Permit li J
` �� MASTER PERMIT
PERMIT #: MST2004 -00359
I
,lv DEVELOPMENT SERVICES DATE ISSUED: 12/7/2004
- 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171'
SITE ADDRESS: 11680 SW SUMMER CREST DR PARCEL: 1S134CD -06200
SUBDIVISION: BURLWOOD NO.3 ZONING: R - 4.5
BLOCK: LOT: 022 JURISDICTION: TIG
REMARKS: Addition of Family room, bedroom, patio & shower.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST: 460 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: THRo- sf RIGHT: 5
VALUE: 36
OCCUPANCY GRP: R3 BDRM: 1 BATH: TOTAL: 460 sf REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
. LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: 1 CLOTHES DRYER:
FURN 0=100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
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: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: 2.00 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 8 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: $ 917.86
CAPELLE, KEVIN & HOLLY ABSOLUTE CONSTRUCTION This permit is subject to the regulations contained in the
11680 SW SUMMER CREST DR DAVID DOUGLAS MCGREGOR Tigard other Code, State of OR. Specialty Codes
11300 SW NOOTKA ST and all other applicable laws. All work will be done in
TIGARD, OR 97223
113 S N OR ST 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 - 524 - 4262 Phone: MOB 314 - 5948 ATTENTION: Oregon law requires you to follow rules
( � Q2 � adopted by the Oregon Utility Notification Center. Those
LI
. Reg #: C 3386 0071287 rules are set forth in OAR 952 - 001 -0010 through
1 952- 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987. •
REQUIRED INSPECTIONS
• Footing Insp Crawl Drain /Backwater Electrical Rough In Rain drain Insp
Foundation Insp Footing /Foundation Dn Framing Insp Electrical Final
Post/Beam Structural PLM /Underfloor Shear Wall Insp Mechanical Final
Post/Beam Mechanical Mechanical Insp Exterior Sheathing Insl Plumb Final
Underfloor insulation Plumb Top Out Insulation Insp Final inspection
Issu d By : ( #,,(J4 -ff1/ Permittee Signature
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b mess day
, ,
Building Permit Application' . FOR OFFICE USE ONLY
City of Tigard E1v53 Received JO /J'/ i Permit No.:V.6 -,.2 / G013
13125 SW Hall Blvd., Tigard, O' <<5" Plan Review
Phone: 503.639.4171 Fax: 503 9 :. �. , f Date/By: PIA ti )), .. I - cy Other Permit:
Inspection Line: 503.639.4175 200 ,,, 1,L e'.I - , Date Ready /By: Allis: ® See Attached Checklist for
Internet: www.ci.tigard.or.us VON 5 ® Notified/Method:4 ei -f'ir Supplemental Information
1 � 7 , V T► 00 \ t,U- M,esso
SQUIRED DATA: 1- AND 2- FAMILY DWELLING
11 Permit fees' are based on the value of the work performed.
13 New construction ❑Demolition P
Indicate the value (rounded to the nearest dollar) of all
0 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I- and 2- family dwelling ❑ Commercial/industrial Valuation: $36,672.00
❑ Accessory building ❑ Multi- family Number of bedrooms: 1
❑ Master builder ❑ Other: Number of bathrooms: 1/2
JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address: 11680 SW Summer Crest Drive New dwelling area: 460 square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: single level addition Covered porch area: square feet
Cross street/directions to job site: off 121 & schools Ferry Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: burlwood no.3 block 1 I Lot no.: 22 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 15134cd -06200 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
460sf single level addition consisting of Family room, bedroom, patio, and shower. Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER " I ❑ TENANT Number of stories:
Name: Kevin & Holly Capelle Type of construction:
Address: 11680 SW Summer Crest Drive Occupancy groups:
City /State /ZIP: Tigard, OR 97223 Existing:
Phone: (503)524 -4262 Fax: (503)524 -9522 New:
0 APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: Kevin & Holly Capelle licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11680 SW Summer Crest Drive jurisdiction in which work is being performed. If the
City / State/ZIP: Tigard, OR 97223 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 524 -4262 I Fax: : (503) 524 -9522
E -mail:
CONTRACTOR
Business name: Absolute Construction
BUILDING PERMIT FEES*
Address: 11300 SW Nootka -
Please refer to fee schedule.
City /State /ZIP: Sherwood, OR 97140 �
Phone: (503) 692 -3381 I Fax: (503) 612 -1741 Fees due upon application . <y,,e3 $645:81
Amount received
CCB lic.: 7128
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: �`G bin) I /� �d, j/e, I Date: / /- Z '9- !J `"1 - * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Permits \BUP- PermilApp.doc 12/03 440- 4613T(I I /02/COM/WEB)
n5T crto3s1
Mechanical Permit Application FOR OFFICE USE ONLY
City Tigard C "� IV E® Date/B:
Date/By:
Permit No.:
1 3125 SW W hall Blvd., Tigard, OR Plan Review
Phone: 503.639.4171 Fax: 503.5 8.1960 Date /By: Other Permit:
Inspection Line: 503.639.4175 N . I I II Date Ready /By: tuns: ® See Page 2 for
Internet: www.ci.tigard.or.us Nov 3 0 2004 - Notified/Method: Supplemental Information
atJ1 i1PA T A R O N
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 d to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- 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 or Job site address: 11680 SW Summer Crest Drive heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 460sf single level addition Gas heat pump 14.00
Cross street/directions to job s off 121" & Scholls Ferry Duct work 2, 14.00 2B.00
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
Subdivision: Burlwood no3. block I Lot no.: 22 Flue /vent for any of above 10.00
Other: 10.00 _
Tax map /parcel no.: 15134CD - 06200 Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
® PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: Kevin & Holly Capelle Environmental exhaust and ventilation
Address: 11680 SW Summer Crest Drive • Range hood/other kitchen
equipment 10.00
City /State /ZIP: Tigard, OR 97223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503)524 - 4262 Fax: (503 - 524 - 9522) toilet compartments. utility rooms) 1 6.80 (0 .50
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 •
Other: 10.00
Business name:
Fuel piping
Contact name: Kevin Capelle $5.40 for first four; $1.00 for each additional
Address: 11680 SW Summer Crest Drive Furnace, etc.
Gas heat pump
City /State /ZIP: Tigard, OR 97223 Wall /suspended /unit heater
Phone: (503) 524 - 4262 Fax: : (503) 524 - 9522 Water heater
Fireplace
E -mail: Range
• CONTRACTOR Barbecue
Business name: By Owner Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal 12
Phone: ( ) I Fax: ( ) Min imum permit fee ($72.50)
Plan review (25% of permit fee) -"
CCB lie.: State surcharge (8% of permit fee) 5150
TOTAL PERMIT FEE 18.30
Authorized signature: • This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Kevin Capelle Date: 11/24/04 * Fee methodology set by Tri- County Building Industry Service Board
i '.Building \ Permits \MCC- PcrmitApp.doc 12/03 440 ( I I /02/COM /WEB)
/UlST efeg - o 0 357
Electrical Permit Appli EN FOR OFFICE USE ONLY
City of Tigard R eceived
Date/By:
No.:
13125 SW Hall Blvd., Tigard, OR 97223 I ( Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Nov 3 ® 2 , my( DatcBy: Other Permit:
t�
Inspection Line: 503.639.4175 Fi t,µ - . 6 � Date Ready /By: /arts: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY
Y''O(FF Tl' Notified/Method: Supplemental Information
TYPI n�1RFC DIVISIOVI
PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. it.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
E 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 ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: 11680 SW Summer Crest Drive ❑Health care facility ❑ Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: 460sf single level addition' FEE; SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: off 121" & Scholls Ferry New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: burlwood no.3 block 1 Lot no.: 22 Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: 15134CD - 06200 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: Kevin & Holly Capelle 601 amps to 1,000 amps 240.60 2
Address: 11680 SW Summer Crest Drive Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
Phone: (503)524 -4262 Fax: (503)524 -9522 relocation
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, re • or ee han according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: / Date: //• Z V 0 V Branch circuits — new, alteration, or extension, per panel
® APPLIC ❑ CONTACT PERSON 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: Kevin Capelle without service or feeder fee, I
Address: 11680 SW Summer Crest Drive
each branch circuit
46.85 1.16.(65 2
Each add'l branch circuit Z 6.65 13.60 _ 2
City /State /ZIP: Tigard, OR 97223 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (503) 524 - 4262 I Fax: : (503) 524 - 9522
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: By Owner
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: I Suprv. Lic.: Subtotal ( ,1Z
Suprv. Electrician signature, required: Plan review (25% of permit fee) NA
Print name: Date: State surcharge (8% of permit fee) Li ,91
TOTAL PERMIT FEE (014.cup
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:\ Building \Permits \ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
A /vr SraUO -O 3 5 c /
•a Y .
Plumbing Permit •A I,. t , tt. NE .D FOR OFFICE, USE ONLY
Received Permit No.:
`'
City of Tigard 3 0 2004 Date/By: y:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 MI F T'G �► ( Date/By: g
24- Hour Inspection Line: 503.639.4175 CITY o ` p► - Date Ready/By: ions. I 0 Sec Page 2 for
Internet: www.ci.tigard.or.us • n% fl g Notified/Method: Supplemental Information
TYPACJF'W FEE* SCHEDULE
❑ Demolition For special information use checklist.
❑ New construction Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ Commercial /industrial SFR (2) bath 350.00
® 1 -and 2- family dwelling SFR (3) bath 399.00
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11680 SW Summer Crest Drive Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:
Manufactured home utilities 110.00
Cross street/directions to job ste: off 121" & Schools Ferry Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Burlwood no3 block 1 I Lot no.: 22 Water service (no. linear fl.: ) Page 2
Fixture or item
Tax map /parcel no.: 15134 -CD -06200 Absorption valve I6.60
DESCRIPTION OF WORK Backflow preventer Page 2
460sf addition to a one level single family dwelling. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
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 16.60
Phone: ( ) I Fax::( )
Tub /shower /shower pan I 16.60 16 , b 0
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Columbia Plumbing Service Water heater 16.60
Address: 6626 Harney Street Other: To#'-\ Fire_ c 5S °
City /State /ZIP: Portland, OR Subtotal 11
Minimum permit fee: $72.50 72 ,5'0
Phone: ( ) Fax: (503) 775 - 8470 Residential backflow minimum permit fee: $36.25
CCB Lic.: 117707 Plumbing Lic. no.: 26 - 603PB Plan review (25% of permit fee) p
State surcharge (8% of permit fee) S. p
Authorized signature: _ f OTAL PERMI "f FEE 1 8 ,�Q
Print name: 4� /%u 6)., /42...-- I Date: N _ 2 i f _o V I This permit application expires if a permit is not obtained within
180 days after it has be en accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i.\ Building \Pcimits \PLM- PetmitApp.doc 12/03 440 -4616T(10 /02/COM/WEB)
i nvy iu• 6.vv4 0•JLMM ILCHir WHICr{ DCRYll.CJ UU3 06I443y IV4.gIL1 r• I
CleariW1ter Services
(')„r cointnitt, tent is clear.
R ECEIVE D
NOV 3 0 1004
CI TY OF EI TIGAAD
November 17, 2004 . ® DIVISIO
•
•
Kevin & Holly Capelle
11680 SW Summer Crest Dr.
Tigard, OR 97223 •
RE: Addition to single family residence located at 11680 SW Summer
'Crest Dr., Tigard, OR
CWS file 4812 (Tax map1S134CD, Tax lot 06200)
•
Clean Water Services has received your Sensitive Area Certification for the
above referenced site. District staff has reviewed the submitted materials
including site conditions and the description of your project(see attached site
plan). Staff concurs that the above referenced project will not significantly impact
. the existing Sensitive Areas found near the site. In light of this result, this
document will serve as your Service Provider letter as required by Resolution
and Order 04-9, Section 3.02.1, and your Stormweter Connection Permit
authorization from Clean Water Services as required by Ordinance 27, Section
4.B. All required permits and approvals must be obtained and completed under
applicable local, state, and federal law.
This letter does NOT etminate the need to protect Sensitive Areas if they are
subsequently identified on your site. •
If you have any questions, please feel free to call me at 503-681 -3605.
Sincerely,
Chuck Buckallew Post -it•• Fax Note 7671 D" 9 y , p" S
Environmental Plan Review To From
I. !_..
Co.lDept.
• Site plan attached Phone* Co w 5
p So3 Sib-3cas
Fax "503 ri .75, Fax A
■
E:1Donlopntcall Svcs15P (1U- 71Concurr ncc I.;Ltcrt \IS 1i4CD06200 - mr iutp.na to want, quality 04- 9.ltot:
2650 SW Hillsboro Highway • Hillsboro. Oregon 97123
Phone: (503) 681 -3600 • Fax: (503) 681 -3603 • www.CleanWaterServices.org
Permit #:V\`> ) -Q y " C d 35
of O
t Address: \ (,'W J i r. .V,.2f ��,� 5 �"
Issued by: , I.c Date: / 7 7
1859
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
1� 1. I own, reside in, or will reside in the completed structure.
01 . 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
A 3A. My general contractor is 410 7 1 2 2
f` I (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
ri 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owner ab 1, t Construction Responsibilities on the reverse side of this form.
(Sig ,/ re of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
CITY OF TIGARD - .
BUILDING DIV ION PERMIT #: MST2004 -00369
13125 SW Hall. Blvd., i igard, OR 97223 DATE ISSUED: 12/7/2004
Phone: (503) 639 -4171 ,:t
Inspection Requests (24 Hrs.): (503) 639 -4175 _..
INSPECTION WORKSHEET FOR DATE: 8/2/2006 TIME: 7 :03AM PAGE: 63
SITE ADDRESS: 11680 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.3 LOT #: 022 TYPE OF USE:
PROJECT NAME: CAPELLE
DESCRIPTION: Addition of Family room, bedroom, patio & shower.
OWNER: CAPELLE, KEVIN & HOLLY, PHONE #: 503.524 -4262
CONTRACTOR: ABSOLUTE CONSTRUCTION PHONE #: MOB 314 -5948
Inspection Request Scheduled For: Date: 8/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 012603 -01 503- 524 -4262 N
Corrections/Comments/Instructions:
/t/(T 0
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,, Date: g --- ' Phone #: (503) 718-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 • MST g DO CL' DO `S'
INSPECTION DIVISION Business Line: (503/39-4171
BUP
Received Date Requested 3-- — U PM BUP
Location ( / 4° •i ..._✓aL1IL , '_�. i Suite MEC
Contact Person Ph ( ) 3 / - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 2 SIT
Post & Beam jc.,z,, )
Shear Anchors
Ext Sheath/Shear I/1/1 1 J
Int Sheath/Shear
Framing
Insulation
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
ZMECLIANWAL
Post & Beam
Rough -In
Gas Line
Sm• 'ampers
(E'L' ` PART FAIL
ECIBRAL
Service
Rough -In
UG/Slab
Low Voltage
Fir-
�w0 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
El Please call for reinspection RE
El Unable to inspect — no access
Fire Supply Line
ADA C
Approach/Sidewalk Date D v Inspector �� Ext
Other:
II
Final DO NOT REMOVE this Inspection recor m the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639.4175 MST -6' 0357
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Dat- Requested 2 — AM PM BUP
Location Suite , pr MEC
Contact Person - (�GZ.0 -ems Ph ( ) ��� 5 x'71 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
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:
PART FAIL
M HANICAL
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 Please call for reinspection RE: D Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2.) R j OC Inspector U L 11 - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL