Permit CITY OF TIGARD MASTER PERMIT
111
r! COMMUNITY DEVELOPMENT Permit #: MST2012 00232
T ( G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/11/2012
Parcel: 1S134CB08000
Jurisdiction: Tigard
Site address: 11190 SW 125TH PL
Subdivision: ANTON PARK Lot: 42
Project: Smith
Project Description: Add a window to the master bedroom bathroom
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: $350.00 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
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'l 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: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF 0
Owner: Contractor:
SMITH, KENT E & OWNER Required Items and Reports (Conditions)
SMITH. BRENDA C
11190 SW 125TH PL
TIGARD, OR 97223
PHONE: 503 - 590 -8223 PHONE:
FAX:
Total Fees: $94.79
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 AR 952 -0 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 0.332.2344.
Issued By: Permittee Signature:
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.
Building Permit Application
Residential • , rA } FOR OFFICE USE ONLY
City of Tigard P. Received Permit No itjO /A.- L
° 13125 SW Hall Blvd Tigard OR 97223
�' g Date /B (( Y OL �3
l� - ., , SEP 1 1 Plan Review ' : Bm� t
Phone: 503.718.2439 Fax: 503.598.19 2 12 Date /B : Mr,14�1. i N is- r
P Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready c Juris. ® See Page 2 for
Internet: www.tigard or.gov CITY Of TIGARD Notified/Method: {p Supplemental Information
elJILDIme, oftfierf?r
TYPE OF WORK REQUIRED DATA: I- 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.
•
® I- and 2- family dwelling ❑ Commercial /industrial Valuation: S350
❑ 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: 11190 SW 125' PI . New dwelling area: • square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Smith Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: 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.
•
Add a window to the master bedroom bathroom
Valuation: S
Existing building area: square feet '
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Kent Smith Type of construction:
Address: 11190 SW 125' Occupancy groups:
City /State /ZIP: Tigard, OR 97223 Existing:
Phone:•(503)590 -8223 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: '
Structural plan review fee (or deposit):
Contact name:
FLS plan review fee (if applicable): •
Address: •
City /State /ZIP: Total fees due upon application:
Phone: ( ) Fax: : ( ) Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEtM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two (2) sets of roof plan with connection details
. and fire department access, along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City /State /ZIP: Permit Fee (includes plan review $180.00
. and administrative fees):
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60
. CCB lie.:
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
la:s1 within 180 days after it has been accepted as complete.
Print name: Kent Smith Date: 9/11/2012 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\ Building \Permits \BUP- RESPennitApp.doc 02/24/2011 440- 4613T(1 1/02 /COM/WEB)