Permit (174) CITY OF TIGARD
MASTER PERMIT
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COMMUNITY DEVELOPMENT Permit#: MST2016-00011
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2016
Parcel: 1 S133DD12900
Jurisdiction: Tigard
Site address: 11849 SW 126TH PL
Subdivision: VILLAGE AT SUMMER LAKE PARK NOA Lot: 166
Project: Coursolle
Project Description: Fire damage repair. Repairing garage side wall and roof structure.
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. Yes
Total: 0 sf Value: $14,500.00 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
0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 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 VB R-3 0
Owner: Contractor:
COURSOLLE,JEREMY M&NANCY B CORNERSTONE DISASTER REPAIR Required Items and Reports(Conditions)
11849 SW 126TH PL 5331 SW MACADAM AVE SUITE 377
TIGARD,OR 97223 PORTLAND,OR 97239
PHONE: PHONE: 503-295-0108
FAX: 503-295-1896
Total Fees: $543.77
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialt od s and all oth r ap 'cable 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 susp ded f m the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi ation Center. Thos rules are s fort in OAR
952-001-0010 through OAR 952-001- 90. ou may obtain a copy of the rules or direct questions to OUNC by calling 03.232.1987 or 1.800. 32.
Issued By: Permittee Signature:
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 completi the project.
Approved plans are required on the job site at the time of each inspection.
Buildiniz Permit Application
Residential
y .
` Received
City of Tigard o1U Date/B l ho
Permit No.:13125 SW Hall Blvd.,Tigard,OR 97223 Plan ReviePhone: 503.718.2439 Fax: 503.598.1960 �1 DateB : Other Permit: �LC.�77
Inspection Line: 503.639.4175 '���� ate Ready/By: Juris ® See PagInternet: www-tigard-or.gov A\N0* IV' otified/Method: � ��0 Supplemen
TYPE OF WO REQUIRED DATA:1-AND 2-FAMILY DWELLING
Permit fees*are based on the value of the work performed.
❑New construction ❑Demolition Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ®Other:Fire Repair 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: $14,500.00
❑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:11849 SW 126`h Place New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: (�(,L 12, (,(� 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Repair garage side wall and roof structure as a result of a fire.Repair with Valuation: $
like materials to match original structure. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Jerry and Nancy Coursolle Type of construction:
Address: 11849 SW 126`h Place Occupancy groups:
City/State/ZIP:Tigard,Oregon 97223 Existing:
Phone:(503)951-7612 Fax:( ) New:
® APPLICANT I� CONTACT PERSON BUILDING PERMIT FEES*
J14
Business name:Benthin Design' om epe
Structural plan review fee(or deposit):
Contact name:Scott Benthin
FLS plan review fee(if applicable):
Address: PO Box 42
Total fees due upon application:
City/State/ZIP:Beavercreek,Oregon 97004
Phone:(503)632-2862 Fax: :( ) Amount received:
E-mail:scott(a-,)bendg.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Cornerstone Disaster Repair Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:5331 SW Macadam Avenue-Suite#377 Solar Installation Specialty Code checklist.
City/State/ZIP:Portland,Oregon 97239 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)295-0108 F )
State surcharge(12%of permit fee): $21.60
CCB fie.: 159758 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:Scott Benthin Date: 1-27-2016 *Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
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
11849 SW 126TH PL, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2016-00011
David Young
Violation Summary:
Inspector Contractor