Permit CITY OF TIGARD MASTER PERMIT
` = COMMUNITY DEVELOPMENT Permit#: MST2021-00466
T t G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/18/2021
Parcel: 2S 111 AD04700
Jurisdiction: Tigard
Site address: 8990 SW PINEBROOK ST
Subdivision: PINEBROOK TERRACE Lot: 70
Project: Hoogandam
Project Description: Infill window with framing, install new window. Remodel kitchen, reinstall new cabinets. Plumbing
re-pipe at kitchen area. Trade permits to be pulled 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: $1,200.00 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'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 N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
HOOGENDAM,SHANE M&LISA M OWNER Required Items and Reports(Conditions)
8990 SW PINEBROOK ST SHANE HOOGENDAM
TIGARD,OR 97224 8990 SW PINEBROOK
TOGARD,OR 97224
PHONE: PHONE: 503-757-3412
FAX:
Total Fees: $140.29
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: Ho'LI q Vag De.We9e Permittee Signature: Ow A 0't't-
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 lob site at the time of each inspection.
Building Permit Appticatio>r�E EIVED el
RECEIVED
Ittl� ()1: t< r. I til t►,l
City of Tigard OCT 2 12021 Received ,;a
Date By. /O/2T.2O� �'r• Permit No.MSr�"'+,/
r 1 3125 SW Hall Blvd.,Tigard.OR 97223Pl t"
Phone: 503.718.2439 Fax: 503.598.19401TV OF TIGARD Date By:eN Q i
Date/By: �� i�7 7i� Other Permit.
T I G A R D Inspection Line: 503.639.4175 p NG Date Ready'By: / Jai,: la See Page 2 for
Internet: www.tigard-or.govck....44 RUiI_DING DIVISION willed h ho i r� ��; Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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
NrAddition1alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
(rl-and 2-family dwelling 0 Commercial/industrial Valuation: $1200
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: '
Job site address: 8999 SW Pinebrook St New dwelling area: square feet
City/State/ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Hoogendam Kitchen 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*arc based on the value of the work performed.
Tax map/parcel no.: ;re—SA— M`: Se pa��� 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.
Infill window with framing, install new window Valuation: $
Remode kitchen wl Remove and re-install hew cabinets Existing building area: square feet
Plumbing re-pipe at kitchen area (all work by owner) New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Shane Hoogendam g Type of construction:
Address: 8997 SW Pinebrook St Occupancy groups:
City:State/ZIP: Tigard, OR 97224 Existing:
Phone:(503) 757-3412 Fax:( )
Ncw:
0 APPLICANT 0 CONTACT PERSON
BUILDING PERMIT FEES*
Business name: RA Gray Construction (Please refer m fee sc&edalJ
Structural plan review fee(or deposit):
Contact name: AJ Michaud
Address:
PO Box 1000 FLS plan review fee(if applicable):
City/State/ZIP: Sherwood, OR 97140 Total fees due upon application:
Phone:(503) 692 4675 Fax::( ) Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* {
E-mail: ajmichaud@ragrayconst.com
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: R7rGrasr-erynrstrueti.onSubmit two(2)sets of roof plan with connection details
0 and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/Z1P: eryVOO r Permit Fee(includes plan review
Phone:( 5j Fax:( )
(Q� and administrative fees): $180.00
State surcharge(12°,of permit fee): $21.60
CCB lie.: r59,
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within ISO days after it has been accepted as complete.
Print name: A g E f UO Date: EO j 1412., *Fee methodology set by Tri-County Building Industrys ( Service Board.
L,Building`Permits`BUP-RFSPcrmitApp.doc 02,24'201I 440-4613T(II:02,COM/WF.ftt
RECEIVED
OCT 2 12021
Property Owner Statement CITY OF TIGARD
BUILDING DIVISION
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
XI 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 CCB 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.
Shane Hoogendam
Print Name of Permit Applicant
<: k\, .\ E'I\''' 'Nc-- --)
10-26-2021
Signature of Permit Applicant Date
--— — —1
Permit#: f •
Address: *. ;" 1•
Issued by: Date: '
This Copy for Permit Offices
FOR OFFICE USE ONLY—SITE ADDRESS: 1ilfoff'4
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
INI Transmittal Letter
T I L,A i I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
tUE1VED
TO: "`j'c5C1� DATE RECEIVED:
'/ NOV 3 2021
DEPT: BUILDING DIVISION
CITY OF TIGARD
FROM: AJ MICHAUD BUILDING DIVISION
COMPANY: RA GRAY CONSTRUCTION
PHONE: 503-692-4675 By: .Agf
EMAIL: AJMICHAUD@RAGRAYCONST.COM
RE: 8990 SW PINEBROOK ST MST2021-00466
(Site Address) (Permit Number)
HOOGENDAM KITCHEN
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 3 Revisions: UPDATED PLANS
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technici D : I I/i /z..I Initials: /4'/k-
Fees Due: ❑ Yes Fee Descifpti n: Amount Due:
$
1 � $
(J J ------ $ 0
Special
Instructions:
Reprint Permit (per PE): 0 Yes 12t< ❑ Done2ic,_.
Applicant Notified: �_ Date: �?/2 Initials: