Permit CITY OF TIGARD MASTER PERMIT
1. COMMUNITY DEVELOPMENT Permit#: MST2021-00322
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/25/2021
Parcel: 1 S133CD15700
Jurisdiction: Tigard
Site address: 11572 SW WOOD DUCK PL
Subdivision: PEBBLECREEK NO.3 Lot: 47
Project: Warren
Project Description: Interior reconfiguration to increase pantry size,widen hallway and create new pass through.
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: $5,000.00 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 Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 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 Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add,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
N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF 0
Owner: Contractor:
YEE,CHESTER C A NEW IMAGE EXTERIORS INC Required Items and Reports(Conditions)
WARREN,ANDREA NICOLE 8630 SW SCHOLLS FERRY RD PMG 326
11572 SW WOOD DUCK PL BEAVERTON,OR 96008
TIGARD,OR 97223
PHONE: PHONE: 503-998-5554
FAX:
Total Fees: $271.06
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
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Issued By: f `` !?/r v Z t �✓L Permittee Signature: e7'k/ �/�L' j`7�7cT'V
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 RECEIVED
' -
Residential FOR OFFICE I cF ("1.1
City of Tigard AUG 1 0 2021 Received/.0 ��6r u`-aQ3
111
13125 SW Hall Blvd.,Tigard,OR 97223 r Date/By ew 4Z // eti Permit No.:
_. Phone: 503.7182439 Fax: 503.598.1960CITY Or TIGAFsD Plan Review C1 r�' 1 '' Other Permit
Date/By: �J !i
Inspection Line: 503.639.4175 }UILDING DIVISION
TIGAI:D Date Read y/B
y: ' El See Paget for 1
Internet: www.tigard-or.gov ?1Abtified/Me,... al, ( - 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 0 Other. equipment,materials,labor,overhead,and the profit for the
CATEGORY'OF CONSTRUCTION work indicated on this application. D.1
› ."-and 2-family dwelling 0 Commercial/industrial Valuation: Sit.. •
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
1 Job site address: ' 1 S i 2 S(� 10 tQ 0d 0 V .ImC ' t&CR_ New dwelling area: square feet
City/State/ZIP: " la. 5 p`C 6. Q (2 C. `1 2_2• , Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: P ck,n-\ Covered porch area: square feet
Cross street/directions to job site: S G4,a\.S e Ct'y Q4 Ja7r(_14- \' on1! O Deck area: square feet
W S \—C..;e;ns k Alit s C\ton-k- of. S t..s Sldvld \ ,a90%13 Other structure area: square feet
R..t[il .li Sw -T0.\, SL) (_►)J.7o� JCL-,.. PIC., REQUIRED DATA:COMMERCIAL-USE"CHECKLIST
Subdivision: 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.
„ ...0 j 2C..._ ‘,, *'-- - S\"1.4. - *L e G" Valuation: $
1 l-' '/I-\a `k4 1 . .a r C.(CD(1,) yr t Existing building area: square feet
b New building area: square feet
OPERTY OWNER ❑ TENANT Number of stories:
Name: krt t\5:4.0� \30til•C, \ Type of construction:
Address: ` \5" -->„ SLL..) La.) 0 s G1 t.„,.c.}'L P \c.c t Occupancy groups:
City/State/ZIP: \\s ust`a6„ 0 Q G1 2'23. Existing:
Phone:(5t , j7' — 'l l g Fax:( )
New:
)-APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(PkasBusiness name: r\e_� �� 4 (l' �A-ex-ko-"S review refer(or deposit):er
Contact name: Structural plan fee(or deposit): 97#
--� `nr, �3S S + /� aa77
Address: $b 3z> S W S t:�4.-\lS \• ti e1/4-\ l •Fol{3 3 2,to FLS plan review fee(if applicable):
City/State/ZIP: �J ec, a ex -0 n 0(Z .Cy--1 o FS
Total fees due upon application:
tl Amount received:
Phone:(S03) W O k C 2 t- 2.. Fax::( )
E-mail:*lrr. E' c2.c.\ex-k. Cor>1 p�lS-orNLOj- tetC-4- rw',
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Pt. ne W i�� (fix Submit O Submit two(2)sets of roof plan with connection details
� and fire department access,along with the 2010 Oregon
Address:ga '3Z St_,-� SL r1+J`\5 '6"e' C-\ Cl ?ft-,S 3)-L Solar Installation Specialty Code checklist.
City/State/ZIP: , aG.vu�o►, TA, c--t 6 Permit Fee(includes plan review $180.00
stra
Phone: 1 3) 1-.18‘- Ck 2,9'Z Fax:( ) and adtnioofpe ive fees):
State surcharge(12%of permit fee): $21.60
CCB lic.: t S S 2 00(g/2, Total fee due upon application: $201.60
Authorized signature:/� k This permit application expires if a permit is not obtained
/ within 180 days after it has been accepted as complete.
Print name: '� , 0..,, t 0 S S Date: O -C -20 2 1 *Fee methodology set by Tri-County Building Industry
Service Board.
i\Rnildine\Permits\BUP-RESPermiton.doe 02/24/2011 440-4613Tf 11/021COM/WEB1