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Permit (48) CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00235 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2016 Parcel: 1 S 134CC03000 Jurisdiction: Tigard Site address: 11960 SW 122ND CT Subdivision: YE-OLDE WINDMILL Lot: 16 Project: Harris Project Description: Enclose entryway and add a 2nd story addition over garage. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 22 Bathrooms: 0 Second: 670 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total. 670 sf Value: $65,000.00 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 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 Fum<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: 3 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 Ecompasin Y Other: N Other Description: 9 BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R-3 670 Owner: Contractor: HARRIS,GABRIEL J&REBECCA A OWNER Required Items and Reports(Conditions) 11960 SW 122ND CT TIGARD,OR 97225 PHONE: PHONE. FAX Total Fees: $2,750.24 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin 23 .�87 or 1.800.332.2344. Issued B v y: ttee Signature: Call 503. by 7:00 a.m.for the next available inspection 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 Ci of Tigard ' Received s Permit No.: Hofer «'�35" �' g ( 2 2015 Date/By: �� 4 13125 SW Hall Blvd.,Tigard,01223 Plan Review 1 Phone: 503.718.2439 Fax: Date/By: / �t Other Permit: Inspection Line: 503.639Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or. TlVdPTIGARDLDING DIVISION Notified/Method: 0 Supplemental Information t 101 Newconstruction ❑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 work indicated on this application. 1-and 2-family dwelling Valuation: $ y g ❑Commercial/industrial ElAccessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: Total number of floors: Job site address: 60 V 11-401 CY New dwelling area: 6 70 square feet City/State/ZIP: V Z 3 Garage/carport area: square feet Suite/bldg./apt.no.:0 Project name: < < K Covered porch area square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet 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 work indicated on this application. Valuation: $ O VC__ fit Existing building area square feet New building area: square feet Number of stories: Name: rl,k 4 Type of construction: Address: 11160 -5a I22 rt Occupancy groups: City/State/ZIP: jrj 0 jy JAZ) Existin g: Phone:(5103) p/ •$ 351 I Fax:( ) New: ill Business name: r Structural plan review fee(or deposit): Contact name: a C�✓tY ��d� FLS plan review fee(if applicable): Address: Z GrG S L' Total fees due upon application: City/State/ZIP: K Of 9 70 7 �� Phone:4A) „ Z 6 Fax: :( ) Amount received: E-mail: 1 AA •PONL Commercial and residential prescriptive installation of roof-to mounted Photovoltaic Solar Panel System. Business name: Submit o(2)sets of roof plan with connec on details and fire de ent access,along wi a 2010 Oregon Address: Solar Installati tial C ecklist. City/State/ZIP: Permit Fee(inc lanreview $180.00 and mistr fees): Phone:( ) Fax:( ) States ge(12%of permit fee . $21.60 CCB lit.: Total fee due upon appication: $201.60 Authorized signature: X This permit application expires if a permit is not ob ained within 180 days after it has been accepted as complete. Z 2 S *Fee methodology set by Tri-County Building Industry Print name: Date: Service Board I:\Building\PermitsNBUP-RESPermitApp.doc 02/24/2011 4404613T(I1/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling City of Tigard Received Permit No.: r 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical ` Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITF—NISARE, REQ1110,A) FOR PLAN REVIEW es No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ 1 ❑ 3 Verification ofapprovedplat/lot. ❑ ❑ 1 ❑ 4 Fire district approval required. Name of district: ❑ ❑ I ❑ 5 Septic sstem permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be a licable to the project under review. 23 Three 3 site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑ 24 Two 2 sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. El ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ Cl including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9,1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 4404613T(11/02/COM/WEB) t ect!jcal Permit Application vi City oy"Tigard I S IfaIj 31%1, I, ate OR r13) ft ,1cr. r 7�t 7rt tSti A Q cir Q_ x8 1eh Oi t�ci, n1 l'S t ,f )7t'.ly fr7 c ,I b i S4;k 1- Tt f r O) 31:()Rfw y yA3 , PIAN REVIEW ti fF�k -----1 Pill Vltiil0 t'11C17C)fI na1L e)iu.ijiCt-:il�y I 1 7 I(:—eat n 4, Ill 111m apply i> i c t 2 ; __... (ofpplat e e.ru_..n dr-]ked l: Clth'1 1!F LJ Setc e' r t t.ra,:7 ( J C'ATECORY OF COAMCC ION i )r r: t3ed,sngn: three �-r-� d - ahcr anal ' f t _I*,-t.t atone, I L._.l t and d slim, [-1 bttiE.iln) I 7(I11J Mti t�rully ] tiii , fluslciu Oilia xndba.:w�.Yrs. . ,�._. .. ioa s1 r1 INFORMATION LAND ►O FII ......-......... Job 1t111 vitt tddrus" Przt po-"p' „ -... ..__..... ........ .._ 1.t.-lSl J....is(�1✓ _t om ._ (l_ 1 ❑ Ci 5 t v ltl' 14 q, Su it hld a,i V (' tJ et)ntu)c: '•- , I h,, „ tt Itdll.�� CYtlyR tl 11 Al( 41 9)1)i? t) t)l)`iitL K\1v n_ ec;tLot ^.UtH1r t C-11 �''( � Ltlrlt it w: L__JL1 A-,_ o,:_ - , .ase.s DESCRIPTION OF %�ORK _ 244a- El 1. 0", _ _ _�._. _ . . j p { '—� rRttfEitfl ��FR re'v4^�r � � ! FEE .. .. Ir _. ... i levt resfdanSal vrnf;lc of usafti-fanuil ehvcfirn aatret. C'itai5tr[t 7111 /./� 97 � [netudta atthchedgxrt t , i lax:( } aid'5u)c� ' a.a 1 4 t) Alil,rt { 'x ed� l __ i i ___ __. ..... ._. ... .... _- ._. ....__. to nrr sht a tt} �. I { i ! Owner titstxtiiataotr: Ihrs r 1�tall ttc, s h lr rt7adc c+:�rc;l��tty tlt�lt t t Si):i�hwt�f9 n�€ � 3 _ T.- _ nudt en. K u)tcndtdfol sale,Ica Its;.ura z!Azit?e Ovtner yi;❑tits,a l r lJ;uer - See Page Rellemable Film, l kPF i 1C.'s'+;_k_ i._._ ._t(3�2'ki 7 {T(A2 l _ t. 1 _ `stavnetior£cecicrssn Pt12ixnie alteration,antlorr la rnuri i.3u s I ti rtat s a arltp o. .:' Ci _._ 1 l7 i Contact nallir,: i 90 143 (,to 4{)(1 top. � i s r t p k rii)!)amp, ltcr ,ss: U: ❑fro i ts0 , t0Cw i { (At a 100 wnp,over xl f r t Temporary services or feederk ftaota)tatron,xfter;ftion, ` rend.or rrfoeatfnrs ------ _ _-- .__.._. _. . _-_ _ ul op,1 IN t ONA R:AC I OR - I .}-.�_-... Bti sin," rlac t e fir;trtch uTCUPS utw salte¢a[uwi_or ea�a ion icr 1 me i I. l . ._ v-.a i.rn,...) n„,t,)nd, , I C�tCt �t3t !Ill' Y-r_t1 r + — -- cadl br lira to h a rr treSr show rat r z FwA rd 1 brvrrch trust i 2 T .. - __ l 1 ftevitlfrntslns(service c,r t"det not atrfudetll 1 CCB Lt,;.: l ,eLiitc tl!-W': ytllt V i I n t ,tl, t rvs or me, r , 11 x 11io t,v, s i�r Suprt,an�rtar rtrl�ti otita.t. .ltt..ee: - -- r - .e y �, ` Date: Y � ft.np rirtt,11t rcr ,: { G'`i4 7� "Tral nus test t 1, of-.d- i � j I r t)t I r i Irfr ttilreSIT page _- a.}r .neL al_ :11 1t,or 2 e XSs(ISl6)[ Prim name: � D itc ----------- tach rdditionxl_ inm!� Itroci 41-(v ablc_inarru'—afthe drove ;`.iinirL 7.fu Mit!( arm.i:•i C 4.: Tttt,C` d:,!3%rl` ,-. z-1a '+i'i( n,.;�U,Oi;t§'qe Mechanical Permit Application + City of Tigard C I�E� lRe ate/By: 1/l /157 Permit No. DO 3 13125 SW Hall Blvd.,Ti �a Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Dale/By: Mspection Line: 503.639.4175Dr f` 2 2015 Date Ready/By: luris: ® See Page 2 for Internet: www.tigard-or.gov Cl• Notified/Method: Supplemental lnformation OF TIGARD .. , 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 mo De 0 liti n F1 Other: mechanical materials,equipment,labor,overhead,and profit. N y":„ �� Value N P14IE1N I i iSYlSM T1 *r t 1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total 5 x Heating/cooling: d a �SRhikI16N AM LOCATION r Air conditioning 46.75 O Job site address: lr S(✓ 22 Ct Furnace 100,000 BTU(ductsvents) 46.75 City/State/ZIP: '/%' Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no, Project name: Heat urnp 61.06 Maf J r w Duct work 23.32 Cross street/directions to job site: H dronic hot waters stem 23.32 Residential boiler(radiator or h dronic) 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 DESORIPTION OF:WORK . Gas fireplace/insert 33.39 Flue vent for water heater or gas r Pfe le AVV fireplace 23.32 611 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PItOPERTX'OWNER © NANT. Other: 23.32 Environmental exhaust and ventilation: Name: err. Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawls ace fans 23.32 APPLICANT i iCONTr} Q1�1 Other: 23.32 Fuelpiping: Business name: $14.15 for first four;$4.03 for each additional Contact name: �j ` Furnace,etc. Address: , S C Gas heat um Wall/suspended/unit heater City/State/ZIP: Water heater Phone:(C�'��) _ Fax: :( ) Fireplace Range E-mail: Barbecue 1 ONTRCrb 3$ '" ; Clothes dryer(gas) ; .. Business name: Other: Address: Subtotal City/State/ZIP: Minimum permit fee(590.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board Print name: Na'aI ti;r-ok Date: 1:.Building,Permits,MEC_PermitApp 040113.doc 440-4117T(1;,02 COM WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-FamilyFee Schedule: .. $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:\Bui IdingTermitsW EC_PennitApp_040113.doc 2 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the ConStrUCtiCn 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 permits. 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: I own, reside in, or,w ill reside in the completed structure and my general contractor is: ........... Name CCB# Expiration Date I wiJ into,m my general contractor that a 11 subcontractors who work on the structure must be licensed with the Construction Contractors Board. 0' -; �� Wl I be l I performing work on property I own,a residence that I reside in, or a residence that I will 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 I., 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 hom towner statement is true and accurate. A" Print Name ^PerrnitAppl-ant atU� Date re Address: '�w 7-1 -------1�7? Issued by: Date: .......... ........... This Copy tor Permit Offices City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT r ■1,111 Request for Permit Action -1 ;c;A k I-) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractorin' Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) (ba be her,`;d Mailing Address: //960 aid /.12.01/141 City/State/Zip: 7--i, v� CPC q 7d-d--.7v � _ Phone No.: C93,)V6 - _5- ITEM(S)TAKE ACTION FOR THE EM(S) CHECKED (1): • G 1 EL/VOID PERMIT APPLICATION. rl REFUN PERMIT FEES (attach copy of original receipt and provide explanation below). • , i : FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: /`7—S Tap/s' — Oo a 3-S- Site Address or Parcel #: /7 60 .Sem 0.,)__. Gy. ---7- 4 �u� �7�-3 Subdivision Name: �"`— Lot #:EXPLANATION: ('3) , 3r,,c.J2._ S CATer t- i jvad veir- 7-( wkeAI CA 1C LW, CaOW 1'11\ lAla e r1fv',;Ca, ,ferri.i* ON 3,?3 a0_ Signature: Date: 3/„V/t,a Print Name: earvlp.�l ��� . Refund Policy 1. I'he city's Community Development Director,Building(>fticial or City I ingineer may authorize the refund of: • .Any fee which was erroneously paid or collected. • Not more than 80"'0 of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80"0 of the application or permit fee for issued permits poor 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. Route to Sys Admin: _ Date 3 , f By i " Route to Records: Date y" i3 /6 Bye Refund Processed: Date //A, By r Invoice Processed: Date By Permit Canceled: Date NM- B 16/ rcel Tag Added: Date By 1:A Building\Dorrno\ReII'errniii\ciion (192314.doe = a 11111 TIGARD City of Tigard April 13, 2016 Gabe Harris 11960 SW 122nd Ct Tigard, OR 97223 Re: Permit No. MST2015-00235 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: 11960 SW 122nd Ct Project Name: Harris Job No.: N/A Refund: ® Check#220657 in the amount of$137.83. ❑ Credit card"return" receipt in the amount of$ . ❑ Trust account"deposit"receipt in the amount of$ . Notes: Refund overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Al( -29vi"C---- Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefunA riaol\ e va-07:r T aB4,19oregon 97223 • 503.639.4171 TTY Relay: 50.684.2772 • www.tigard-or.gov 111,1 City of Tigard TIGARD Accela Refund Request e 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: Gabe Harris DATE: 3/31/2016 11960 SW 122nd Ct Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 401827 Case#: MST2015-00235 Date: 2/2/2016 Address/Parcel: 11960 SW 122nd Ct Pay Method: CreditCard Project Name: Harris EXPLANATION: Refund overpayment of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. ; - Refund Example: Building Permit Fee Example:: 2300000-43104 $Amount Cash Over 100-0000-48001 $137.83 TOTAL REFUND: $137.83 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff / If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTE ADMINISTRATION USE ONLY Case Refund Processed: Date: 1//.3`/47 By: A I:\Buildinl,\Refunds\RefundReyuestdoc x 09/01/2010 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11960 SW 122ND CT, TIGARD, OR, 97223 August 14, 2017 at 9:21 :52 AM Record Type: Record ID: Residential - Master Permit MST2015-00235 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Provide gfci outlet at front porch. 406.8 Provide box extensions and missing faceplates at back garage walls. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11960 SW 122ND CT, TIGARD, OR, 97223 December 5, 2017 at 9:38:00 AM Record Type: Record ID: Residential - Master Permit MST2015-00235 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - NoCofO Comments: Corrections complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11960 SW 122ND CT, TIGARD, OR, 97223 December 5, 2017 at 9:37:08 AM Record Type: Record ID: Residential - Master Permit MST2015-00235 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Corrections complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11960 SW 122ND CT, TIGARD, OR, 97223 December 5, 2017 at 9:36:12 AM Record Type: Record ID: Residential - Master Permit MST2015-00235 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Correction complete. Violation Summary: Inspector Contractor