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Permit CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2012 -00203 -r tGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012 Parcel: 1 S125DB05400 Jurisdiction: Tigard Site address: 7255 SW SHADY LN Subdivision: SHADY DELL NO.2 Lot: 28 Project: Koeber Project Description: 1001 sq ft addition of bedroom and bath to second floor, no change to existing footprint. Plumbing under separate permit, PLM2012- 00198. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 22.5 Bathrooms: 1 Second: 1001 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 1001 sf Value: $104,023.92 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 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: 1 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 4 Mfd 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: ADD SF VB R -3 1001 Owner: Contractor: KOEBER, ROBERT SWANCO INC Required Items and Reports (Conditions) 7255 SW SHADY LN 408 NE 110TH ST PORTLAND, OR 97223 VANCOUVER, WA 98685 PHONE: PHONE: 503- 804 -0128 FAX: 360 -573 -7786 Total Fees: $3,493.54 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 0 R 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: J'- 4V ac Permittee Signature: r I ( Call 503.639.4175 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. Building Permit Applicatio' f,,. Residential � � AUG 2012 FOR OFFICE USE ONLY City of Tigard Received r J �y g (/ 1 i �' . Permit No.�/, ( - oaQ (X) " 13125 SW Hall Blvd., Tigard, OR 972 IV y '� ' ® DateB t g OF l CARD Plan Review . Phone: 503.718.2439 Fax: 503.598 ii , o )� s o D `' �/ 'Z(f ( + they Permit: TIGARD Inspection Line: 503.639.4175 3NG i:,3itI`IN11ON Date Ready/By: � t El See Page 2 for Internet: tv ww.[igard or.gov • .tified/Method_ A. > 1 :( A. Supplemental Information • :; A'• l 11 %mil '- , y - C...• TYPE OF WORK . • . r QUI ^ i D DATA: 1- AND 2- FAMILY DWELLING 72 ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. (` Indicate the value (rounded to the nearest dollar) of all F fT:, Additiort alteration/replacement . ❑ Other: equipment, materials, labor, overhead, and the profit for the Z / CATEGORY OF CONSTRUCTION work indicated on this application. dwelling Valuation: / 023 �Z ® 1 -and 2-family g ❑ Commercial /industrial '. 7 , ❑ Accessory building ❑ Multi - family Number of bedrooms: 4 + 1 n ❑ Master builder ❑ Other: Number of bathrooms: 2+4 l � " JOB SITE INFORMATION AND LOCATION r Total number of floors: 2 Job site address: 7255 SW SHADY LANE New dwelling area: 1001 square feet L d City /State /ZIP: TIGARD, OREGON 97223 Garage /carport area: N/C square feet l N Suite/bldg. /apt. no.: Project name: 2 FLOOR ADDITION Covered porch area N/C square feet Cross street/directions to job site: EAST OF 74" & SOUTH OF TAYLOR'S FERRRY Deck area: N/C square feet Other structure area: N/C square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST . Subdivision: I Lot no.: Permit fees' are based on the value of the work performed. Tax map /parcel no.: Indicate the value (romded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the _ DESCRIPTION OF. WORK work indicated on this application. I" ADD PARTIAL SECOND FLOOR ONTO EXISTING SINGLE LEVEL HOME Valuation: $ WITH NO CHANGE TO THE FOOTPRINT Existin g building area square feet M New building area: square feet Z ❑ PROPERTY OWNER ❑ TENANT Number of stories: ,I Name: ROBERT KOEBER Type of construction: Address: 7255 SW SHADY LANE Occupancy groups: City /State /ZIP: TIGARD, OREGON 97223 (w Existing: ,� Phone: (503)246 -0734 Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES * Business name: ZAROSINSKI ENGINEERING AND DESIGN, INC (Please relerro fee schedule) Structural plan review fee (or deposit): Contact name: DEAN P. ZAROSINSKI PE Address: 1400 NW 155 CIRCLE FLS plan review fee (if applicable): .� N O City /State /ZIP: VANCOUVER, WA 98685 Total fees due upon application CCN Phone: (360) 513 -2746 Fax: : (360) 576 -8698 Amount received: ,_,5 Q 9 E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: SWANCO , 'iC Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 40a t 9 110 r Solar Installation Specialty Code checklist. City /State /ZIP: VA/4 COLVVE -� 'WA 9868 5 Permit Fee (includes plan revie $180.00 and administrative fees): Phone: ( 5 , 3) 9a4 012 Fax: (%CV 573 '7'78 State surcharge (12% of permit fee): $21.60 CCB lic.: 6 $ IAA' 7 AC t 3 — Total fee due upon application: $201.60 Authorized signature: T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: DEAN P. Zr \ROSI \S PE Date: * Fee methodology sct by Tri- County Building Industry Service Board. I yf Mechanical Permit Applicati r �, • P iVE FOR OFFICE USE OONLY Received City of Tigard Date/By: Permit No.J - n 13125 SW Hall Blvd., Tigard,OR 97223 AUG 0 1 2012 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 DateJRy: Other Permit: T I G A It D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: 1uris: ® See Page 2 for Internet: www.tigard- or.gov V 4a6°9�c1 Notified/Method: - jp Supplemental Information BUILDING DIVISION 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 Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts/vents) 46.75 City /State /ZIP: Furnace 100,000+ BTU ( ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work j 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 . Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 A PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: -pc, I'3 �0 r3 F n Environmental exhaust and ventilation: Range hood/other kitchen Address: 2 s c_,) S13, t( 1_,,,,,1 equipment 33.39 City/State /ZIPS ; A . Z Z Clothes dryer exhaust 33.39 '� , 2 7 3 Single -duct exhaust (bathrooms, Phone: aO 3) a 6 _ c .7 rR y Fax: ( ) toilet compartments, utility rooms) 23.32 APPLICANT ( - ❑ CONTACT PERSON Attic /crawlspace fans 23.32 name: ' // Other: 23.32 Business L, O 0 M J 5 � E A-7 Jc 4 ' Lbo w 1i G Fuel piping: Contact name: t - t ,.3 �.-h n inn ° � � $14.15 for first four; $4.03 for each additional n J t t / $E / W TH 02AJE C Furnace, etc. Address: / Gas heat pump City /State /ZIP: pl.T LA,>J� h2 9.77-.;_7 Wall/suspended/unit heater Phone: ( 563 )25 9 _ 7 q9 n ' Fax: : (50; IQ 6-7- - Z$ Water heater Fireplace E-mail: Leo t1tr 5 t - t - . O( 1 p A 1+00 - C-0 oil Range CONTRACTOR Barbecue Business ntame: + Clothes dryer (gas) �r, um ; S �/ r/.}TJ 0 G v. , coo Li Al _r_i Other: Address: / e c< / / s iviLtA0.7.4 012 J.1 �_ MECHANICAL PERMIT FEES* Subtotal City/State/ZIP: ? 7, ,� /4 h 0 t 0 7 9 7239 Minimum permit fee ($90.00) Phone: Co3 )D "5,79 (4 Fax: by '2 z 5 7. L 3 2 s( Plan review (25% of permit fee) CCB lic.: 61 , f � 1,► 41.1104 State surcharge (12% of permit fee) I TOTAL PERMIT FEE AID - Authorized Sl n i This permit application expires if a permit is not obtained within 180 g�,�, ' . v - days after it has been accepted as complete. Print name I. r ` - Date: • Fee methodology set by Tri- County Building Industry Service Board 1:\ Building \PermitsVMEC- PermitApp.doc 09/09 /10 440 - 46171 (11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC- PermitApp.doc 09/09/10 2 JUL -06 -2032 07:36 AM dk it5c1 2tru1 503 246 0734 P -8, Electrl�� Perttai t(�UG 01 2012 E • ., � 1, i.', of Ir ;•:i I i � ,. Tigard 11312$ SW Han swa. _ Roc 7igard � y � , Ptmn Rwiew ' . 11 -. • . ` .. Phone: 503.718.2439 I0 612 7 4 ' r-';',1' , Other hint Inspection Lino: 1,639.4173 J ' Owe Itmsfelly: her 1 I0 rim tape a ter ' , - In : + t HaiA:d$lydwd: _ � +'T �y-j 1 0q, 1 ralme■at as i.' gaga 7 �7�' [w tt, N' .".',1 T•`ftr.. .F.,VM .' 7 a... - '� F.l Ilit ❑ New construction ❑ A dditionfalteratiott/replacement Pk= e -- • . • A nu • plea Wiliam • ". below): ❑ Sono as or Rode 402 carpe or Glare 13 Paedla! mar eras, sronea. ❑ Demolition ❑Other: Hi : r!�,;r • � �� ,. vebaeQle ntlla0ls Rik tempo Moms ad boetteadr. e� •r ,y '..�• " ° . q..' ;∎ .:• , y� =, , meal 10,000napset130 Oil 51t er r. 3 a an to oneaI, or enaeede le,0oo O -ose amttentued S 1- and2- iterrdkydwelling Al Cainnterolal /ladustrial ❑ Aeoensorybuilding mope fa ill aim fond Won entriegt II Multi - fared • Manor bulider ❑ Other Ore pony. 0lonoD sloe ell ttvw or • �+ ]. "e,s !, K+�' i s i i b�. �rT' n Oleranneeyeyetno. la Preyed rte m. ,c_ V: �. � r�r!E':� J4'I D Mena Omen ewer toadnf 0'eA'.'8 ^.1•2'.'1 -3 - , lob ao.: lob site addross. 103111, co mon CI Ste or MOM rake. del coda 0BaaatiotW rank rake . , City/State/ZIP: OBeetlitaere Mlles. O Supply venom kr non illm 1 Olrmrdeue inseam m 400 vale courts:. Suitiebldg./tipt no.: _ J Project name. 8 i�leendeerrya Were® a rain. Oyu ttaeaVdireetl0ne to job site ;° .,^ '�'a < t - 71 ,0 : • MEIN SE Pen reIAeatlal Ogle- or smelnAnntly dwell MI unit Model stinted rape. Suhdivinioa: —1 Lot no.: I,000 et} R or lab 168.54 4 tax roe4tl)ktncel no.: 111 Ea set San . R. or - • on 33.97 _ fl WA _ t�.+ ,r : l Fir,' G � Ja;� tk .,: > ,�r�+1r F?z �0�' •rr'e IA atom R 1111 7100 12 Limbed eamrgr, atttki lbaity III 71.e0 13 rend wi • . ft Semites or Paters In . i iii ^• py��c 200 amps or lead 13 OiS}( ��ggfife: r `: . t. I m . " ..: . 101 e._,.: SOa °"I" El Neste 401 carpe to 620 mops II 1fA.31 2 601 1000arm 301.04 2 ASS: over 1.000 152.25 2 Cityl9tetta/Z[P: Tempura* tomato or leviers Installation attention, ova, rdeeatlea Pbotle: ( ) Fdot: ( ) 100 mpg or ld 39.36 ' — 7 - Owner Ixls$allotion: This installation is being medc on propane that'( own which Is not 201 rumps w 400 MP 111.08 ¢ 2 1 intended for sate. lease, rent or exchange, a; Herding to ORS 447. 449, 670, and 701. 4ot tartiw to 999 arms 164.54 2 Branch elre* ta- neat, nitration or entensbo, • r pygel (keno signature: elate A. Pee for Pau)! Petits WA woy� i >Mr7,1 loin <, above se v Ise ;Winder fie, f r at 'c .. A.1. z•ac..L. ,i. � iD,l �' L s l Aiftg?L±m .:,-L , ir.,.t r.41 2 Strelriesa rime: B. Pee for We obegits weaver service ar Ikeda Poe. first Contact •lane: tirade &wit 36.18 1 Addeaoa: End r+dd'1 tend tend circuit <vcircuit 1,42 y 2 M - Mean novice or feeder not larlesde0 City/9tate+�P �� i i . 61.84 2 phone ( ) ` Pa:: ( ) Itsere teeiosl 1.11 67.84 _ 13 E -®all: - 6'1.54 � er,•�• i y r ,..��• .� ;, gibe acu0lrxBghdne 61.14 2 ' gi afmsleGD a tbnMedkltere)e 13051ness name: SC.-07rc.c.) i P lC • owed, alteatlaa, or mon Ion Patel 2 Sad add . . I i _, •,t • , . - ____ ab . Address t� �X ' q Z 6 1Q G OE- Additional fetooaloa 1 to mini, 11111111011.1116 25/ he ' Q / J c ' loo ptlpeden (t In rain) 625/ hr i Chy!$1NIdZIP: C�^i rnrfutrial 4 6.15/ hr Or Phone: L C D ' ) 6,68 7n f ( Fax: (S ?3 ) W ' 3104 lmpeenons tbt Vital no the b 90 hr s • - Meal lleted %hr min CCB Lie.: 1,9 2 Zg f Electrical Lie:C$fii Super. Li o.: 31 ;'", "Tr Som. Ble la fpaie r'f Subtatnk lydre, required: Plan reviav (3194 of petgdt Inc) ?rift' rr> a: /Male. dsrA ie0 Cam 7- a7- ?Al2 Stem surcharge (1254 of permit site): i Ant/mine' signatt1AC_ ` r lmnni PPpt nn a ass ob ( ��/ ((( rei porsnft ameatus. a�ireeif a panne not 1.P RIM 011600: 1 B Pre otter et $been mooted a eemplata. • Mamba at inrpecsone tamed papaant. t:+ttattroploo+aw.e•ramlaro doe mow o 410-/1 Ilrt 117e1IG7 t Z9i' l-£L9-09£ ums poi $ doe dL*7 :gO Z6 oe IT Focus on Travel, Inc./The Travel Specialists 14335 SW Allen Blvd. Beaverton, Oregon 97005 USA 503- 646 -3700 Fax:503- 643 -5979 travel @focu so ntravel. corn Agent Statement Bob Koeber From: 4/2/2012 BK To: 4/29/2012 Agent ID: BK Agent No: 6888 Issue Date Invoice No Client Name • Tkt/Confirm No Start Date Vendor Name Passenger Name Total Fare Commission Status Agent Comm Rate Date Paid Remarks 1/31/2012 203957 Koeber /Bob 472530866COU 3/8/2012 Alamo Car Rental Brown /Dennis 164.27 8.21 • Inside 0.00 0.00 Outside 5.75 70.00 164.27 8.21 5.75 Travel Type Fare Commission Agent Commission % of Total Car 164.27 8.21 5.75 100.0% Booking Count = 1 Total Agent Commission = 5.75 5/2/2012 3:59:56 PM Agent Statement: BK Page 1 • .14 ° Building Division Development Code Provision Review TIGARD Residential Projects Building Permit No: 6 - CWS Service Provider Letter Received: Yes ❑ No ❑ N/A f2" Routed Plans: Original Plan Submittal Date: g(t ft 1st Revision Submittal Date: ❑ Site Plan Only 2 Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked ( items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact fir 12t ke-4 at 503 - 718 -or 4 a @tigard- or.gov) Land Use Case No. Name - O H' Setbacks: Front 2 b Rear / r' Side Street Side 7 Garage ZO Er Maximum Building Height 3 D Actual Building Height 22J s Er Visual Clearance N� Er Easements 1 l Sensitive Lands Type: / Notes: /n v2 A tP i., � / 4./s; .,.. - /a - /Ke (- • Original Plan: Approved ,0' Not Approved ❑ Date: 5 / - Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) ❑ Actual Slope: Notes: Original Plan: Approved ❑ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov) ❑ Street Trees ❑ Protected Trees Notes: Original Plan: Approved ❑ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes ❑ No ❑ Date Routed to Building: Page 2 of 2 CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2012 -00203 -r tGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012 Parcel: 1 S125DB05400 Jurisdiction: Tigard Site address: 7255 SW SHADY LN Subdivision: SHADY DELL NO.2 Lot: 28 Project: Koeber Project Description: 1001 sq ft addition of bedroom and bath to second floor, no change to existing footprint. Plumbing under separate permit, PLM2012- 00198. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 22.5 Bathrooms: 1 Second: 1001 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 1001 sf Value: $104,023.92 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 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: 1 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 4 Mfd 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: ADD SF VB R -3 1001 Owner: Contractor: KOEBER, ROBERT SWANCO INC Required Items and Reports (Conditions) 7255 SW SHADY LN 408 NE 110TH ST PORTLAND, OR 97223 VANCOUVER, WA 98685 PHONE: PHONE: 503- 804 -0128 FAX: 360 -573 -7786 Total Fees: $3,493.54 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 0 R 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: J'- 4V ac Permittee Signature: r I ( Call 503.639.4175 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. Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 7255 SW SHADY LN, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection 04/24/2013 00:00 MST2012-00203 PASS - C of O Violation Summary: Inspector Contractor