Permit _ CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit MASTER
MST2022-00075
Date Issued: 04/12/2022
T I G A R r: 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134CC03000
Jurisdiction: Tigard
Site address: 11960 SW 122ND CT
Subdivision: YE-OLDE WINDMILL Lot: 16
Project: Harris
Project Description: Add(8)magnum push piers to right rear corner.
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: $10,000.00 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 Healers: 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<10OK: 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 WIG 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:
ADD SF VS R-3 0
Owner: Contractor:
HARRIS,GABRIEL J&REBECCA A CONCRETE LIFTING SOLUTIONS LLC Required Items and Reports(Conditions)
11960 SW 122ND CT PO BOX 4614 1 Special Inspection-Pilings,
TIGARD,OR 97225 TUALATIN,OR 161279 Drilled Piers and Caissons
PHONE: PHONE: 503-595-5110
FAX:
Total Fees: $409.67
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
oc91M1-M1n threw,nhg AR oc,jmn1-cm Yrv,ma„nkfain a rnn,of tha;lilac nr rl ran+m,nefInne In rL isic h,r Tallinn Sc 4 919 10117 nr I n 499 9144
Issued By: Y"'('_4 Permittee Signature: �/ft--- v l�r�
l
Call 503.639.4175 by 7:00 a.m.for the next available inspection dat
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 Permpit ADplicatiol4 ECEIVED Cto
�1 Jti26.hrr +/'(___ H.R(ii 1.1(,_ I SI (iAL_l
MAR 2 12022 Raeeiv�a
City of Tigard »any: �' Sl t Na.; i'
II 2 n 13125 SW Hall Blvd.,Tigard OR 97223��I Y OF 71GARD q� aii
Phone: 503-718-2439 Fax: 503-598- Date/By:ew YZ Related Permit:
TI(,ARD Inspection Line: 503-639-0175 3L.ILDING DIVI N DatcR dy/B 'JI�f"Z) r ® See Page 2for
Internet: www.tigard-or.gov No' ,7 Supplemental Information
TYPE OF WORK REQUIRED DATA:I-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
❑Addition/alteration/replacement VI.Other:F6vIADATi Or^t SVfeDt21 equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
i 3.J-and 2-family dwelling ❑Commercial/industrial Valuation: $ fl0a On U
0 Accessory building 0 Multi-family Number of bedrooms: 1).10 Cli' LG
❑Master builder ❑Other: Number of bathrooms: No C ,-„4r
JOB SITE INFORMATION AND LOCATION Total number of floors: Z, �-�T�*
Job site address: I t 1 Q 0 5 L.) I a 2N b Cr— New dwelling area: O square feet
City/State/ZIP: 11 rT2-0 . D/2. 67 z..a _ Garage/carport area: O square feet
Suite/bldg./apt.#: Project name: -3-A 2 fl js I^C?,xh foota Ott 5,uefoR Covered porch area: 6 square feet
Cross street/directions to job site: Deck area: osquare feet
Other structure area: 0 square feet
REQUH2ED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
`S ' a _ C C O �o 00
O Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: 34-
,. equipment,materiels,labor,overhead,and the profit for the
',.. 't ,DE/SCRIPTION OF WORK nc� ;.: work indicated on this application.
An/ Of) /,4 I/i) _ pas,4 09 S TO
Valuation: $
ilei6/4 T-- _ Existing building area: square feet
New building area: square feet
Pa PROPERTYY OWNER 0 TENANT Number of stories:
Name: G�N� r S Type of construction:
'Address: //9t 6 SKI /22 Ain Cam' Occupancy groups:
City/State/ZIP: 77644.ao D2 ?72.Z3 Existing:
Phone:($03) g'1 0 - g Ff3 5 Fax:( ) New:
® APPLICANT 0 CONTACT PERSON ,.,
BUILDING PERMIT FEES* I
Business name: 0��5 e/M� Z6 f� L . AYG review fee(orer ro posit aty
Structural plan fee deposit):
Contact name: �}7f' ' ZIJ/�awi Px -
Address: �L fj p �Ss J7,/ FLS plan review fee(if applicable):
�r2.. Total fees due upon I
City/State/ZIP: 11/4Af-470 v L i t/ - 7S'S P apP cation:
Phone:(344)) ,.5//,j_ 2_7,„L Fax::( ) Amount received:
E-mail: _ d p4s`i a k j` � /�1yr PHOTOVOLTAIC SOLAR PANE SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business main:�6„r Z/�Ata SOG U770/�ls Submit two(2)sets of roof plan with connection details
Address: � n/ and fire department access,along with the 2010 Oregon
( ' 0, t3ok 2( ./ Solar Installation Specialty Code checklist.
City/State/ZIP: 7 44,1err?y. o/, 970 6 '2. Permit fee(includes plan review $180.00
qq L and administrative fees):
Phone:(sue) Jr/J/' S i/ U Fax:( ) State surcharge(12%ofpemrit fee): $21.60
CCB Lic.: a 2
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: GarroLOSE P S/ yJK D8fe: 3/2/72 Z * Fee methodology set by Tri-County Building Industry
Service Board.
t:\Building\Permits\BUP_COM_PennitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
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