Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2015-00146
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/26/2015
Parcel: 2S103AC04400
Jurisdiction: Tigard
Site address: 12567 SW 114TH TER
Subdivision: WALNUT GROVE Lot: 13
Project: Ericksen
Project Description: Replace exterior window with French doors, enlarging the opening.
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: $6,000.00 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: D 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: 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 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&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 VB R-3 0
Owner: Contractor:
ERICKSEN,RICHARD&SARAH OWNER Required Items and Reports(Conditions)
12567 SW 114TH TER 12567 SW 114TH TER
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-504-3017 PHONE: 503-504-3017
FAX:
Total Fees: $303.98
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rul- are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy the itres,421,51irect questions to OUNC by calling 503.232.1987 or 1.800. . 344.
Issued By: Permittee Signature:
Call 503.60r by 7:00 a.m.for the next available inspeCti• date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential VIM FOR OFFICE l'SF ON IA
City of Tigard RECEIVED RDeacteived ♦ J, lS60
Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
.111 Phone: 503.718.2439 Fax: 503.598.. 1 2 2015 Date/B : i( //Ss-. Other Permit:
T 1 G A RI) Inspection Line: 503.639.4175 Date Ready/By: orris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TiGAR� Notified/Method: b$— I - —am Supplemental Informs Jn
E'$Y vo a i ,\'l`; UN dreft-v,1144 EL •-.1
TYPE ORK 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: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $6000
® 1-and 2-family dwelling ❑Commercial/industrial
❑Accessory building Multi-family
Number of bedrooms: NA
❑Multi-famil
❑Master builder 0 Other: Number of bathrooms: NA
JOB SITE INFORMATION AND LOCATION Total number of floors: NA
Job site address: 12567 SW 114th Ter New dwelling area: NA square feet
City/State/ZIP:Tigard OR 97223 Garage/carport area: NA square feet
Suite/bldg./apt.no.: Project name: ►-Doers o>l7 L,g5,A) Covered porch area: NA square feet
Cross street/directions to job site:Walnut Deck area: NA square feet
Other structure area: NA square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Walnut Grove Lot no.: 13 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.: R2022129 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Replace exterior window with french doors.Enlarge opening with new header. Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Richard Ericksen Type of construction:
Address: 12567 SW 1146 Ter Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:Richard Ericksen
FLS plan review fee(if applicable):
Address: 12567 SW 114th Ter
Total fees due upon application:
City/State/ZIP:Tigard OR 97223
Phone:(503)504-3017 Fax: :( ) Amount received: /(74, d-7--
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: richericksengmail.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mou, -a PhotoVoltaic Solar Panel S stem.
Business name:TBD 1 �°>LVNC Submit two(2)se •f roof plan with co•• tion details
and fire department a •ss,along w the 2010 Oregon
Address: Solar Installation Specia , Cod, ecklist.
City/State/ZIP: Permit Fee(includes • review $180.00
and admin.• ati • fees):
Phone:( ) Fax:( ) State surcharge(1 /o of permit - : $21.60
CCB lie.: Total f- due upon application: $201.60
Authorized signature: /1/0-12r-)/ This per application expires if a permit is not obtained
J within 180 days after it has been accepted as complete.
,�f Date: *Fee methodology set by Tri-County Building Industry
Print name:
'iL l.H IZ � L
� � KSG✓v Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
r
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
yr
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
/G ef, 1) t72_/LI:sE,c'
rint Name of Permit Applica
`/ 9-2-2- o/g
= 1. .t of P- -Applicant Date
Permit#: /fr'I:Sf 6--00/5'(0
Address: /A-5-‘ / C v..�� `: �
/ .� �2 9)>—a? ice". ,
Issued by: ,g.7, Date: A�.ZG/5 i.I-1:
This Copy for Permit Offices