Permit 1111 y q CITY OF TIGARD MASTER PERMIT
I ' COMMUNITY DEVELOPMENT Permit#: MST201500074
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/27/2015
Parcel: 25111 CA05600
Jurisdiction: Tigard
Site address: 9440 SW LAKESIDE DR
Subdivision: SUMMERFIELD NO.12 Lot: 676
Project: Gran
Project Description: Enlarge main floor bathroom by moving wall between bathroom and bedroom. Mechanical,
electrical and plumbing permits to be submitted separately.
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: $38,000.00 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: 0 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 ervice 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 8,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:
GRAN,CATHERINE M DALINE CONSTRUCTION Required Items and Reports(Conditions)
GRAN,MARIE A 14635 SW 106TH AVE
115 SAINT ALBANS RD TIGARD,OR 97224
KENSINGTON,CA 94708
PHONE: 503-530-8234 PHONE: 503-730-5983
FAX: 503-718-7562
Total Fees: $1,059.07
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. • • •. •egon law requires you to follow the rules adopted by the Oregon Utility Noti' - '•n Center. Those rules are set forth in OAR
952-0' -0010 through OA'.' ! 001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 03.•s: 1.87 or 1.800.332.2344.
Issu d By: �_ �∎JI i` � Permittee Signature: \\\\
_� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. v
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 RECEIVED
Residential FOR OFFICE USE 0\I 1
City of Tigard MAY 14 2015 yd. /y ,eS -- - Permit No. ��/J D407y
• 13125 SW Hall Blvd.,Tigard,OR 97223 ���5" •_ "�`"
= Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TI(�ARC l�ate/By: ' t Other Permit:
t�i. `h i� Inspection Line:g 03.63 8.4175 BUILDING DI VIS" to Rea etZ 6 �(� .//6t S Pagel for
Internet: www.tl ardor, ov ohfied/Method: /Q�7� Su meotsl laformafion
Lr) ,i7—)f}7/ -
TYPE OF WORK ' Print name:
❑New construction ❑Demolition REQUIRED DATA:1-AND 2-FAMILY DWELLING
®Addition/alteration/replacement ❑Other: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION equipment,materials,labor,overhead,and the profit for the
1-and 2-family dwelling work indicated on this application.
® y g ❑Commercial/industrial
❑Accessory building ❑Multi-family Valuation: $38000 (/'
❑Master builder ❑Other: Number of bedrooms:
JOB SITE INFORMATION AND LOCATION Number of bathrooms:
Job site address:9440 SW LAKESIDE DRIVE Total number of floors:
City/State/ZIP:TIGARD,OR.97224 New dwelling area: square feet
Suite/bldg./apt.no.: Project name:MASTER BATH REMODEL Garage/carport area: square feet
Cross street/directions to job site:98TH AVE. Covered porch area: square feet
Deck area: square feet
Other structure area: square feet
Subdivision: _ Lot no.: REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Tax map/parcel no.: Permit fees'are based on the value of the work performed.
DESCRIPTION OF WORK Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
Enlarge main floor bath (/0//C /09-44 4 i=ce / Tf/, �/ ejv) work indicated on this application.
/°L/r1/ Et: /1EC , / k!, TD , /ot cz-e-6D Valuation: $
q'7L/ (6-7-- /9--/efL /et/T, jC Existing building area: square feet
❑ PROPERTY OWNER ❑ TENANT New building area: square feet
Name: 31-rt/ere Iki c 6/2 Number of stories:
Address: 9qaG 5A) (j //„5e jig. Type of construction:
City/State/ZIP: fl of I C c/l q 7 c s Occupancy groups:
Phone:1j(/ -) '30, S2 3 e Fax:( 1 ) Existing:
® APPLICANT ❑ CONTACT PERSON
New:
Business name:DALINE CONSTRUCTION BUILDING PERMIT FEES*
Contact name:DAVE (Please refer to fee schedule)
Address: 14635 SW 106th Ave. Structural plan review fee(or deposit): 3 4. /9
FLS plan review fee(if applicable):
City/State/ZIP:Tigard,OR.97224
Total fees due upon application:
Phone:(503)7305983 Fax::( ) Amount received: 34,13, /9
E-mail:dave@daline.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
Business name:Daline Construction ✓ roof-top mounted PhotoVoltaic Solar Panel System.
Address:14635 SW 106"Ave. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
City/State/ZIP:Tigard,Oregon.97224 Solar Installation Specialty Code checklist.
Permit Fee(includes plan review $1 80.00
Phone:(503)7305983 r 1(p Fax:(503)7187562 and administrative fees):
' fr� Hv V State surcharge 12%oee
CCB lic.:184319 10 � f permit fee):� )' $21.60
Total fee due upon application: $201.60
Authorized signs
qt4\ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
(:\Building\Permits 1BUP-R Permi p doe 02/24/2011 440-46131(Il/02/COM/WEB)