Permit (52) INCITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2016-00376
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 10/13/2016
T[4 . :t.L 9
Parcel: 1 S 133C D 13500
Jurisdiction: Tigard
Site address: 11840 SW TALLWOOD DR
Subdivision: PEBBLECREEK NO.2 Lot: 26
Project: CIBULA
Project Description: Voluntary repair of existing foundation using helical piles.
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
DwellingUnits: 0 No
Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $18,240.00 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
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.'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:
CIBULA,PETER ROBERT JR&STEPHA RAMJACK OF SOUTHERN OREGON LLC Required Items and Reports(Conditions)
11840 SW TALLWOOD DR PO BOX 11701 1 Special inspection
TIGARD,OR 97223 EUGENE,OR 97440 required...Pilings,Drilled
PHONE: PHONE: 541-501-8940
FAX:
Total Fees: $651.96
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 w rk is suspended for more the 180
days. ATT ,--0 : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center ose rules ar- set forth in OAR
952-00 '"11010 throug OAR• -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 7 1.800
Issued f # _,
/C
d Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspectio 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.
BuildingPermit Application
Residential
FOR OFFICE USE OWN
City of TigardCI
1 k°`" Received
III ug 13125 SW Hall Blvd.,Tigard,OR IP a Date/B : ..qt
lam. Permit No.: v T�� .,,, -. -
i. Plan Review —
Phone: 503.718.2439 Fax: 503. '60
T I G A R D Inspection Line: 503.639.4175 rt �� b Date/B : Other Permit:
Date Ready/By: I� H See Page 2 for
Internet: www.tigard-or.gov �� tiu Notified/Method: (tr' Supplemental Information
Otha
TYPE OF
V
,1lG®,V,`�`�� /*`Ldl eT REQUIRED DATA:1-AND 2-FAMILY DWELLI
NG
0 New construction Demolition Permit fees*are based on the value of the work performed.
Addition/alteration/re lacement Indicate the value(rounded to the nearest dollar)of all
P ®Other:Foundation equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $18,240
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11840 SW Tallwood Dr New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223
Garage/carport ag arport area: square feet
Suite/bldg./apt.no.: I Project name: t` ,‘lit 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: I 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.
voluntary repair of existing foundation using helical piles Valuation: $
Existing building area: square feet
New building area: square feet
14 PROPERTY OWNER I 0 TENANT Number of stories:
Name:Stephanie and Pete Cibula
Type of construction:
Address: 11840 SW Tallwood Dr.
Occupancy groups:
City/State/ZIP:Tigard,OR 97223
Existing:
Phone:(503)781.2028 Fax:( )
New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:RamJack West
(Please refer rofeeschedute)
Contact name:Curt Klein Structural plan review fee(or deposit):
Address:PO Box 11701 FLS plan review fee(if applicable):
City/State/ZIP:Eugene,OR 97440 Total fees due upon application: ,.357-7 s
Phone:(503)278.5570 I Fax::( ) Amount received:
E-mail:curt@ramjackor.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name:RamJack West Submit two(2)sets of roof plan with connection details
Address:PO Box 11701 and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP:Eugene,OR 97440 Permit Fee(includes plan review
Phone:(541)393.8151 Fax:( )
- and administrative fees): $180.00
State surcharge(12%of permit fee): $21.60
CCB lic.: 146906
Total fee due upon application: $201.60
Authorized signature: - °
7 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Curt Klein I Date:9/26/16 I *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-13ESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)