Permit (5) CITY OF TIGARD MASTER PERMIT
' 1 1 COMMUNITY DEVELOPMENT Permit#: MST2023-00489
Date Issued: 09/26/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S26/202 6100
Jurisdiction: Tigard
Site address: 12643 SW 138TH AVE
Subdivision: ROSE MEADOWS Lot: 20
Project: HOLTHAUS
Project Description: Stem wall repair from vehicle impact.
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: $2,500.00 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
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 SF VB R-3 0
Owner: Contractor:
HOLTHAUS,ROBERT A CORNERSTONE DISASTER REPAIR Required Items and Reports(Conditions)
12643 SW 138TH AVE 5331 SW MACADAM AVE SUITE 377
TIGARD,OR 97223 PORTLAND,OR 97239
PHONE: PHONE: 503-295-0108
FAX: 503-295-1896
Total Fees: $213.21
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 Utilit ica Cent se rules : - .et forth in OAR
oc9-nn1-nnln thrniinh CIA IQ qr,9-nn1_nnan VniI may min rn i of the..rnlac nr riirart niicctinnc to(11 INC! i Tallinn cm 919 R r nn'339 914
Issued By: . Permittee Signature:
all 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 Application
Residential FOR OFFICE USE ONLY
City of Tigard v Received
,1111 ����'` ,� aanteByReview //,1� 3 Permit (�a j�s3-" cO`!
° 13125 SW Hall Blvd.,Tigard,OR 97223 I 7L t/
S' Phone: 503.718.2439 Fax: 503.598.196 Date/By: 1 Vo Z"j Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: `Q j / I t i5 ® See Page 4 for
Internet: www.tigard-or.gov SEP 2 6 2023 Notified/Method: 1/ 1 j 3 /� Supplemental Information
Igt4TYPE OF WORKCITY OF TIGARD ���!!// ��•��//
REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑DeriZA❑New construction
SING DIVISION Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 'J Other: P,It pI equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
g.1-and 2-family dwelling ❑Commercial/industrial
Valuation: $ LIC)
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: l2(p 7 3 S,„i 3?rM),,,e New dwelling area: square feet
City/State/ZIP: 'f l C;Aa / . q/7 j�� Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:JjOL1N.�L V / j3 �f_ Covered porch area: square feet
CrossPt-Pia-
strreet,/directions to job site: / ' 1 /"r Deck area: square feet
� t-PJ i 2Ay Acz 51' ,--1 -J [_ i & lsa Je-3 Other structure area: square feet
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
c.._ DESCRIPTION OF WORK work indicated on this application.
4,1) 1 ( .,(_� Valuation: $
i
_/C �r 1 fir, ��_° I
a-'- wi 3 fi_
Existing building area: square feet
New building area: square feet
g. PROPERTY OWNER ❑ TENANT Number of stories:
Name: Do is J Lm,Y jrs Type of construction:
Address: 2c,,,7 3 5 vti f 3evi „i Occupancy groups:
City/State/ZIP: -ri Cvlit Existing:
Phone:( ) Fax:( ) New:
h APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: U/A PH C.frkerovAc pc
(Please refer to fee deposit):
schedule)
t� Structural plan review fee(or deposit):
Contact name: SA/IdA HCVk,,h5"..
FLS plan review fee(if applicable):
Address: �� 1 St✓" - —'�D 2V(
r Cq. Total fees due upon application:
City/State/ZIP:
i (GA /C // 7 Z7, Amount received:
Phone:6133 ) 35 /77../ Fax::( )
E-mail: So il qC\j1 I Si(aC,f Jr le.C m c7 4i.co i PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRAC OR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 1•0 f LS1-4 pi SA.Tea_ 9...A ra h it Submit two(2)sets of roof plan with connection details
/ and fire department access,along with the 2010 Oregon
Address: S'.3 31 S T•fl c1 D i A 4, '4i 37 Solar Installation Specialty Code checklist.
y
Cit !State/ZIP: I'"7l C) ��� $180.00
Phone:(9 i) (jogFax:( )I Permit Fee(includes plan review
� �� � and administrative fees):State surcharge(12%of permit fee): $21.60
CCB lic.: *�'
J 7(5 ,
Total fee due upon application: $201.60
Authorized signature This permit application expires if a permit is not obtained
v.f �.,.... ..�, within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: }W 5%j 04, Date: 6i 2 Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 01/25/2023 440-4613T(I 1/02/COM/WEB)