Permit CITY OF TIGARD MASTER PERMIT
I 0 COMMUNITY DEVELOPMENT Permit #: MST201000201
T [GA A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2010
Parcel: 2S102BB00809
Jurisdiction: Tigard
Site address: 10210 SW BROOKSIDE PL
Subdivision: BROOKSIDE PARK Lot: 3
Project: Greenwell
Project Description: Fire damage restoration for insulation only. No plans required per Mark VanDomelen.
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: $21,266.00 Rear: 0
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Storm Sewer:
Tubs /Showers: Garbage Disp: Water Heaters: Water Lines: Drains: Catch Basins:
Bckflw Prevntr:
Footing Drain: Ice Maker: Hose Bib: Backwater Value:
Other Fixtures:
Drywell- Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Fum <100K: Vents: Woodstoves: Gas Outlets:
Fum > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add9 500 sf: 201 -400 amp: 201 -400 amp: W/O Svc/Fdr:
Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF 0
Owner: Contractor: ,
FROHNERT, FRITZ E LIVING TRUST 33 RESTORATION INC Required Items and Reports (Conditions)
BY FRITZ E FROHNERT E TR 16169 SE 106TH AVE
10210 SW BROOKSIDE PL CLACKAMAS, OR 97015
TIGARD, OR 97223
PHONE: PHONE: 503- 353 -8833
FAX: 503 - 353 -8933
Total Fees: $457.32
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other a/• - cable law. All work will
be done ' • = a • • an. • 'th approved plans. This permit will expire if work is not started within 180 days of issuance, or if work i ` spended for more the 180
days •TTENTION: Oregon - • -quires you to follow the rules adopted by the Oregon Utility Notification Center. •'=�- rules are set forth in OAR
9 - 001 -0010 through OAR • 2 •01 -• • • • . ou may obtain a opy of the rules or direct questions to OUNC by calling 503.232 : 332.2344.
Issued By: �i•• Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available ins • • • . ate.
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 Permit Application ' _
Residential _ viii OFFICE (SE ONLY
/�
City of Tigard Received
Date/B : 7 % - Permit No.: L /•�dVe., _2
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
II Phone: 501639.4171 Fax: 503.598.1960 Date/B : Other Permit:
T l ` 1, D Inspection Line: 503.639.4175 Date Ready /By: JAS: ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
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 Other: tesTa Q,A, i.) equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ill- and 2- family dwelling ❑ Commercial/industrial
Valuation: $ 2 / 2 6 6 • 18 .
❑ Accessory building ❑ Multi- family
Number of bedrooms: '3
❑ Master builder ❑ Other: Number of bathrooms: i
JOB SITE INFORMATION AND LOCATION Total number of floors: (
Job site address: /0 Z f 0 S'cJ g ZODIC c 1 D S PC1A c E New dwelling area: g square feet
City/ State/ZIP: 6 4 a Or2- .C, v ,3 97 Z.Z. -- Garage/carport area: '2_74 square feet
Suite/bldg./apt. no.: Project name: /0 — / 9 . Covered porch area: 2, l c.t square feet
Cross street/directions to job site: Deck area: .0 square feet
/7 9c - JOA(.•(e J J — Rau J L-C t 0. ` Other structure area: I C -z_ square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 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.
f�l�. E
L�tAm W G,(- (2c, 7)) v2-4" U,� — Valuation: $
0 LA-AA. l t — 1/)StJ(_IA -13"/ ' PAt l elPonni Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 1e)! C G2 -70 A) a — / ( Type of construction:
Address: / CU Z/ O S LA.) Z J2-U 6 le--S 1 t61 L p- L..4 C C Occupancy groups:
City/State/ZIP: 71 C L/ v& 0 C) 72,2.3 Existing:
Phone: (.3) '1q'( — 8 10 Fax: ( ) New:
13 ❑ CONTACT PERSON NOTICE
Business name: 33 1 c�To /2_4 V All contractors and subcontractors are required to be
Contact name: L 7�1 L licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / 6/ 6 S / O 6 AA .J jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/ State/ZIP:
M f i l '� O f c1 t C 7 "0 ( S apply:
Phone: (5;,s S`'' _ s-g33 Fax :: (S o3T R.5 3 — T 5 3 3
E -mail:
CONTRACTOR
Business name: ' .3 3 iz (D v , 2 11 - v .\) I •-)C— BUILDING PERMIT FEES*
Address: l ( i 6 S Sc / v G 1L9 Ax Structural refer to fee schedule)
S � 97 v Structural plan review fee (or deposit):
City/State /ZIP:
a /tt-c. v M ,vi U _ 1 S
(' 5-3?
FLS plan review fee (if applicable):
Phone: (SV'9 --,s,- 3 — D 8*? 3 F ax: (30 3s Total fees due upon application:
CCB lic.: /,S"-7 2 S �(J /
/` Amount received: 15 7.3A
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: L Z`, � ,,,i(.e Date: /07 7/ NO * Fee methodology set by Tri -County Building Industry
Service Board.
l :\Building\Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(l l /02 /COM/WEB)