Permit CITY OF TIGARD MASTER PERMIT
'`1 s, n, COMMUNITY DEVELOPMENTIIII
Permit#: MST2 02 1-001 30
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/27/2021
Parcel: 2S103CA00212
Jurisdiction: Tigard
Site address: 13140 SW HOWARD DR
Subdivision: WOODCREST NO.2 Lot: 24
Project: Callaway
Project Description: Gas Fireplace installation
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: $6,500.00 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
• Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bcktlw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
• Natural Gas 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 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: NI
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
CALLAWAY,KEVIN J OWNER Required Items and Reports(Conditions)
13140 SW HOWARD DR 13140 SW HOWARD DRIVE
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: PHONE: 503-989-9928
FAX:
Total Fees: $426.20
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 503.232.1987or�1.88000..332.2344.
Issued By: HORy VGINI/DeeWe ffa Permittee Signature: OfvAppUcQ.-ton
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.
RECEIVED
lilt
'+ Information Notice to Owners AboutR 2 i°�'
,,-..„4., t •��t ITY 0�TIGARfJ
r,- • r tl'UGti n esponsibilit� LDING Div1SI0N
\ _; (ORS 701.375 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many preblame
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's withhoicling Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4888.
• Unemployment Insurance Tax! Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's business identification Number(BIN); is a combined number for both Oregon
Withholding and Unemployment insurance Tax. To file for a BIN, call 503-046-8001 or go to
httpafwww oregon.00v/DOR/BUS/docs/211-055.gdf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the joh. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503-947-7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even If you didn't actually wIthhold the tax.
For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website et www.irs.gov.
Other Responsibilities of Homeowners:
Oode Oumplienee.Aa the penult holder ful a cunstrutlion project, me nomeowner is responsible
for notifying buildina officials at the aonrooriate times, sn that the rail iirart inorcctinri can ra
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as failing tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
700 Summer St NE, Suite 300, PO Box 14140,Salem, OR 97309-5052
Telephone:503-378-4621 -Fax: 503-373-2007
Website Address'wwry.oregan.gov/ccb
f/property_owner adopted 9-23-08 This Copy for Permit Applicant
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued, (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside In, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CUB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the Information on this homeowner statement is true and accurate.
4-V/i CalLi ,gWoi
Print Name of Permit Applicant
Signature orermit A Date
I
Permit#:
‘4•1
Address:
Issued by data: r14
This Copy for Permit offices
. j Building Permit Application 5_ zif,
4 Residential RECEIVED [OR OFFICE 151.O\l l
a- City of Tigard , Received T7.� 7/ �,t 2�
APR 41 0�1 Date/By: b� OS PermitNo.:M41 L(l 'W/3O
� ;11 i 13125 SW Halt Blvd.,Tigard,OR 97223 Plan Review y Zh /I,�a/
; Phone: 503.718.2439 Fax: 503.598.1960 pa By. ! V A"r Other Permit:
l 1t,ti .f1 Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: �N 7 � El See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Noi.:.i ethod: / ...."! Supplemental Information
(") 6 / '
TYPE OF WORK DATA:RE REQUIRED -AND 2-FAMILY DWELLING
Q )t
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
DR.Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
` t sk/14 1-and 2-family dwelling ❑ Valuation: $Commercial/industrial Q
Number of bedrooms:
'� ElAccessory building El Multi-family❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I 3 I LA O SW kb W -o a IZ 6 V t New dwelling area: square feet
TT
City/State/ZIP: G--f j ' U Q O)''l 2-?_...
Garage/carport area: square feet
Suite/bldg./apt.no.:i.
Project name: 4it Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
'21 n— 4 40\nl 01) V E'— Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed_
Tax map/parcel no.: 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.
C -Ft�f-P - 4A( - 11NJ�`I l_L Valuation: $
Existing building area: square feet
New building area: square feet
43 PROPERTY OWNER ❑ TENANT Number of stories:
Name: eCt 1 1 e{ p Type of construction:
V Address: I ✓1 ! +D HP ina410+1) w�) V� Occupancy groups:
,�`aCity/State/ZIP: 7-1 lejc) op._ 011�' Existing:
!" Phone:� at - �a 2 Fax:( ) New:
It
C 4PPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedale�
Contact name:
I Structural plan review fee(or deposit):
1 (Salt , f ^ - FLS plan review fee(if applicable):
Address: I,3 l t cEW a y/
�; �1 Total fees due upon application:
City/State/ZIP: I l )!'Dl d O! �'L
I � Cct 2� Amount received:
Phone: Fax :( )
I. PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
1-mad: ` 1J a lJl lrO C s e. co Y 1'1 .
1 Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: �Gv�j(Gty Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/Z1Y: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%ofperntit fee): $21.60
CCB lie.: Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Zi-_---— —s Date:3 r� *Fee methodology set by Tr-County Building industry
I, !/C Service Board.
I:1Building its1B -RESPennitApp.doc 02/24/2011 440-0613T(I1102/COMIWEB)
J
rfci;auical Permit Application
CI Of Tigard Received Permit No
•,7 g Date/By: M.5I ' )---z ill l/
v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit.
T I G A RD Inspection Line: 503.639.4175 Date Ready/By: Jens: M See Page 2 for
Internet: www.tigardor.gov Notified/Method: Supplemental Information
TYPE OF WORK
COMMERCIAL FEE* SCHEDULE—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction I.Addition alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL.EQUIPMENT/SYSTEMS FEES*
g/1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
, + Air conditioning 46.75
Job site address: 1.3 IL 7 0 St„i 1_,..,i lAj(f(. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1-7 1(3"Y/1 D 61 '7 2.-47/1 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
1 ZI 5l_ * I4 ))� -r 2 Residential boiler(radiator or
r V hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert % 33.39 'V> >A
/� p R Flue vent for water heater or gas r�
/7z1�/K i "t /-+ie UPS FJ Jgt/ LU`�i 4 Jp fireplace V 23.32 f+3 T64
`// �� pr,/I �J �// �j FL
�� Log lighter(gas) 23.32
/tee/ AiD j '�T 1T1 Alai /rLA* Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent ��� 23.32 i
Other: 23.32
CSKEROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
I.� . ,�1 Call Range hood/other kitchen
Name: I.,�/l/ 1' 1 p:17g6t;_y_(�,� ("') ,�/ equipment 3339
Address: ' 3 1 {t) 5/A ii 1/ !G_. Clothes dryer exhaust 33.39
City/State/ZIP: ♦ �n/`d 0�_� GI 1 L3 Single-duct exhaust(bathrooms,
t3 J ( ' +t toilet compartments,utility rooms) 23.32
Phone: )tg .06) 1 Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON Other. 23.32
Fuel piping:
Business name: $14.15 for first four,$4.03 for each additional
Contact name: 1 C I 11 a.Ar' Furnace,etc.
^ ` �D /� � o Gas heat pump
Address: /J Y�W Wall/suspended/unit heater
City/State/ZIP: 1 ' Intl_ ' 1 L1J Water heater
Phone: 't' /nra Fax::( ) Fireplace
/ /� Range
E-mail: l n n Lt J is l4A �( ►fib d.5( cI- ��r,a, - (.(/` Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: d/� e t� MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: - • Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
This permit application expires r a permit Is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tn-County Building Industry Service Board
�
Print name: K \A C la Vie Dater FL/7t0'
I:\Building\PermRs\MEC_PemutApp 40113.doc 440-4617T(11/02/COMMEB)