Permit i. ., ; . ; - i,. . ,'.l '
CITY OF TIGARD WI- ,2° %z MASTER PERMIT
,� .ijtf
• • COMMUNITY DEVELOPMENT - Iv Permit #: MST2012 00245
� Date Issued: 10/04/2012
. ,IIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 1 S133DA01700
Jurisdiction: Tigard
Site address: 11067 SW SUMMER LAKE DR
Subdivision: AMART SUMMER LAKE Lot: 39
Project: Swearingen
Project Description: (2) small additions of 20 square feet each and a patio cover of 435 square feet. 11/08/12:
REPRINTED to add gas fireplace, duct work, range hood, (4) gas outlets and 60' of storm drain.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 40 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 15 Smoke
' Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: Yes
Total: 40 sf Value: $100,000.00 Rear: 15
• PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 60
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 •
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0 •
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 1 Other Units: 2
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn >7100K: 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: 5 •
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 40 '
Owner: Contractor:
SWEARINGEN, GERRIT V & THOMAS FORCE Required Items and Reports (Conditions) .
DANNER, KIMALA R 11015 SW SUMMERLAKE DR t
11067 SW SUMMER LAKE DR TIGARD, OR 97223
. TIGARD, OR 97223
•
PHONE: PHONE: 503- 351 -2080
FAX:
Total Fees: $2,644.50 '
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 OAR - 1 -009 . 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: AK Permittee Signature: , D/(/. fP�G /�'f1-/'70N
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.
11 _y 'II CITY OF TIGARD MASTER PERMIT
1- COMMUNITY DEVELOPMENT Permit #: MST2012 00245
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/04/2012
Parcel: 1 S133DA01700
Jurisdiction: Tigard
Site address: 11067 SW SUMMER LAKE DR
Subdivision: AMART SUMMER LAKE Lot: 39
Project: Swearingen
Project Description: (2) small additions of 20 square feet each and a patio cover of 435 square feet.
BUILDING
Floor Areas Required Setbacks Required
Stories' 1 Bedrooms: 0 First: 40 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 15 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors' Yes
Total: 40 sf Value: $100,000.00 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0
Tubs /Showers 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 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: 1 Other Units: 1
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 •
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less' 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr 0
Ea addl 500 sf 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 5
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 40
Owner: Contractor:
SWEARINGEN, GERRIT V & THOMAS FORCE Required Items and Reports (Conditions)
DANNER, KIMALA R 11015 SW SUMMERLAKE DR
11067 SW SUMMER LAKE DR TIGARD, OR 97223
TIGARD, OR 97223
PHONE: PHONE: 503 - 351 -2080
FAX:
Total Fees: $2,532.38
This permit i -d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and a ther applicable law. All work will
be dor- in accordance approved plans. This permit will expire if work is not started within 180 days of issuance, o 'rk is suspended for more the 180
day . ATTENTION: Oregon -w - • • 4
es you to follow the rules adopted by the Oregon Utility Notification Cent-.' rules are set forth in OAR
95.- 001 -0010 t rough OAR 952 — 1 -009 .1'x/1
ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232 *� -rul '44.
10 I .-= �'
Iss -d By: Permittee Signature: �/ . L I I�Cl� .
Call 503.639.4175 by 7:00 a.m. for the next available inspe • • - Vie.
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.
4
00
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard
R eceived n Q, t / n 57P0/01-004,911:c DateBy: 9 6:9 O, Permit No.:
114
- n 13125 SW Hall Blvd., Tigard, OR 97223 c f Plan Rev - • .I t
Phone: 503.718.2439 Fax: 503.598.196o EP P 2 4 2012 Date/B : ice• Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Rea By: Juris: 10 See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: (d Supplemental Information
BUILDING DIVISION "' a-1.`
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ 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
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $100,000
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11067 SW SUMMER LAKE DRIVE New dwelling area: 40 square feet
City/State/ZIP: TIGARD, OR 97223 Garage/carport area: square feet
Suite/bldg./apt. no.: Project name: SWEARINGEN REMODEL Covered porch area: 0 .258 1/35 feet
Cross street/directions to job site: SCHOLLS FERRY TO SUMMER LAKE DR SOUTH Deck area: square feet
HOUSE IS ON LOWER LOOP, SOUTH SIDE OF STREET Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: AMART SUMMER LAKE I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 1S133DA01700 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.
ADD 2 VERY SMALL ADDITIONS TO BACK SIDE OF KITCHEN Valuation: $
REMOVE ONE "BUMP OUT" OF 2' 0" X 9' 6" Existing building area: square feet
ADD 2' 0" x 28' 6" New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: SWEARINGEN, GERRIT & KIMALA Type of construction:
Address: 11067 SW SUMMER LAKE DRIVE Occupancy groups:
City/State /ZIP: TIGARD, OR 97223 Existing:
Phone: (593)524 -4919 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: THOMAS FORCE, BUILDER (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: TOM FORCE
FLS plan review fee (if applicable):
Address: 11015 SW SUMMER LAKE DRIVE
City/State /ZIP: TIGARD, OR 97223 Total fees due upon application: y�J
Phone: (503) 351 -2080 Fax:: ( ) Amount received: - wg g , •
E -mail: thosforce @aol.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: THOMAS FORCE, BUILDER Submit two sets of roof plan with cone details
and fire dep. . - t access, along ' • a e 2010 Oregon
Address: 11015 SW SUMMER LAKE DRIVE Solar Installation i •cialty • . • checklist.
City/State /ZIP: TIGARD, OR 97223 Permit Fee (Inc plan review $180.00
. admini :. tive fees):
Phone: (503) 351 -2080 Fax: ( ) Sta . harge (12% of pe •'t fee): $21.60
CCB lic.: 14091 7 /A1i(f4 %� f Total fee due upon application: $201.60
Authorized signatur �� - -� --- %A This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
// / * Fee methodology set by Tri -County Building Industry
Print name: TH 1 . H. OR '- Date: 09 -24 -12 Service Board.
1 :\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440- 4613T(ll /02 /COM/WEB)
Plumbing Permit Application _
Building Fixtures REC iv D FOR OFFICE USE ONLY
Received '/ fQ,� n_
City of Tigard q : 7
Date/B j 1 Permit No.: �f /Qv / 00 a
2 2
a 13125 SW Hall Blvd., Tigard, OR 9 4 2012 y
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 D Date Re
TIGARD C I' i Y OF Date Ready/By: luris: Ill See Page 2 for
Internet: www.tigard -or.gov �In� VISION Notifi Supplemental Information vs'
TYPE O K FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
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 (I) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11067 SW SUMMER LAKE DRIVE Catch basin or area drain 18.76
City /State /ZIP: TIGARD, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: SWEARINGEN REMODEL Manufactured home utilities 50.03
Cross street/directions to job site: SCHOLLS FERRY Manholes 18.76
SCHOLLS FERRY TO SOUTH ON SUMMER LAKE DRIVE Rain drain connector 18.76
HOUSE IS ON THE SOUTH SIDE OF THE STREET Sanitary sewer (no. linear ft.: _) Page 2
ALONG LOWER LOOP Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: AMART SUMMER LAKE I Lot no.: Fixture or item:
Tax map /parcel no.: 1S133DA01700 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
KITCHEN REMODEL
Dishwasher 1 25.02
MOVE KITCHEN SINK LOCATION ON SAME WALL WITHIN 3 FEET Drinking fountain 25.02
PP---1-75 LC fie,5 3" KAU) - L Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: SWEARINGEN, GERRIT & Itlli>�Nrt l Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11067 SW SUMMER LAKE DRIVE K-C72111-14 Garbage disposal 25.02
City/State /Z[P: TIGARD, OREGON 97223 Hose bib 1 25.02
Phone: (503 )524 -4919 Fax: ( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: THOMAS FORCE Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: TOM FORCE
Roof drain (commercial) 12.51
Address: 11015 SW SUMMER LAKE DRIVE Sink/basin/lavatory 1 25.02
City /State /ZIP: TIGARD, OREGON 97223 Solar units (potable water) 62.54
Phone: (503) 351 -2080 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: thosforce @aol.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: WESTERN PLUMBING, INC Water piping/DWV 56.29
Address: 9460 SW TIGARD AVE, SUITE 101 Other: 25.02
City/State/ZIP: TIGARD, OREGON 97223 Subtotal
Phone: (503) 639 -5296 Fax: (503) 684-9015 Minimum permit fee: $72.50
CCB Lic.: 2439 Pop, Plumbing Lic. no.: 3429PB Plan review (25 % of permit fee)
ARP' State surcharge (12% of permit fee)
Authorized signature�� TOTAL PERMIT FEE
Print name: T 6 it t � i I � Date 2.y" /Z- This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMU- PennitApp.doc 10/01/09 440 -4616T(10 /02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard CE � Received %' a in Permit No.: / t 9r! ,. , ' ., 66 At
.511 - a 13125 SW Hall Blvd., Tigard, OR 9 1 r L Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TIGARD Inspection Line: 503.639 s E P 24 2012 Date Ready/By: luris ® See Page 2 for
Internet: www.tigard- or.gov J Notified/Method: Supplemental Information
ClayOFTIGAR
TYPE OAMINGDwISION 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: 11067 SW SUMMER LAKE DRIVE (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: TIGARD, OREGON 97223 Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: SWEARINGEN REMODEL Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: SCHOLLS FERRY TO SUMMER LAKE DRIVE Duct work i 23.32
ON LOWER LOOP, SOUTH SIDE OF STREET 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: AMART SUMMER LAKE Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: 1S133DA01700 Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
EXTEND 2 FORCED AIR DUCTS APPROXIMATELY 36" Gas fireplace/insert 33.39
Flue vent for water heater or gas
ADD DUCTING FOR DOWN DRAFT COOK TOP VENT FAN fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: SWEARINGEN, GERRIT & KIMALA Environmental exhaust and ventilation:
Address: 11067 SW SUMMER LAKE DRIVE Range hood/other kitchen
equipment t 33.39
City/State /ZIP: TIGARD, OR 97223 Clothes dryer exhaust 33.39
503 524 -4919 Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: THOMAS FORCE, BUILDER Other: 23.32
Fuel piping:
Contact name: TOM FORCE $14.15 for first four; $4.03 for each additional
Address: 11015 SW SUMMER LAKE DRIVE Furnace, etc.
Gas heat pump
City/State /ZIP: TIGARD, OR 97223 Wall/suspended/unit heater
Phone: (503) 351 -2080 Fax: : ( ) Water heater
Fireplace
E -mail: thosforce @aol.com Range
CONTRACTOR Barbecue
Business name: THOMAS FORCE, BUILDER Clothes dryer (gas)
Other:
Address: 11015 SW SUMMER LAKE DRIVE MECHANICAL PERMIT FEES*
City/State /ZIP: TIGARD, OR 97223 Subtotal
Phone: (503) 351 -2080 Fax: ( ) Minimum permit fee ($90.00) '3'3 Z�
Plan review (25% of permit fee)
CCB lic.: 14091 +gri / State surcharge (12% of permit fee)
Am•raff4PIP TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: / days after it has been accepted as complete.
Y
Print name: THOM • H. FORC Date: 09 -24 -12 * Fee methodology set by Tri -County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 440-4617T (I 1 /02/COM/WEB)
RECEIVED
s P 242012
SW SUMMER LAKE DRIVE Cl OFTIGARD BUIL IINGDIVISION
EL V. N
PUBLIC SIDEWALK 191.8 Y
ELEV. o 62.00
190'
AIF 1
SEWRVILE \ k tg
\t, 480
1 w O
120 N krA
N OW
. .
. . . .
. v _ _ _ _ _ .
. .
. p . .-.. --,.. *I
: ari
rk 140 ' A'
i'
1 ► r 1 100
O I ♦ II A
Y+ o
r LOT SQUARE FOOTAGE 6758 ) O
H AGES 0
I ∎ , HOUSE FOOT PEXISTING 1844 MD ♦ . ^ I r O
♦ CONCRETE FLATWORK-E7USTING 1740 � , r
' NEW PA710 ROOF COVERAGE 435
OVER EXISTING PATIO 390
NEW COVERAGE 45 1
►
TOTAL EE IMTAG S LOT COVERAGE 4605 1 �
AGR S OF iOU LO T IOUS I AGE 60%
Id ♦ HOUSE ADDITIONS ♦ 1
10'6 "x2'0" 8'6 "x2'0 8 I. /
N; • OHL-. PA TIO 28'6' c •FAD ITION 3so' p4
': 12Q ® ROOF COVERAGE 435`SQ FFT 100 It
1104H = - - SET BACK LINE
di
' 550 p O
SURFACC O
pi
,I N DRAINA E N
pi . DIRECTI N ,
1 41.1 . 1 I' ELEV.
ELEV. 7,4.23 189.0
188.5
PLOT PLAN SCALE 1/16" = 1' 0"
11067 SW SUMMER LAKE DRIVE TIGARD, OR 97223
MAP & TAXLOT 1S133DA01700
IN I ° Building Division
Development Code Provision Review
T IGARD Residential Projects
Building Permit No.: ` 5 TAP / a — 00 4 �5--
Site Address: ! /0(D7 tW i fc2. LA-lc f Dd.
Project Name & Lot No.: EA2 / KNekEtJ
CWS Service Provider Letter
Required: Yes ❑ No
Received: Yes ❑ No
Routed Plans:
Original Plan Submittal Date: AO / 2
1st Revision Submittal Date: ❑ Site Plan Only
2nd 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 o y if approved. ' / d
Planning Review (contact at 503 -71801 7 7 U or @tigard- or.gov)
Lapd Use Case No. /Ed
Di Zoning f 7 t,4 v)
Er Setbacks:
Front / ¶ Rear / S Side 4 Street Side / to Garage 7'0
❑ Maximum Building Height /1//14 Actual Building Height /lry /.4.0.44.4•/-
O Visual Clearance /1/ /i4
❑ Easements N/
❑ Sensitive Lands Type: 4V/4
Notes:
Original Plan: Approved M Not Approved ❑ Date: ""l'S' — / Z
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: a ./0
Notes:
Original Plan: Approve Not Approved ❑ Date: /Z
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of2
,v City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
lv /
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 o ❑
Date Routed to Building: �" C 2 ���
•
,
Page 2 of 2
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
11067 SW SUMMER LAKE DR, TIGARD, OR,
97223
Residential - Master Permit
299 Final inspection
06/28/2013 00:00
MST2012-00245
PASS - No C of O
Violation Summary:
Inspector Contractor