Permit e CITY OF TIGA I I MASTER PERMIT
( .3 !- /'3.
1 , COMMUNITY DEVELOPMENT Permit #: MST2012 00191
T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2012
Parcel: 2S 103BA01000
Jurisdiction: Tigard
Site address: 12400 SW 121ST AVE
Subdivision: LERON HEIGHTS NO.2 Lot: 28
Project: Ausbie
Project Description: Repair fire damage to garage roof, walls and (5) roof joists 1/30/13 REPRINT Add (1) fan for
bathroom
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 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: Yes
Total: 0 sf Value: $60,000.00 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 Storm Sewer: 0
Drains: 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
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 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 addl 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 8 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:
REP SF VB R -3 0
Owner: Contractor:
AUSBIE, DONNA D KENNEDY RESTORATION Required Items and Reports (Conditions)
12400 SW 121ST AVE 315SE7THAVE
TIGARD, OR 97223 PORTLAND, OR 97214
PHONE: PHONE: 503- 234 -0509
FAX: 503- 234 -4479
Total Fees: $1,540.71
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 t obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: LV jL.C(0 r Permittee Signature: ad Ar 4 77O' 4
Call 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 job site at the time of each inspection.
1
MASTER PERMIT
IIII CITY OF TIGARD
Q : COMMUNITY DEVELOPMENT Permit #: MST2012 -00191
T j G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2012
Parcel: 2S103BA01000
Jurisdiction: Tigard
Site address: 12400 SW 121ST AVE
Subdivision: LERON HEIGHTS NO.2 Lot: 28
Project: Ausbie
Project Description: Repair fire damage to garage roof, walls and (5) roof joists
BUILDING
Floor Areas Required Setbacks Requ
Stories: 2 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: Yes
Total: 0 sf Value: $60,000.00 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 Storm Sewer: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains. 0 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 Srvc/Feeders Branch Circuits
1000 of or less: 0 0 -200 amp: 0 0 -200 amp: 0 WI 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 8 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:
REP SF VB R -3 0
Owner: Contractor:
AUSBIE, DONNA D KENNEDY RESTORATION Required Items and Reports (Conditions)
12400 SW 121ST AVE' 315 SE 7TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
PHONE: PHONE: 503- 234 -0509
FAX: 503- 234 -4479
Total Fees: $1,439.91
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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1987 or 1.800 32.2344.
Issued By: by next a s o Permittee Signature: /!
Call 503.639.4175 b 7:00 a.m. for the ne available in • : ion date.
This permit card shall be kept In a conspicuous place on the Job site . til completion of the project.
Approved plans are required on the Job site at the time • f each Inspection. '
Building Permit Application
1(eiideiitlaI RECEIVED FOR OFFICE USE ONLY
CI of Ti and Received ' Permit t3' g Date/By: 7 AC 1 )10 -Go l 4
I n 13125 SW Hall Blvd, Tigard, OR 9722 ' I Plan Review ►
Phone: 503.718.2439 Fax: 503.598.1 60 2 5 2012 Date/By: i , 7 1 other Permit:
T I G A R V Inspection Line: 503.639.4175 CITYOFTIGARD i•ir� OFTIGARD Date Ready/By: p / A ir,. rte: 12I See Page 2 for
Internet: www.tigard-or.gov ov lilt 11 Notified/Meth d:er i/ . •ffil Supplemental Information
BUILDING DIVISION .9 0
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
1 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
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i -. Valuation: $ C. 0,000
1- and 2- family dwelling ❑ Commercial/industrial ^'
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 3
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Job site address: it-it 00 S lZt sr AVE k . New dwelling area: 0 square feet
City /State/ZIP: ¶, (, A 1u , 0s. en LV Garage /carport area: S 2.S square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
I. ST ('- esr • NO[L'N pH i 21 cr ave Other structure area: square feet
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Subdivision: /Ttl 4. II Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax Tax map /parcel no.: 'LS l 03 ��} 0 0 D
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New building area: square feet
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Name: Type of construction:
Address: Occupancy groups:
City/ State/ZIP: Existing:
Phone: ( ) Fax: ( )
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Contact name: (a e-0 F F Go 2E
FLS plan review fee (if applicable):
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Total fees due upon application: 4'
City/ State/ZIP: TL (, , 0 R. ptl i 11
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Phone: (S H ti 3 , 3q Do �l 13 I Fax :: (SOS) 'j' 3. 31OD Amount received:
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Business name: KNN1,1 R srOjLp AoN Submit two (2 ets of roof plan wit , .nnection details
and fire departme .cress, alon . ' ith the 2010•Oregon
Address: 1 i S S E 1 /WC:, Solar Installation Spec : 'ode checklist.
City/State/ZIP? Q V M OR. Q 7 Zt Permit Fee (incl . s . , review
h TLI ' la d i H - $180.00
an i ministrative - es):
Phone: (So 3 ) /11..1 , 0 5 - 0 e Fax: (WI ) 7.311 , H 6 11 cl State sur - : ge (12% of permit fee): $21.60
CCB lic.: 3 y 0 Z
Total fee due upon application: $201.60
Authorized signature: V4 � - � This permit application expires if a permit is not ob ,. ed
within 180 days after it has been accepted as complete.
Print name: Ge0 F F ( Date: - / 25"! It • Fee methodology set by Tri- County Building Industry
Service Board.
I:\ Building \Permits\BUP- RESPennitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12400 SW 121ST AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
03/27/2013 00:00
MST2012-00191
PASS - C of O
NOTE final inspection should say PASS- NO C OF O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12400 SW 121ST AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
03/27/2013 00:00
MST2012-00191
PASS - C of O
NOTE final inspection should say PASS- NO C OF O
Violation Summary:
Inspector Contractor