Permit CITY OF TIGARD MASTER PERMIT
IS • COMMUNITY DEVELOPMENT Permit #: MST2012 -00068
T f G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 2S103CB08900
Jurisdiction: Tigard
Site address: 12492 SW QUAIL CREEK LN
Subdivision: QUAIL HOLLOW - EAST Lot: 47
Project: Borgman
Project Description: Build storage loft in 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: No
Total: 0 sf Value: $3,500.00 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 Storm Sewer: 0
0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvelFeeders 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- 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
Other: N Other Description: Ecompasin g: N '
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-4 0
Owner: Contractor:
BORGMAN, MATTHEW I & AUDREY L GTM CONSTRUCTION INC Required Items and Reports (Conditions)
12492 SW QUAIL CREEK LN 17735 MARDEE AVE
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 702 - 610 -0450 PHONE: 503 - 635 -2059
FAX:
Total Fees: $244.13
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
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1987 or 1.8 332.2344.
Issued By: / � Permittee Signature: � 4k _ _. _ _ _
Call " 75 by 7:00 a.m. for the next available Inspection d e This permit card sha • = kept In a conspicuous place on the job site until completio • ect
Approved plans are required on the job site at the time of each Inspection. —
J
Building Permit Applicatio (�
Residential E�� �J Fnn OFFICE USI; ONLY
City of Tigard 4 Received Permit No.:
APR 2 012 DateB : � � ���a- ,eet56
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Ry a �
C Phone: 503.718.2439 Fax: 503.598.19 Al ( I Other Permit:
Date/By:
FIG n k O Inspection Line: 503.639.4175 Gn OF TI GA R D Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Not i _�
ethod: 4' /' // A. ,' Supplemental Information
TYPE OF WORK / R QUIRED DAT ! 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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling El Commercial/industrial
Valuation: $3500
❑ 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: 12492 SW Quail Creek Lane New dwelling area: square feet
City / State/ZIP: Tigard, OR 97223
Garage/carport area: square feet.
Suite/bldgJapt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: 160
square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
Build a storage loft in an existing garage. Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Matt & Audry bORGMAN Type of construction:
Address: 12492 sw Quail Creek Lane
Occupancy groups:
City/ State/ZIP: Tigard, OR
Existing:
Phone: (702)610 -0450 Fax: ( )
New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: GTM Construction, Inc. (Please refer to fee schedule)
Contact name: Gary Structural plan review fee (or deposit):
Address: 17735 Mardee Ave FLS plan review fee (if applicable):
City/State/ZIP: Lake Oswego, OR 97035 Total fees due upon application: [ •
Phone: (503) 635 -2059 Fax : : ( ) Amount received: 4 4 /5-
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial : d residential prescriptive installation of
_ roof -top mount. • PhotoVoltaic Solar Panel System.
Business name: GTM Submit two (2) s • f roof plan with connectio • • Is
Address: same and fire department ac along with the : I Oregon
• Solar Installation Specialty , , e c l : •+ 1st.
City/State/ZIP: same Permit Fee (includ • - "ew $180.00
Phone: (same) —
nistrative fees .
Fax: ( )
CCB lie.: 55557 481/4 State surcharge (12% of permit fee): ` $21.60
Total fee due upon application: 01.60
Authorized signature: —•' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Gary Mimnaugh I Date: 4/4/12 * Fee methodology set by Tri-County Building Industry
I:\ Building \Permits\BUP- RESPermitApp.doc 02/ 24/2011 440- 4613T(l 1 /02/COM/WEB)