Permit (109) CITY OF TIGARD MASTER PERMIT
1 ' COMMUNITY DEVELOPMENT Permit#: MST2023-00469
Date issued: 11/09/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AA14100
Jurisdiction: Tigard
Site address: 12200 SW 128TH AVE
Subdivision: BELLWOOD NO.3 Lot: 160
Project: TOWNLEY
Project Description: Enlarging kitchen door opening for a new sliding glass door.
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: $3,477.00 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 Dist); 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 Tvpes 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
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temo SrvclFeeders 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-1 000v: 0
1000+amp/vat: 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:
TOWNLEY.JAMES PACIFIC EXTERIORS LLC Required Items and Reports(Conditions)
12200 SW 128TH AVE 14724 BOTHELL WAY NE
TIGARD,OR 97223 LAKE FOREST PARK,WA 98155
PHONE: PHONE; 206-877-3087
FAX:
Total Fees: $240.63
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: -/ � Pehe next vi Signature:le Inspection�d date.
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Call 50 . 9.4175 by 7:00 a.m.for the next available date.
This permit card sha! ept 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.
J
Building Permit Application
Residential �e^e'" � _ FOR OFFICE USE ONLY
ErCl of Tigard GV G V dived p
g Date/By: '9// /1', p5_ Permit No.:p57 9.13,3�.4� Q
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev ewrf `V / ri[� W /
Phone: 503.716.2439 Fax: 503.598.1960 SEP 14 2023 Dalc/By: I0/�Z3 Other Permit:
T i G A R D Inspection Line: 503.639.4175 Date Ready/By: ( / Jens: ® See Page 4 for
Internet: www.tigard-or.gov CITY OF TIGAPI9ahfiedimethod: In 31 j3 /9� {
"� qq Supplemental Information
DVii-�'t�'�BI41JInN ir1C., 4.41
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑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:2678 equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation:industrial it "77
El Accessory building El Multi-familyNumber of bedrooms: 0 ,J
❑Master builder 1. ®Other: Residential Number of bathrooms: 0
JOB SITE INFORMATION AND LOCATION Total number of floors: 0
lob site address: 12200 Southwest 128th Avenue New dwelling area: 0 square feet
City/State/ZIP: Tigard, OR 97223-1865 Garage/carport area: 0 square feet
Suitelbldg./apt.no.: NA Project name: OR-1242 Townley Covered porch area 0 square feet
Cross street/directions to job site: Deck area: 0 square feet
On SW 128th Ave Other structure area: 2678 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.:2S1o4AA14100 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 14100(2S104AA) 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.
§i in rnnlarae Pnt vstlth uardi t, door Valuation: $
G \JI ,
reframe for slider Existing building area: square feet
New building area: square feet
ill PROPERTY OWNER ❑ TENANT Number of stories:
Name: James Townley Type of construction:
Address: 12200 SW 128th Ave Occupancy groups:
ls's City/State/ZIP:Tlgard, OR 97223 Existing:
kJ
Phone:((503)332-8892 Fax:( ) New:
IN APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
i (Please refer to fee schedule)
r` Business name:Pacific Exteriors LLC
Structural plan review fee(or deposit):
t Contact name: Paris Hall
FLS plan review fee(if applicable):
Address: 9570 SW Barbur Blvd#304
", City/state/ZIP:Portland, OR 97219 Total fees due upon application:
Phone:2064925041 Fax::( ) Amount received:
E-mail: Paris@pacificexteriorslic.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System
Business name: PBCIfIC Exteriors LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
4 Address: 9570 SW Barbur Blvd#304 Solar Installation Specialty Code checklist.
City/State/ZIP:Portland, OR 97219 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:Q064925041 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:241425 (a`l,(p11.yl r
y Total fee due upon application: $201.60
Authorized signature: l� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Paris Hall Date: 8/25/2023 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(1 1/02/COM/WEB)