Permit 1 ! Ili CITY OF TIGARD MASTER PERMIT
11 I ' COMMUNITY DEVELOPMENT Permit#: MST2015-00175
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2015
Parcel: 2S104AA04300
Jurisdiction: Tigard
Site address: 12320 SW 127TH AVE
Subdivision: BELLWOOD Lot: 23
Project: Bonnono
Project Description: Interior remodel: kitchen, master bath, hall bath, new flooring throughout.
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: Yes
Total: 0 sf Value: $20,000.00 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
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 1 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
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
BONNONO.DENNIS ROBERT AND SQUARE DEAL REMODELING CO INC Required Items and Reports(Conditions)
CAROL LYN 8603 SE STARK ST
12320 SW 127TH PORTLAND,OR 97216
TIGARD,OR 97223
PHONE: 503-590-5509 PHONE: 503-254-4156
FAX: 503-254-4206
Total Fees: $790.64
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 i• - •r•ance • 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. •TTENTION: Oregon - re. ' s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 -001-0010 t ough OAR 952-00 *090. o may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1 7 or 1.800.332.2344. f
ssued By: . 41' , /A ^ •1 ,1 Permittee Signature: K kt`5 N'•
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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
ANCity of Tigard ECE!VE El DaRecte e/iBveyd: /O s /s Permit No.: ✓ 0O!5-60 1 7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i r .y+
S Phone: 503.718.2439 Fax: 503.598.1960 Date/By: !O I S J P, J 3j Other Permit:
T 1 C;1 R D Inspection Line: 503.639.4175 OCT T 5 2015 Date Ready/By: 4!/r Juris: See Page 2 for
Internet: www.tigard-or.gov l 7 Notified/Method:q�0/,4s Supplemental Information
TYPE 0 WORK Utz 1R A`NI) REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ' � N PI V I�111 Il' 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.
® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $20000
❑Accessory building ❑Multi-family Number of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms: 2
a 3 a-e) JOB SITE INFORMATION AND LOCATION Total number of floors: 1
Job site address: 3.30-SW 127th Ave New dwelling area: 0 square feet
City/State/ZIP:Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Bonnono Covered porch area: square feet
Cross street/directions to job site: 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
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Interior remodel,new kitchen,master bath,hall bath,new flooring throughout, Valuation: $
dry rot repair at floor Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Dennis&Carol Bonnono Type of construction:
Address 27. SW 127a'Ave Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing:
Phone:(503)590-5509 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:Square Deal Remodeling (Please refer to fee schedule)
-- Structural plan review fee(or deposit):
Contact name:Chris Kreipe •
FLS plan review fee(if applicable):
Address:8603 SE Stark St.
City/State/ZIP:Portland OR 97216 Total fees due upon application: ��//
Phone:(503)254-4156 Fax::(503)254-4206 Amount received t��' �j�.��
E-mail:chrisk @squaredealremodel.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Square Deal Remodeling Submit two • sets of roof plan with connection d- :ils
and fire depart - t access,along with t 1- ■ I Oregon
Address:8603 SE Stark St Solar Installation :•cialty Co.• ecklist.
City/State/ZIP:Portland OR 97216 Permit Fee(inc I.: plan review $180.00
adminis - 've fees):
Phone:(503)254-4156 Fax:(503)254-4206 Stat- urcharge(12%of permi -- : $21.60
CCB lic.:79188 Total fee due upon application: $201.60
Authorized signature Ci.*(9i/�--V// . _C e This permit application expires if a permit is n obtained
D within 180 days after it has been accepted as complete.
Print name:Chris Kreipe t Date: 10-5-2015 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-461 3T(I 1/02/COM/W EB)
nical Permit A, 11ic.,' ji 1 FOR OFFICE USE ONLY
City of Tigard VIE/ Received ��Date/By: rQ Y r Permit No.:H W5-Z /7e
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' Phone: 503.718.2439 Fax: 503.598Ot67 Date/By: Other Permit:
T 1 A R n Inspection Line: 503.639.4175 r n Date Ready/By: Juris: Ea See Page 2 for
Internet: www.tigard-or.gov tin Notified/Method: Supplemental Information
Ellie TYP E.Vi1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
+Q�fn.' Mechanical permit fees*are based on the value of the work
❑New construction ® Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$5,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I-and 2-tastily dwelling ❑Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total
1 2.?j9.o JOB SITE INFORMATION AND LOCATION Heating/cooling:
127th Air conditioning 46.75
Job site address: 1 0 SW 127 Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 1 23.32 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other': 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Install/duct(2)new bath fans,(1)kitchen hood,move heat register 3' fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Oth
® PROPERTY OWNER ❑ TENANTS' 23.32
Environmental exhaust and ventilation:
Name:Dennis&Carol Bonnono Range hood/other kitchen
v0 equipment 1 33.39 33.39
Address:�731fSW 127 t5 Ave Clothes dryer exhaust 33.39
City/State/ZIP:Portland OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 2 23.32 46.64
Phone:(503)590-5509 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Square Deal Remodeling
' Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Chris Kreipe Furnace,etc.
Address:8603 SE Stark St Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland OR 97216 Water heater
Phone:(503-)254-4156 Fax::(502)254-4206 Fireplace
Range
E-mail:chrisk @squaredealremodel.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Square Deal Remodeling Other:
MECHANICAL PERMIT FEES*
Address:8603 SE Stark St Subtotal 103.35
City/State/ZIP:Portland OR 97216 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)254-4156 Fax:(503)254-4206 State surcharge(12%of permit fee)
CCB lie.:79188 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Q days after it has been accepted as complete.
Authorized signature:X � < C x/ * Fee methodology set by Tri-County Building Industry Service Board
Print name:Chris Kreipe v v` J Date: 10-5-2015
1:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
From: 10/22/2015 14:21 #518 P.001/001
RECE/V
OCT ��
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT s 2015
BUIL p/GF TIGARD
Request for Permit Action NG
DIV/SIGN
.I.1 6 A E I) 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.iigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPennits @tigard-or.gov
FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: L( 1)/( k.(
INVOICE TO: (Business or Individual)) Jvj(j , G f y Y100 CI I Y1 et
Mailing Address: 8603 S
City/State/Zip: fa-( V3.d
Phone No.: 50 3 _- Z - 'J ( 5 6
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (1):
/ ❑ C s --- OID PERMIT APPLICATION.
0:174 REFUN D P ' RMIT FEES (attach copy of original receipt and provide explanation below).
NVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: f\fl 5 T 20 i S -- 00 t 7-Ss
Site Address or Parcel#: t Z-3 Z 1;7 `j (,J t 7 Ave
Project Name: :V.011.4 clYl-p
Subdivision Name: Lot#:
EXPLANATION: ilGl`d e 4 j t4 4rr i i vr3l"e_ dc) i v r-z2 39 s;..t- vi.1 u cz f l cv1 4,5
A..;kl,,-1 re,,rwttt t:1Qrtt'c.tt4i'cnn • i4c.-vciI V�(v h 171 �S
4.„10 SOY- +e, S A,. V�
•
Signature: (oi t�--�vet Date: Q — Z Z - Zv t S
Print Name: r r[� %-e
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fcc when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFI:ICI.. I SE 0\I.1
Route to S s Admin: nazzgAiscw,z Route to Records: UMW 9 B -
Refund Processed: Date /t'jf M B• i' Invoice Processed: Date
Permit Canceled: Date A/Aall B Parcel Tal Added: Date HIM
I:\Building\Forms\RegPermitAction_092314.doc
41,11:G ARVA
City of Tigard
November 19, 2015
Square Deal Remodeling
Attn: Chris Kreipe
8603 SE Stark St.
Portland, OR 97216
Re: Permit No. MST2015-00175
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 12320 SW 127th Ave.
Project Name: Bonnono
Job No.: N/A
Refund: ® Check#219259 in the amount of$403.83.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Reduction in project valuation resulted in decrease in permit fees due;refund the
difference.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
113125.SW.I allR lv�• Ti g,�Q gon 97223 • 503.639.4171
I.\Building\Refun s i rr irutiq uon tr e n - verp y.
TTY Relay: 503.684.2772 • www.tigard-or.gov
• City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Square Deal Remodeling DATE: 11/06/2015
Attn: Chris Kreipe
8603 SE Stark St REQUESTED BY: Dianna Howse
Portland, OR 97216 AD
TRANSACTION INFORMATION:
Receipt#: 202863/400116 Case#: MST2015-00175
Date: 10/05/2013 & 10/14/2015 Address/Parcel: 12320 SW 127th Ave.
Pay Method: CreditCard Project Name: Bonnono
EXPLANATION: Reduction in project valuation from $20,000 to $3,000 resulted in reduction in permit
fees. Refund 100°ro of difference.
rk7
.:.REFUNDINFORt�IATION:. - -
Fee D _
':Re fund'=
'Exiii i151.
e�.�Buildiri�Perriit`Fe' �E�` �1'e
P g e;'`< - - -" ...... . ..... ": amp
Building Permit Fee 230-0000-43104 $228.13
Plan Review Fee 230-0000-43106 148.30
12% State Surcharge 100-0000-24001 27.38
TOTAL REFUND: $403.83
APPROVALS: SIGNATURES DATE:
If under$3,000 Professional Staff
"lam _L ham/
If under$12,500 Division Manager
If under$23,500 Department Manager
If under$30,000 City Manager
If over$30,000 Local Contract Review Board
TIDEMARK-SYSTEM ADMINISTRATION_USE'O_NLY' -``==`_ c,f;: `-'
Case Refund Processed: Date: //// 9/, By:
I:\Building\Refunds\ReFundRequest.doc x 09/01/2010
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12320 SW 127TH AVE, TIGARD, OR, 97223
Residential - Master Permit
699 Mechanical final
PASS
MST2015-00175
David Young
New permitted mechanical ok.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12320 SW 127TH AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2015-00175
David Young
Violation Summary:
Inspector Contractor