Permit CITY OF TIGARD MASTER PERMIT
11111 • COMMUNITY DEVELOPMENT Permit#: MST2021-00145
-FIG.ARL) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1S1352021
Parcel: 1 S135DB04800
Jurisdiction: Tigard
Site address: 11465 SW 92ND AVE
Subdivision: DOGWOOD RIDGE Lot: 8
Project: Hartmann
Project Description: In-kind structural repair to roof and exterior deck damage by tree strike
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: $45,000.00 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: 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: 0
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 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:
HARTMANN FAMILY TRUST BELFOR USA GROUP INC Required Items and Reports(Conditions)
BY HARTMANN,PATRICK T& 185 OAKLAND AVENUE SUITE 150
SYLVIA M TRS PORTLAND,OR 97230
11465 SW 92ND AVE
PORTLAND,OR 97223
PHONE: PHONE: 503-803-8914
FAX:
Total Fees: $1,207.60
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: fierily Vct.+vVe.Wege Permittee Signature: I*)tvAppllcax'I.evt
Call 503.639A175 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 IP _ 4 e
Residential RECEIVE I FOR OFFICE USE ONLY
/
. City of Tigard Received
� !/�� Permit No.:Mt/��tLt92 y W I /5
11 APR 1 �IT° 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:an Review U/ ! ^gyp
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: 7/ /24 /7 k Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy:II( ) kris. R. See Page 2for
Internet: www.tigard-OLgov QI 11 nits., -, '' iVr- '1F edMIethod: 2` Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑ New construction 0 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 KOther: RE IP'Asr, equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application ,///
Valuation: $
X 1-and 2-family dwelling ❑Commercial/industrial J�O
❑Accessory building El Multi-family Number of bedrooms:
A0 Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i/116 SS 543 eta ao ANrE New dwelling area: square feet
City/State/ZIP: \t,fv J o R Garage/carport area: square feet
i
Suite/bldg./apt.no.: Project name: 1-1o(4-rvm. ,Y\ I2.erAtlz- Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
ho - lc,tJ4 S-i-CJc v rt:( I�[Pahr-s ^}a F A Valuation: $
)c-1 er�07.- -Q e-C-k-- D_A-P"Ai-e,OC> 6 j Tke_ Sif; Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: 5,,(ir,� A r1"4,1 '4'k filar ..,.,,-) Type of construction:
Address: I I9(, SL- I Pf..i A Ie Occupancy groups:
City/State/ZIP: "ri.G,ASS-O) C) Existing:
Phone:(!fb3)8a5. Iola Fax:( ) New:
N, APPLICANT $ CONTACT PERSON BUILDING PERMIT FEES*
Business name:.4-a Ya�4j_ girovv(e-I Forpn S•c_S (Please refer to fee schedule)
Contact name: tvT Structural plan review fee(or deposit): '135, 3
k�ti., OL►Pr1A
Address: 15 OO J4W (3el1 l ari w $I.V t S-}4 aL oo FLS plan review fee(if applicable):
9 Total fees due upon application:
'c �.{City/State/ZIP: p� -ptJOf.- `�poa, O
p Amount received:
Phone:(91 ) 44 5- -755 / Fax: :( )
E-mail: K o Co A S F, ES.Pe(' PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: (' E t_Fba. P2oPaR.'r5 e.esrofZAA-fl co..) Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: la ga3 Ne" A t1-P02T w rry Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/Z1P: 70 R-'rLA^tpa 6(4- el 7�3 a and administrative fees): $180.00
Phone:(SS-63) 40e, e8eU Fax:( )
// State surcharge(12%of permit fee): $21.60
CCB lie.: lyG973 7/ / 3 Total fee due upon application: $201.60
/
Authorized signature: C This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ge-rJ Q(,►eetek•-17 Date: *Fee methodology set by Tri-County Building Industry
y i L1 ZI Service Board.
I:\Building\Pemdts\BUP-RESPermitApp.doc 02/24/2011 440-46I3T(11/02/COM/WEB)