Permit CITY OF TIGARD MASTER PERMIT
II s : COMMUNITY DEVELOPMENT Permit #: MST2012 -00308
T1GARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S 102C D03400
Jurisdiction: Tigard
Site address: 13840 SW 100TH AVE
Subdivision: SHILO Lot: 3
Project: Gilliand
Project Description: Repair damaged residential wall and foundation
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: $0.00 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'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 & 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:
GILLILAND, WAYNE G & DIEDRA J SERVPRO OF HILLSBORO FOREST GROVE Required Items and Reports (Conditions)
13840 SW 100TH AVE PO BOX 1786
TIGARD, OR 97223 HILLSBORO, OR 97005
PHONE: PHONE: 503- 648 -8513
FAX:
Total Fees: $97.79
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 wit
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 Notificatio Center. Those rules are set forth in OAR
952- 001 -0010 through O - 52 - 001 - e 90. You may obtain a copy of the rules or direct questions to OUNC by calling 5' .232.1987 or 1.800.332.2344.
Issued By: A/144 ■/ votes- Permittee Signature: (/
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
Thls permit card shall be kept In a conspicuous place on the job site until c • pletion of the project.
Approved plans are required on the job site at the time of ea Inspection.
Building Permit Application RECEIVE p
Residential 1 (112()I 1 1(1 1' ON1.1
City of Tigard DEC 1 8 2012 Received ( �g 0 5' Permit N, . S 7 3o0. —OD30:
II I • 13125 SW Hall Blvd., Tigard, OR 97223 � Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARD Date/B : Other Permit:
1 I t - A it n Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: k r /. ® See Page 2 for
Internet: www.tigard or.gov Notified/Metho I l ( Supplemental Information
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: DAi'*14Lc izerA.t 4. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
and 2- family dwelling ❑ Commercial/industrial Valuation $ .3
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 3 8 40 S w l 8 a 1. k • New dwelling area: square feet
City /State /ZIP: 11 1. Z. 3 Garage /carport area: square feet
e
Suite/bldg. /apt. no.: Project name: N ettl dl p Covered porch area: square feet
Cross street/directions to job site: 6, / ( C.,( K 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
Z. 5 ��'2.. 0 3 �e equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
1eIp Art a. 'DIPtrnR D R-% S i O4ik r /t't_. (J!}u.
Awl) p . It � Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: ' 3 z 4 C to t eel 11 14,6E_ Occupancy groups:
City/State /ZIP: 11 C t4 1 6 Q. Q A2 L S Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT 'CONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
� Pu LAP Structural plan review fee (or deposit):
Contact name: („ f } Q...1.5 N eS" 1.E. Q,QO
FLS plan review fee (if applicable):
Address: L B 5 0 510 CE iltQ 14 l US $l.J A l STE f O (c,
City/State /ZIP: IS V E > a CI S
Amount received: C` - 7, 7?
Total fees due upon application:
Phone: ($U3) 3 4,1 to Sl Fax: : ( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E - mail: C. !N U 105 t 4 N S € (.0 t o.' 1 S ms t.
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: SS a0 ? Zip D F At Id.SB6Rv <Awe_ Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: ? .0 . (Si-. t , b Solar Installation Specialty Code checklist.
City /State /ZIP: N tL,L5sasRG 012, 5 I tZ. 3 Permit Fee (includes plan review $180.00
and administrative fees):
Phone: (' o ) ( d i► S (S Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: ' (o 1 55, f ? ' )
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �—w Date: * Fee methodology set by Tri-County Building Industry
"ems 0.4 I4..` Dfe.�) tip ti ( LO I t Service Board.
I: \ Building \Permits\BUP- RESPennitApp.doc 02/ 24/2011 440- 4613T(11/02 /COM/WEB)
CITY OF TIGARD MASTER PERMIT
II s : COMMUNITY DEVELOPMENT Permit #: MST2012 -00308
T1GARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S 102C D03400
Jurisdiction: Tigard
Site address: 13840 SW 100TH AVE
Subdivision: SHILO Lot: 3
Project: Gilliand
Project Description: Repair damaged residential wall and foundation
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: $0.00 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'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 & 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:
GILLILAND, WAYNE G & DIEDRA J SERVPRO OF HILLSBORO FOREST GROVE Required Items and Reports (Conditions)
13840 SW 100TH AVE PO BOX 1786
TIGARD, OR 97223 HILLSBORO, OR 97005
PHONE: PHONE: 503- 648 -8513
FAX:
Total Fees: $97.79
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 wit
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 Notificatio Center. Those rules are set forth in OAR
952- 001 -0010 through O - 52 - 001 - e 90. You may obtain a copy of the rules or direct questions to OUNC by calling 5' .232.1987 or 1.800.332.2344.
Issued By: A/144 ■/ votes- Permittee Signature: (/
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
Thls permit card shall be kept In a conspicuous place on the job site until c • pletion of the project.
Approved plans are required on the job site at the time of ea Inspection.
CITY OF TIGARD MASTER PERMIT
II s : COMMUNITY DEVELOPMENT Permit #: MST2012 -00308
T1GARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S 102C D03400
Jurisdiction: Tigard
Site address: 13840 SW 100TH AVE
Subdivision: SHILO Lot: 3
Project: Gilliand
Project Description: Repair damaged residential wall and foundation
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: $0.00 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'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 & 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:
GILLILAND, WAYNE G & DIEDRA J SERVPRO OF HILLSBORO FOREST GROVE Required Items and Reports (Conditions)
13840 SW 100TH AVE PO BOX 1786
TIGARD, OR 97223 HILLSBORO, OR 97005
PHONE: PHONE: 503- 648 -8513
FAX:
Total Fees: $97.79
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 wit
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 Notificatio Center. Those rules are set forth in OAR
952- 001 -0010 through O - 52 - 001 - e 90. You may obtain a copy of the rules or direct questions to OUNC by calling 5' .232.1987 or 1.800.332.2344.
Issued By: A/144 ■/ votes- Permittee Signature: (/
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
Thls permit card shall be kept In a conspicuous place on the job site until c • pletion of the project.
Approved plans are required on the job site at the time of ea Inspection.