Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00065
Date Issued: 03/31/2021
T I i;AP.f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114BB15800
Jurisdiction: Tigard
Site address: 16096 SW 103RD AVE
Subdivision: RIVERVIEW ESTATES Lot: 4
Project: Ellsworth
Project Description: Demo existing cabinets, moving sink location and removing beam.All trade permits to be
obtained separately.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $30,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0Catch Basins: 0
Bckfw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywall-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
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: 0
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:
ALT SF VB R-3 0
Owner: Contractor:
ELLSWORTH,ANGELA R&JEFFREY J FEINAUER&SONS Required Items and Reports(Conditions)
16096 SW 103RD AVE 18329 NW HERITAGE PARKWAY#71
TIGARD,OR 97224 ALOHA,OR 97007
PHONE: PHONE: 503-730-6004
FAX:
Total Fees: $903.52
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 952-001-0090. 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: \\ Q�Dew e Permittee Signature:
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 Application E ill E D ,Q.212 2 t
Residential l i n FOR OFFICE.USE ONLY
fES 2t 2021
. City of Tigard IN,„` ;K"Q.�r232a� ';� MSTZOzl2YlD6'5
,a, Permit No.
13125 SW[tall Blvd..Tigard,OR 972�l IY OF IIGA D Plan R vuw U Q'�
Phone: 503.713.2439 Fax: 503.59 D„Wgy. 1/2 ``J Other Permit:
TIGARD Inspection Line: 503.619.4175 73�ILLANO DIVISION Date Ready/137 / , h '' ® See Paget for
Internet: www.tigartl-or.gov V„ ed/Method: (") / . ' Supplemental Information
TYPE OF WORK GIB' REQUIRED DATA 2-FAMILY DWELLING i
0 New construction t]Tlemolition Permit tees*are based on the value of the work performed.
--- Indicate the value(rounded to the nearest dollar)of all I
Addition/alteration/replacement 0 Other: equipment,materials,tabu r,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
I-and 2-family dwelling 0 Commercial/industrial
Valuation: $ 30,000.00
❑Accessory building 0 Multi-faintlyNumber of bedrooms:
❑Masltr builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address. j g Cp S v i ICY 3 IZ p A V E New dwelling area: square feet
City/State/ZIP: `It-IAR9 g Gil 7''ji_ Garage/carport area: square feet
Suite/bldg.iapt.no.: Project name: Eii$.. Covered porch area: square feet
Cross street/directions to job site: Stir4; Du\RAHptA/( ?k Deck area: square feet
l� Other structure area: square feet,
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*arc based on the value of the work performed.
fax map/parcel no.: 20 z 30 (} 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.
kiTCI- ) \t76P10Del,•
Valuation: $
demo existing cabinets and moving sink location &REMOVING BEAM Existing building area square feet
all trade permits are to be obtained separately New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( ) New:
APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: am Q G4' U_IJVIv L U frr 1 W c . Please;vier to fee schedale
.,�n n7 ^ Structural plan review fee(or deposit): 5.3
Contact name: -PAX i)L/ LI e Iv l
Address: 2 t.1.4.1 clk
I �U �A �� � ��� ���t� ZS FLS plan review fee(if applicable):
City/State/ZIP: AL�t H A 1 CX 11 c 3
Total fees due upon application:
Amount received:
Phone:(eltjl ) 6-63 -o5(-2 Fax::( )
E-mail:V a✓ • PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photovoltaic Solar Panel System.
Business name: F El N Au erz ,, s O' J 1-LC. Submit two(2)sets of roof plan with connection details
r 1r. and fire department access,along with the 2010 Oregon
Address: 18 � y W l..f♦' t.,1'� rKIAN - 1 Solar Installation Specialty Code checklist.
City/State/ZIP: Al.-0-HA
t Permit Fee(includes plan review
y pt1 V`HA ' CS.- 1 �� and administrative fees): $180,00
Phone:(tr�3) qa ' 1r�Gc,t4.. Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 1 Oq i303 4, 7/2-1 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
fff within 180 days after it has been accepted as complete.
Print name: J G� Date: /2./2-( *Fee methodology set by Tri-County Building Industry
1 Service Board.
I:1Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T111/02,COM/WEB)