Permit CITY OF TIGARD BUILDING PERMIT
;r'- a : COMMUNITY DEVELOPMENT Permit#: BUP2013-00206
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2013
Parcel: 2S110AD90003
Jurisdiction: Tigard
Site address: 14824 SW 109TH AVE
Project: Canterbury Woods Subdivision: CANTERBURY WOODS CONDO Lot: 3
Project Description: Siding,window and gutter repair.
Contractor: EVERGREEN PACIFIC INC Owner: EVANS, KATHLEEN A
9117 SW BURNHAM ST 14824 SW 109TH AVE
TIGARD,OR 97223 TIGARD,OR 97224
PHONE: 503-624-1337 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: MF
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 09/23/2013 $164.96
Demolition
Occupancy Grp: Occupancy Load: 12%State Surcharge-Building 09/23/2013 $19.80
Dwelling Units: 0 Plan Review 09/23/2013 $107.22
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 09/23/2013 $6.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $5,100
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $298.48
Required: Required Items and Reports(Conditions)
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, 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 calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ` 1 a
a 503.639.4175 by 7:00 a.m.for the next available ection date.
This permit card shall be kept in a conspicuous place on the job si„ ntil completion of the project.
Approved plans are required on the Job site at the tim of each Inspection.
Building Permit Application
Commercial RECEVED FOR OFFICE USE ONLY
City of Tigard AUG 2 0 2013 Received f�„� „ri g
Date/13y: V
Permit No� .20/3...201z2e,6
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: �0/Z.3 .�_g'/V Other Permit:
Ti GARD Inspection Line: 503.639.4175 CITY OF TIGAR® Date Ready/gy: luris' See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method.of l3 n� Supplemental Information
Oti / '-
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling Valuation: $ /� CL
❑Commercial/industrial
❑Accessory building X Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: //� #- //,t 2< x.,_ /(c7/2/ �lh -7Z New dwelling area: square feet
City/State/ZIP: /yl/Jy / tie..� ./ 7/7Z3 Garage/carport area: square feet
Suite/bldg.lapt.no.: Project name: (.--/i7//f/„.,4',,,. \7 It i d"IS _ Covered porch area: square feet
Cross street/directions to job site: 77 j 7LA�`,z,,^` /, AtJeD Deck area: square feet
//) 7/ /._f f / ,,,c Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: /(/// - Lot no.:A//J 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.: // �T
/(%//t7 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
42/<G / /--2fi f�''. eL L ,4/, /. A/ei('-r-/-) Valuation: $
'clQ lc Cf. /L 1 J Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: t �� , , -S 7174///g -,5 /�.�1/.��,1/,/ Type of construction:•
Address: //r� Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
,APPLICANT 4 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
p/F/,«`TN /\,4,/7e-/C pyr. Structural plan review fee(or deposit):
Contact name:
T/L/z_ l FLS plan review fee(if applicable):
Address: l7 7 S a_ A
Total fees due upon application:
City/State/ZIP: 7747,917.J / rA /rc/,
Amount received:
Phone:( L7) (7A - 1- ---.7 Fax: :(f 2) (24 /6- *
E-mail: 41--Id- �! PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
C/ f �-7t z�/ /L Z///(. cm/ Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
f-�(/./7/7(t7w / I jl 7/\/.6_ and fire department access,along with the 2010 Oregon
Address: l//7 �� ,/SLi / ',4/ �f/11 Solar Installation Specialty Code checklist.
City/State/ZIP: 7 Permit fee(includes plan review $180.00
77/7171/- / C/l /t and administrative fees): _
Phone:(i , ) G-4 _ /g 7," Fax:(G ) ,:,z4_ /�7 State surcharge(12%of permit fee): $21.60
CCB lic.: Lf/57/ �./ 7 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
f�p within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Print name: i Date: V /3 Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)