Permit CITY OF TIGARD MASTER PERMIT
14 ■ . COMMUNITY DEVELOPMENT Permit#: MST2016-00157
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/05/2016
T r t_ /�f2,D9 Parcel: 1 S 134CB05400
Jurisdiction: Tigard
Site address: 11125 SW TONY CT
Subdivision: ANTON PARK Lot: 16
Project: FIRE-Flex
Project Description: Fire damage repair in garage, utility, and kitchen.
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: 1 Third: 0 sf Right: 0
Detectors: No
Total: 0 sf Value: $18,500.00 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
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!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:
FLAX,LAURA FIRE INDUSTRY RESTORATION EXPERTS If Required Items and Reports(Conditions)
GADDIS,JERRELL PO BOX 2133
11125 SW TONY CT OREGON CITY,OR 97045
TIGARD,OR 97223
I PHONE: PHONE: 503-305-7285
FAX:
Total Fees: $647.96
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe.alty Cedes and all oth= ape icable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issu-nce, or if work s sus ended • more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Noti cation Center. Thos rul=, are •rth in OAR
952-00 •.10 throug IA'R 95 -$01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling .03..l'.2.198 ,r 1.800.•32. 44.
• —mill
las ed By: i/ 4� - Permittee Signature:
i
Call 503.639.4175 by 7:00 a.m.for the next available inspection dat'.
This permit card shall be kept in a conspicuous place on the job site until comple'f•n of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential rt)R OFI Ii ►. I 'l OyI 1
City of Tigard Received /
DateBy /../
A, /,, 677___ Permit No.:nu-no/6_cols 7
71111 13125 SW Hall Blvd.,Tigard,O''i "v Plan Review .✓✓� _ �,
_ Phone: 503.718.2439 Fax: 503 6' ' Date/gy: 9 )2,C i E Other Permit:�kl-'0
5 31
.'
1 f,,-\I;1} Inspection Line: 503.639.4175 Date ReadyBy: Juris: See Page 2 for
Internet: www.tigard-or.gov APR 2 6 2016 Notified/Method- II CU i I 0 Supplemental Information
TYPE O)F TIGARD a��l
('� REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction BIS ('t�nivisION 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 ►•1 Other: ut men`� — �le.t eq 'p t,materials,labor,overhead,and the profit for the
CATEGORY OF t, ' UCIION work indicated on this application.
Pit d 2-family dwelling 0 Commercial/industrial Valuation: $ /13( C`l
Number of bedrooms:
• Accessory building 0 Multi-family
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1112 6 SiAT-Fair e-T New dwelling area: square feet
City/State/ZIP: 716�Q n 0 a T7 2 Garage/carport area: square feet
Suite/bldg./apt.no.: `"1"�'1 Project name: j Covered porch area: square feet
itCross street/directions to job site: Deck area: square feet
t
Other structure area: square feet
\QUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 'I le/ Lot no.: P- t fees*are based on the value of the work performed.
Indica the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipm- .materials,labor,overhead,and the profit for the
ESCRIPTION OF WORK work indi . ed on this application.
44cpti-4Q..., p„e si —E//// --4 /, � �y,j3 Valuation: $
1"3��+ -, V I /u t F..L W1 m/ Existing buil u.,g area: square feet
/j ieY2 ca_ Q#1/F/),, New building are.. square feet
et,PROPERTY OWNER,_v 0 TENANT ( Number of stories: ./
Name: - ` Type of construction:
�Address: 1,+y Occupancy groups:
City/State/ZIP: l( lyls1Ji 0 ``t CO1'23'23 Existing:
Phone:(qg i g3ilde Fax:( ) New:
APPLICANT CANT - )Y ]��.',�/ CONTAC
T PERSON BUILDING PERMIT FEES*
�IV ��i�76 Lt C. ftJerre+rk►afa lej
Business name: Structural plan review fee(or deposit):
Contact name: e f `����.!
rJ / FLS plan review fee(if applicable):
Address: ?j5.7S
City/State/ZIP: if�� � OTotal fees due upon application•
a q / ` �� Amount received:
Phone: J ! Z� l�g69j Fax::( )
E-mail: .w 2fd., b jej ��J PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
vAcrom roof-top mounted Photo Voltaic Solar Panel System.
Business name: 6I 45 a/04/5,141 4 J gicperzts Submit two(2)sets of roof plan with connection details
"W `'rand fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZI l �� q-790, Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ..72 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 1 : b ��/
/ i %—
Total fee due upon application: $201.60
Authorized signature: .' i i This permit application expires if a permit is not obtained
/ within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: Date: ���� Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)