Permit CITY OF TIGARD MASTER PERMIT
I. COMMUNITY DEVELOPMENT Permit#: MST2022-00004
Date Issued: 02/08/2022
T f ;A RE) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134ACO2624
Jurisdiction: Tigard
Site address: 11175 SW BOXWOOD CT
Subdivision: ENGLEWOOD NO.3 Lot: 181
Project: BAKER
Project Description: Converting RV door to double entry door and a new partition wall+add 132sf storage above existing
garage.
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. $6,768.96 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
Bckflw 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
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 COM 0
Owner: Contractor:
SCHUMAN,GARRY D OWNER Required Items and Reports(Conditions)
BAKER,CATHERINE L
11175 SW BOXWOOD CT
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $321.90
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 B y Edgard° Malotoado- 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 iob site at the time of each inspection.
42 XV'614-e
Residential FOR OFFICI. I F 0\I )
-r rim,—-..s I Received
tine' 7:"_7:•_7-7_-7,s!"'"- . , - --f_11- -RECEIVED D-../Br *in 1-1 477- Permit No.:
Il -.t__,L_ .,:
.•-• —4
rIciARD Inspection Line: 503.639.4175 DEC 2 8 2021 Date Ready113 : ( Juris: fil See Page 2 for
Internet: www.tigard-or.gov ified/Method: Supplemental Information 1
! CITY OF TIGARD 1
DLL..
• .,1, uP % 9011..DING DIVISION
0 New construction 1 El Demolition Permit tees' are based on the value of the worK performed.
Indicate the value(rounded to the nearest dollar)of all
gl Addition/alteration/replacement D Other equipment,materials,labor,overhead,and the profit for the
I CATEGORY OF CONSTRUCTION ' work indicated on this application. G7
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.1E•22;:zs;
tiii‘i.e04111a,LiVr CiIiii6
Number of bedrooms:
0 Accessory building 0 Multi-family
Number of bathrooms:
1 L_I 4.v.taSiCi buttuCi i Uj vita. ---I
I
Job site address: i i 1 7 5 5 IA.) R 69y (...0 0 a C.77 New dwelling area: square feet
City/State/LIP: "1-i q ‘,. v‘e, , 0 R- (1 .3- z. ,_ 3 Garage/carport area: square feet
S l
1 u itclbidglapt,no.. - di A i l'i i:;1.:71.144,14,-, < ) ,
/ az key-, Covered porch area: sq iiiiiii feet i Cross street/directions to job site: Deck area: Ayuare feet
5t)CC)ri- 0 i'L.) LA_.7(I)!) Cf 1-62 61.) Bo)4(,4 160(4 Otitet-stractuiearVLI 3 frsiquare feet
C.'T i RFOUIP.FIli DATA.COMMERCIA!.-TISP CHECKLIST :
I ,
SubtilYisitiii. a-l/V C i.e-.3 1 } e)r)A LI 1 1 Lui.... 1 0 I ! Permit ices' ale based on the vaitte of Inc work performed.
indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: S 3LEAC ' 02- & a Li equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation:
' C0i0(i e WT. L'A 1^Ci e RI) Door. To 5rg DoqtaHe. i
. Existing building area: square feet
..• ,-, .
Eio-m-r Odezr i t--,0".1 L.)Ca-r- i I )<' i 2./..)r eil To
LW:IN)V et L,,--t-olla le- 4 v'e 4 (Al' L i kV"re Ci S-TerV*41 (i C: New building area: square feet
i g PROPERTY OWNER - .1,1 I Number of stories: 1
I
Name: G c-A. v•v,y S,-. 1, u yo ii Al / at-+-1",r B k e ir• Type of construction:
Address: I I ( i (s--. ,S_Li.2, Ben x LA,oexj cr, Occupancy groups:
City/State/ZIP: -I-(-es a v‘cp1 0 0 ci.7 --a.2 —3 Existing:
•
1 - - — - - - - - 1 - - - - -
I Phone:(CI 711 a(3 S-- 1 I-1 2, "7- ' 'Fax-1.' ) N.,/qC New:
2'APPLICANT El CONTACT PERSON BUILDING PERMIT FEES*
(Please refer IV fee schedule
Business name:
Structural plan review fee(or deposit): I
I
Contact name: AM C::. A_.S_ Abac)e-_
--1 FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received: ,
Phone:( ) I Fax .( ) _________I
I PHOTOVOLTAIC SOLAR PANEL SYSTENI FEES*
E-mail: 6a-e-r\iScin@ 0480 . Got)"
Commercial and residential prescriptive installation of
I CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: eZ(//4,Cf Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 429-164-6- ' Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/ZIP: $180.00
and administrative fees):
Phone:( ) I Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: i Total fee due upon application: $201.60 I
. -
Authorized signature:4.1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
i *Fee methodology set by Tri-County Building Industry
Print name: Ga j,,, ry Sc.k(...1 v t4 ii g I Date: 1 Z.j'2_6 i 2.,I Service Board.
1:\Building\Permits\BUP-RESPermitkpp.doc 02/24/2011 440-4613T(11/02/COMIWEB)
4--..e
FOR OFFICE USE ONLY-SITE ADDRESS: //h
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
r Transmittal Letter
i f(.i A R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: At 1 ySoN Artin.S-i-vcu1 J DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: C-c, vr7 .5eI.c. vv) A JAN10YOU
COMPANY: CITY OF TIGARD
PHONE: C .• 1 - 2 5 - I y 2 - BUILDING DIVISIOW
EMAIL: ��-a 0 r y Sc ) IA&Ai • C o(►1
RE: i 1175 5LJ raoX Looe,e1 en MST 2 o Z Z.- 0 002 W
(Site Address) (Permit Number)
L.a-r 1 F31 aAlci l ew occ ( 11
(Project name or subdivisi name and 1 t number)
City o-4' r; gekv,c
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. 3 Revisions:
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: ,—i f--C-c/ r i Ldne-r >"0
FICE USE ONLY
Routed to Permit Technici : e: 1 1,2 2-1 - Initials:
Fees Due: ❑Yes No Fee Desc pt><on:
Amount l
. $
j _ 6 )Q E, , ,r6-
Special
Instructions: �Reprint Permit(per PE): 0 Yes No ❑Done,"
Applicant Notified: `JCL---Date: /�G/i Initials:
Property Owner Statement
REr E1VED
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed withM 2 8 2O2
Construction Contractors Board to sign the following statement before a building permi p (aAK,
issued. (ORS 701.325 (2))
BUILDING DIVISION
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 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.
Pr-rry" Sc,l/A Al.
Print Name of Permit Applicant
C SC„_ _ 1 / 2- 6 /z
Signature of Permit A plicant Date
Permit#:
Address: _._ .3•
.
s. .y
l
Issued by: -_- Date
This Copy for Permit Offices