Permit (23) III CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2021-00211
T I(IA :.I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/22/2021
Parcel: 2S110DD14000
Jurisdiction: Tigard
Site address: 10650 SW SUMMERFIELD DR
Project: Summerfield Club House Subdivision: SUMMERFIELD Lot: B
Project Description: Remove and replace 4'x 4'section of concrete for multiple mail boxes.
Contractor: JON EDWARD ERICKSON Owner: SUMMERFIELD CIVIC ASSOCIATION
15280 SW 94TH AVE 10650 SW SUMMERFIELD DR
TIGARD,OR 97224 TIGARD, OR 97224
PHONE: 503-730-9220 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VA Permit Fee-Additions,Alterations, 09/19/2021 $73.61
Occupancy Grp: R-3 Occupancy Load: 0 Demolition
12%State Surcharge-Building 09/19/2021 $8.83
Dwelling Units: 0
Plan Review 09/08/2021 $47.85
Stories: 0 Height: 0 ft
Info Process/Archiving-Sm$0.50(up to 09/19/2021 $1.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $1,100
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $131.29
•
Required: Required Items and Reports(Conditions)
1 Special Inspection(see plans)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale 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 calling 503.232.1987 or 1.800.332.2344.
Issued By: Ho-U.y Va.i,DL Weg& Permittee Signature: Om,ApptitApti,crm
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 Applicatio V
Commercial
nECEI`lE imimmoillimiliiii QI i 12
City of Tigard SEP 1 107. Dete/BYd ` 45)Z/ • C,, Permit
NISI e 2c-i —C)C z,2 II
111 " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi
Phone: 503-718-2439 Fax: 503-598-196Q;ITY OF TIGARD Date/By: 1 - J6•'1) it Related Permit
Inapeetion Line: 503-639a175 3UILDINGDIVISION R :, e !% S Page 2for
. TIGARO ..Sopplemeafal Information
Internet: www.tigard-or.gov i
TYPE OF WORK TIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 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 TZI Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling 1C Commerciallindustrial
0 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: /O(j,�(.' .5l.. )rr f/IYTt;k p/Et I, J)R . New dwelling area: square feet
City/State/ZIP: 7( C 4 R t) OR /g 7 i-i 4L Garage/carport area: square feet
Suite/bldg./apt.#: ['Project name: rtr ULl r Pt.6. IV1/11/-&9AG.5 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#: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK
work indicated on this application.
KeOierthe- tI'8tr x S" secs-:bti e-g ex;57 I b� C .-1 .r?fr a Valuation: $J/C�c . L.) (1
p�
s �/� Existing building area: square feet
fDla r" or/ �$ Lot�Gere e r per GYITorc-heei
specs -(t cd.9/ >"7 _5-heel : G'a'1e 9 / —sief/r e/ 4.4, New building area: square feet
g,PROPERTY OWNER ❑ TENANT/ Number of stories:
Name: .$L)IWI4$Z c 4 pl at. CI $OC'4 0 a`�1 Type of construction:
Address: /06S 0 5kili 0-f /t,/ I ,ef) .p e , Occupancy groups:
City/State/ZIP: r(6/tgli-(r) , 0 '7 2'i Existing:
Phone:(5-03) 670 01 3 ( Fax:( ) New:
++ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: (ir�
�, Structural plan review fee(or deposit): `i '7t 6
Contact name: 'TO Iii Cie.,( `(s 0A
FLS plan review fee(if applicable):
Address: IS 1.6o 5c- ' ,,e
City/State/ZIP: 1-1(�4g 1),, OIe 1j 7d z. Total fees due upon application:
y Amount received:
Phone:(5-1,3) "�y/,3 o--qz z o Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail p e IO CHAI'O b J. , _ me raF/ C 0 ys Commercial and residential prescriptive installation of
CONTRACTOR / J roof-top mounted PhotoVoltaic Solar Panel System.
Business name: .SQ(-P Pit jorr'€�y'� "St1 A (drag re( -dl Z/ o,' Submit two(2)sets ofroofplan with cormection details
_ I� and Sre department access,along with the 2010 Oregon
Address: ,c z. g 0 5� 9 ' 4-V&, Solar Installation Specialty Code checklist.
City/State/ZIP: -r i G 4-RP, 0 it- `)I 2 Z 1 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(13) 7,0- �z0 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: /623 97 i& Z-3 d 7 Total fee due upon application: $201.60
Authorized signature This permit application expires if a permit is not obtained
9 within 180 days after it has been accepted as complete.
• Fee methodology set by Tr-County Building Industry
Print name: ' a r Date: / /4oz4 Service Board.
1:\Building\Permrts\BBUP COM_PetmitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)