Permit a CITY OF TIGARD MASTER PERMIT
• COMMUNITY DEVELOPMENT Permit #: MST2012 -00010
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2012
Parcel: 2S 103DA05500
Jurisdiction: Tigard
Site address: 13465 SW 107TH AVE
Subdivision: FANTASY HILL Lot: 6
Project: Hurley
Project Description: Enlarge existing dormer, some interior remodeling.
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: 48 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 48 sf Value: $10,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs/Showers: 1 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 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 1
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
in
Other: N Other Description: Ecompas g: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R -3 48
Owner: Contractor:
HURLEY, DENNIS & DANA PAUL SOLONIKA & SONS LLC Required Items and Reports (Conditions)
13465 SW 107TH AVE 4114 FRAZER RD
TIGARD, OR 97223 SUBLIMITY, OR 97385
PHONE: PHONE: 503- 930 -3597
FAX:
Total Fees: $573.71
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. ATTE e • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C - - Those rules are se forth in OAR
952 -001 -I s 0 through O • ' • -' r 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. - / or 1.800.3 2.23 • . -
Issued =y: " / l ' 0 � Permittee Signature: %Ii r. /
Call 503.639.4175 by 7:00 a.m. for the next available Inspectlo da e.
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 RECEIVED FOR 01.11LE ISE
City of Tigard Received , /. ffiffora Permit No.: •03. l a -tee A)
I a 13125 SW Hall Blvd., Tigard, OR 9722 /` �� 2 0 2012 Plan Review ��, ' / _ e , er Permit:
C
Phone: 503.639.4171 Fax: 503.598.1960 Date/13y: A 1�
Inspection Line: 503.639.4175 e ReadyBy: Jaris: ® See Page 2 for
I' I G A R D
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: 17 a Supplemental Information
BUILDING DIVISION a Le rl fw ' . -
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.
Valuation: $10,500
0 1- and 2- family dwelling ❑ Commercial /industrial
❑ 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: 13465 SW 107 Ave New dwelling area: 48 square feet
City/ State/ZIP: Tigard, Or Garage/carport area: square feet
Suite/bldg ./apt. no.: I Project name: Dormer expansion Covered porch area: square feet
Cross street/directions to job site: Park St. & 107 Ave Deck area: square feet
Westward on Park St. off 99W to 107 Ave. Turn left onto 107 Ave, procede Other structure area: square feet
one block to the end. Site is on the right. REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: N/A I Lot no.: 5500 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.: 2S13DA -05500 equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
To enlarge an existing dormer by 48 sq. ft. (6X8) Valuation: $
Work will require re- roofing existing dormer, placing one window, and siding to Existing building area: square feet
match existing New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Dennis and Dana Hurley Type of construction: Stick frame
Address: 13465 SW 107 Ave Occupancy groups:
City/State/ZIP: Tigard, Or. 97223 Existing:
Phone: (503)698.6659 Fax: ( ) New:
❑ APPLICANT 0 CONTACT PERSON NOTICE
Business name: Paul Solonika and Sons LLC All contractors and subcontractors are required to be .
licensed with the Oregon Construction Contractors Board
Contact name: Robert Solonika under ORS 701 and may be required to be licensed in the
Address: 4114 frazer Rd. SE jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: Sublimity, OR 97385 apply:
Phone: (503) 930 -3597 I Fax: : ( )
E -mail: dndhurley @frontier.com or ksolonika @hotmail.com
CONTRACTOR
Business name: Paul Solonika and Sons LLC BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address: 4114 frazer Rd. SE
Structural plan review fee (or deposit):
City/ State/ZIP: Sublimity, OR 97385
FLS plan review fee (if applicable):
Phone: (503) 930 -3597 I Fax: ( )
Total fees due upon application:
CCB lic.: 169100 S
3/ 1 /
�° Amount received: f / to . &41
Authorized signature: e This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Dennis urley Date: i —70 ,rz . Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 1 0/01/09 440- 4613T(11 /02/COM/WEB)
Electrical Permit Applicatio
l:l)R OFFICE l'sr o Nl_,
City of Tigard JAN 2 0 2012 Received MM." Permit No.: -009 0
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598 OF TIG AR D Date/B : Other Permit:
•
T I G A R D Inspection Line: 503.639.4175 G DIVIS Date Reaay/ey: tuns: ® See Page 2 for
Internet: www.tigard or.gov BUI Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ['Addition of new motor load of ❑ "A ", E , "l -2 ", "l -3 ",
Job no.: Job site address: 13465 SW 107th Ave I OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Dormer expansion ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Westward on Park St. off 99W to 107th Av Description I Qty. I Fee. I Total I •
New residential single or multi family dwelling unit.
procede one block to the end. Site is on the right. Includes attached garage.
Subdivision: N/A Lot no.: 5500 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 2S13DA-05500 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 7500 2
To supply electrical to new bathroom. One light, one or two duplex outlets residential (with above sq. ft.) - -
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Dennis and Dana Hurley 601 amps to 1,000 amps 301.04 2
Address: 13465 SW 107 Ave Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/ State/ZIP: Tigard, Or. 97223 relocation
Phone: (503)968.6659 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 40I amps to 599 amps 168.54 2
intended for sale, lease, rent, or ex c l • e Y, I's 1 g to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, Qer panel _
Owner signature: � `1" ! 4.4. aa✓ S ate: A. Fee for branch circuits with
❑ APPLICANT I ®C 0 ' ACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Paul Solonika and Sons LLC B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Robert Solonika branch circuit
Each add'l branch circuit 7.42 _ 2
Address: 4114 frazer Rd. SE Miscellaneous (service or feeder not included)
manufactured Each d
City/State/ZIP: Sublimity, OR 97385 dwelling, service and/or f eeder 67.84 2
Phone: (503) 930 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: dndhurley@frontier.com or ksolonika @hotmail.com Sign or outline lighting 67.84 2
CONTRACTOR 449 Signal circuit(s) or limited- energy
Business name: P • ul Solonika :.. Sons LLC panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: 4114 fraze ' d. ": / f '� (( /► Additional inspection (1 hr min) 66.25/ lie •
D (�l / Investigation (1 hr min) 66.25/ hr
City/ State/ZIP: Subli , OR 97385 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 931 • 97 Fax: ( ) Inspections for which no fee is 9000 / hr
specifically listed (fs hr min)
CCB Lic.: , , ' 100 Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature :/( This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: L —'emu /v / 5 u )2 it: Die' • Number of inspections allowed per permit.
l:\ Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(l1ro5/COM/WEB
Plumbing Permit Application .
Site Utilities RECEIVED
IN iv City of Tigard nae/B I e /2_ Permit No.: 9r 0 -000
13125 SW Hall Blvd., Tigard, OR 972A 2 0 2012 Plan R ev i ew
C Phone: 503.718.2439 Fax: 503.598.1960 . Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: mss: Ri See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I En I Total
® Addition/alteration/replacement ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13465 SW 107th Ave Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/ State/ZIP: Tigard, Or
Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: I Project name: Dormer expansion Manufactured home utilities 50.03
Cross street/directions to job site: Park St. & 107th Ave Manholes 18.76
Westward on Park St. off 99W to 107th Ave. Turn left onto 107th Ave, precede Rain drain connector 18.76
one block to the end. Site is on the right. Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: N/A I Lot no.: 5500 Fixture or item:
Tax map /parcel no.: 2S13DA -05500 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
To enlarge an existing dormer by 48 sq. ft. (6X8) Dishwasher 25.02
Work will require connecti to existing plumbing Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Dennis and Dana Hurley Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13465 SW 107 Ave
Garbage disposal 25.02
City/State/ZIP: Tigard, Or. 97223 Hose bib 25.02
Phone: (503)968-6659 Fax: ( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Paul Solonika and Sons LLC Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Robert Solonika
Roof drain (commercial) 12.51
Address: 4114 framer Rd. SE Sink/basin/lavatory 1 25.02 25.02
City/State/ZIP: Sublimity, OR 97385 Solar units (potable water) 62.54
Phone: (503) 930 -3597 l Fax:: ( ) Tub /shower /shower pan 1 12.51 12.51
E -mail: dndhurley@f'rontier.com or ksolonika@hotmail.com Urinal 25.02
CONTRACTOR Ili) Water closet 1 25.02 25.02
Water heater 37.52
Business name: ' Water p 1 in WV 56.29
Address: - Other. 25.02
City/ State/ZIP: Subtotal
Phone: (' )' Fax: ( ) M inimum permit f ee: $72.50
CCB Lic.: Plumbin ic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: Z TOTAL PERMIT FEE
Print name: .� N NA S N V 12 its c Date: / - ZO Z 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 Service Board.
1:\ Building \PermitAPLMU- PermitApp.doc 10/ 01/09 440- 4616T(10/02/COM/WF.B)
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 per mits.
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:
1 1 I ' 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.
1 or
TAP 1 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.
per." S
Print Name of Permit Applicant
/—? 0-/
ignature of Permit plicant / Date
Permit #: H a c (.g, 000/0
l?��Go5 w lay P►O
Address: S t r hd
Nl '
Issued Date: 047
This Copy for Permit Offices
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
13465 SW 107TH AVE, TIGARD, OR, 97223
Residential - Master Permit
280 Insulation
06/07/2013 00:00
MST2012-00010
PASS
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
13465 SW 107TH AVE, TIGARD, OR, 97223
Residential - Master Permit
615 Mechanical rough-in
02/21/2013 00:00
MST2012-00010
FAIL
80 cfm fan required with 5 inch flex to approved vent to the outside
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
13465 SW 107TH AVE, TIGARD, OR, 97223
Residential - Master Permit
280 Insulation
06/07/2013 00:00
MST2012-00010
PASS
Violation Summary:
Inspector Contractor