State of OR. Specialty Codes
12580 SW KAREN 6320 NE SANDY and all other applicable laws. All work will be done in
TIGARD, OR 97223 PORTLAND, OR 97213 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 - 590 - 2936 Phone: FAX 282 - 1426 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #` il 240 27345 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
Framing Insp /
Electrical Final
Fi - Inspection
.111 Ma Is- ued By : / 4 to 1 , kil / / Permittee Signature :
Call (503) 63. 4175 by 7:00 p.m. for an inspection needed the next business day
Billiding Permit Application FOR OFFICE USE ONLY
City of Tigard Dates : �, a •/ , 7_ , _ M � 7 ; •
13125 S W Hall Blvd., Tigard, OR 9722
P emut No.: 7 � W
3 Plan Re 4 Other Permit:
503.639.4171 Fax: 503 � a t � �p�° N II� I NP 'h II it 1 Date/B : 3i l r / f
� ` I l ate Ready/By: Juris: ® See Attached Checklist for
Inspection Line: 503.639.417 I (
Internet: www.ci.tigard.or.us r k�� i- ed /Method: Supplemental Information
,•r,. - ,. * ^ r,k '!J , #.6 ' S:'�= ^e:', ;.earl:, wsi6;'T=..«
. >..:3 ���,. :,ry- ,e �..._ ., •., -, - . . .._ .. U. :, n x� a "tl� rr,:,�t- t�k.,,��r.,,: x.. .. r . ,,.,x,�
p Y px6;, • ,i,in . "t3. '. t"^ er 'a: , � s`.`� pf- 9 .q. ^'. nz�f^'av'.31x ? fi r{ 9 "ir�� 4, � I � • A ' 1
'� I , < o '' x:'i : g :- ^ITYP,, WO RKr -'g.t ee >� !"t. � „� .,., , , '� REQUIRED DATA 1 AND 2- F AMILY DWELLING
°�^�ti�?��a�a *�?,�.� >�=��+.�,�s �s . !. � _`�,,.s:=a>:.,�,.���w�a�� .�� ti�tn�t'"�..at;- ..: �� ,�_.�:_ 4^ . , ,�^ � tit, ��rr >„ � ^.���.a� ; .:.:��. -.,.. r ',. �- , �, I> •.•a ,= ; ..
❑ New construction
❑ Demolital\ Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
jigt Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
.,,. "<�_.: F, t - v',F.r: <,...,, :, - ;,,,�r lication.
,:4��� a, �;z' . ;�.'�''''ztfr�: k.°t� ;s ;�,...�s . °i ��i�,X�.;: - .,i.,, , �',:�; fir. .,, work indicated on this aPP
GI , P •4, , , ., t: P PPP CATE ttatf: NS, 4 2T TIO ` ; 4 4 1: ., .:,
' . il :,s
Valuation: $ 3( f Qo
R 1- and 2- family dwelling ❑ Commercial /industrial )
El Accessory building ❑ Multi- family Number of bedrooms:
ED Master builder El Other:
Number of bathrooms:
�° - =St?k- '��S.+i�r:,; *tt#- = cXr>n� c � ..w rt.x1a`a<^ :h6a ;a ;, - - - ?' :'° ,, s >:
. 6 r JOB SITE INFO ,, Total number of floors:
Job site address: ID 5g O, O, e \,., f kare,r■ New dwelling area: square feet
City/State /ZIP: \;1 e yy-eR t V C q 7oa ? Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: J � . . �.� � Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
1<cfre,r 12-7 ' Other structure area: square feet
lieliU EDTDATA COMME L USEZHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
y ��0 v DQ Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: 0 S lo 0 equipment, materials, labor, overhead, and the profit for the
' ' , = t V gi ' DESCRIP�T " O N ' O : WORK . r t ` " l ¥ 4 f work indicated on this application.
fi ' -- r witMi s a ��. " .. sh:."wa I2, , #-,. p t9 .� yv._ ,mom v , 0. ,,A:,` �:�
Valuation: $
IN)e4,1/4.D ---- e7\ A - , Unr0C'� i yIc.�_
j � Existing building area: square feet
0 Px',- - -r,r, \�o c-, 'rNer c k 1 1C-)
New building area: square feet
• V : a- l' ? . . r . �'¢ TENANT
,�� � � i� s _� � ,=� � , � " �� N � % � � Number of stories:
PBO�EBT4I 0�3'NER
a� # . n ,�. ; � .t _,ms's
Name: \ tP U-r (\ Type of construction: .
Address: 125 ' C> , NW T Occupancy groups:
City/State /ZIP: "---; `, ' f 61-703 Existing:
Phone: (($ ) 5C, (� .- ' 3Vp Fax: ( ) New:
Rif 'Ts. .1,;.:,„ a'n.'< 4i� ,r,l" �l„ N d"'" �, q
^ _ �: ,, i yr! PI';ICANT . ? � . ^ CONTACT PE ROS , .. ° °• I
, �.. , � *,`�"E�_ � :� _.. , •' , � ��:_ i, ��� �.,� tea- ,_�:. „ -. ,.A�..,, �- ��;�.!t ;��, _ ,; •..� �:�s.�fk� m � , �.�;.; �NO�ICE l
� ' '
Business name:' \) 4 , j rim,j e .., + u,-.5 / (v mil, Y N .,,Jy.;t n cs All contractors and subcontractors are required to be
��� licensed with the Oregon Construction Contractors Board
` J
Contact name: J 1 ,l�jC� P under ORS 701 and may be required to be licensed in the
Address: 6 � ,c___, C."-, 1 lA 6 0\ jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: ( "77-1-07 I t 0 R - 7 '- I f apply:
Phone: (562)) Z$ T `-t Fax: : (5o) • Z:8 - 1 X1'2 -6 •
E -mail , (/ y
�,�.� -. v��3^c:= . .. -, . �. ,
,.;. .; ., xn..x.> .,,.,,�, ^<.. �- ;:e.c6�:?a:a3�,t p�'i£+'t= r Ana '�4`r:% �i
.h• x r ' ° i?? .�I�.:. .y,F=:Y$ 3 6616 •� ::rSie •zx,, ii raRi;=-N , •,,;t M .. ; ? "
,3' a s . •r , ..� I :: - GONrTRACTOR ; r n ".�,ri w :;
- �..a ', -Hs ,� a'? »',. -, +�E '4�4- 'x.�'a3f:k?,z�z.htY;�; x�:,��..- -. c. :., _,..,,A- ��:�,. aa -�, „ . -. a_5 x
Business name:
Address:
t J 1 , �- p � r BUILDIIVG�P EItMIT 4F'EES
Please refer to fee schedule.
City/State /ZIP:
_ Fees due upon application 6 3 - 7 7
Phone: ( ) Fax: ( )
� Amount received
CCB Iic' i `Z ,
'7 '3 `-!
Date received:
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: 3/511/ * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Permits \BUP- PermitApp.doc 12/03 440-4613T(1 I /02 /COM /WEB)
Building Division
ni Plan Submittal Requirement Matrix
"---� Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
_" T 4 06,f;Submittal o 44_
1 � � t �� i S N i b rzMSA �.$ £G S T
! y �
1 (Inelud e , add <honsnad a lte ra ti o ns ) R e u> at
r, s � F� t �'� �' L "fir +. �" 4 1 V 4 T t' e q 9 x tt a TI
k 4 F X13 dp 9' i d z #� r "3 J y a �' . s
9p i a� i
g .y�: "o av
�,.ta ., 75�s �" ;'W 1, ��?S�'��•.. •Ax� ._.�r�, k,.x '�43cj3A, .. e�..�'vroFtx.. x�"'tns.
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(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.
i:\ Building \Forms \COM- PlanSubReq.doc 12/24/03
•
Gs it)
Electric 1 Permit Apph Ciltlon FOR OFFICE USE ONLY _ Y ` 0''"
City of Tigard �aR l 5 1� /
Received
:� DateBy: Permit No" ( — 61Or�7$ Ana
13125 SW Hall Blvd., Tigard, OR 97223 OF I. Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 G � w t '' Other Permit:
Inspection Line: 503.639.4175 v„Q,N ! Date Read B Y Juris a See Page 2 for
_. �.� Y
Internet: www.ci.tigard.or.us 8 ij Notified/Method. Supplemental information
' i ,t ' rfa . : i- W a s • '', s i "", " .PL N V,. W
❑ New construction f Addition/alteration /replacement Please check all that apply:
Service over 225 amps, comm'1 EHazardous location
❑ Demolition ❑ Other: ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
t , r to a „ § I (AT'.E 9 @I+" CONSTR Fx ° ` � b £ r" A of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building System over 600 volts nominal units in one structure
Buildin over three stones ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder 0 Other:
Occupant load over 99 persons Manufactured structures or
.n
JOB SIJ.ik = lrt3 ATI011' " " , ; ` f ❑E gress /lighting plan RV park
7 ' ' 7 St W ❑Health -care facility ❑Other:
Job no.: Job site address: ) ' r Submit 2 sets of plans with any of the above.
City /State /ZIP: �� r i 7 2x-3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: : .t .:,.. -,.. F;,.., :.... 5.** `SG$ED'04C' , ' 1 :
Description Qty. Fee. 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.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
gar ', a", DESCRIPTIO, pFi�WORK, rv `'';` . a ,l" " 1 - t Each manufactured or modular
dwelling, service and /or feeder 90.90 2
.. ( -' \- t d t% ^ t ' OC) Vv , LAD, f i,..- Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
;� ; _; -,. = 0 fit° t *`;' "t t:tr filar VT47 7Me I; °- 201 amps to 400 amps 106.85 2
;" 0",pgQP WIE: k „TENANT " " e :
.. ". " °'. ", ,. , .k� , ., .. f w.... ,... 401 amps to 600 amps 160.60 2
Name: �VC., LA. 1 - 601 amps to 1,000 amps 240.60 2
Address: ) • 8. 6j S A.) V Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP f_.4--10e j O i- Temporary services or feeders installation, alteration, and /or
Phone: (S03) 2000 0 amps : 2. 36, Fax: ( ) relocation
or less 66.85 1
Owne • tallation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for 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
'�' ti ° ii'' " �; li
.1;'�;�' � A;�PICANT � a :" '' �`�.� a +� � " ®CONTACT PARSON .�, A. Fee for branch circuits with
t. a. � service or feeder fee, each
Business name: branch circuit 6.65 2
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)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
•
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
V� r ` ` o r
l`'i ,f .. x. a a.,,CQ1TACsTOR .... _ �; �., :, i panel, alteration, or
extens
on. Describe: Page 2 2
Business name: C c am ( a --4 -; , L „4,(_t__-
Address: Each additional inspection over allowable in any of the above
0 I Per inspection 62.50
C ity/State/ZIP:
O � 2 ' l t (7
Phone: 9'' 3/ Investigation per hour (1 hr nun) 62.50
Phone: \ � j — aL/(0$ !� Fax: ( ) Industrial plant per hour 73.75
�/
War” �E PERT ttinE3*; ' :
CCB Lic.1// /700 Electrical Lic.: /?— Suprv. Lic.: , p,4,/ `j Subtotal
Suprv. Electr si g l4 atute, required: !0/,-70.- f��� /6 � 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:
} � � �rJG.'C;� 3 - i S —Oz..- * Fee methodology set by Tri- County Building Industry Service Board
�, rA a .-
** Number of inspections per permit allowed.
i Building \Permits\ELC -Per tApp,doe 12/03 440- 4615T(1 0/02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alai;in
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
terli VIEROM WOI K�0,
_�.. . __... .�„ �.�w,�,_�_,.._ `�..,���.,._.•1:1•N rte
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
i \ Building 'Permiis\ELC- PertnitApp.doc 04/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GORGE ELECTRIC INC
PO BOX 806
HOOD RIVER, OR 97031
Electrical Signature Form
Permit #: MST2004 -00078
Date Issued: 5/3/2004
Parcel: 2S104AA -03800
Site Address: 12580 SW KAREN ST
Subdivision: BELLWOOD
Block: Lot: 028
Jurisdiction: TIG
Zoning: R -4.5
Remarks: Replace existing covered patio with new sunroom.
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:
STEVE SUTTON GORGE ELECTRIC INC
12580 SW KAREN PO BOX 806
TIGARD, OR 97223 HOOD RIVER, OR 97031
Phone #: 503 - 590 -2936 Phone #: 541 - 386 -2468
Reg #: ELE 14 -20C ��
LIC 111706 \D \
SUP -- "/8'S S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising lectrician
aat
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour / Q�
BUILDING Inspection Lin 03) 639 -4175 MST ' eX - 6 W 7
INSPECTION DIVISION Business ' : (503) 639 -4171
BUP
Received Date Requested ..I AM PM BUP
• . • ,
Location
, • L' � ��.�' � � %�' Suite MEC
•
p�
Contact Person % A• Ph ( ) 5 O 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
��� fJ _
Ftg Drain � 7 C i 44) D ' _ 'L.C (�� ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 9.0 `
Shear Anchors
Ext Sheath /Shear -
Int Sheath /Shear / s �.'�' —� -
Framing / C
Insulation
Drywall
Dwal Nailing �
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceilin. i ■
Roof 11 .
.. u /
• -
■
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
ELECTRICAL -
Service
Rough -In
•
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line 4 /
ADA ,(/ �
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection recor • from the job site.
PASS PART FAIL