Permit •
CITY OF TIGARD SITE WORK PERMIT
111111 • COMMUNITY DEVELOPMENT Permit#: SIT2013-00026
T LGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2013
Parcel: 2S110AA00200
Jurisdiction: Tigard
Site address: 14130 SW 105TH AVE 1
Project: Canterbury Terrace Apartments Subdivision: KING CITY TERRACE CONDO Lot: 3-6
Project Description: Installation of 25'of CPVC from water meter to fire riser.
Contractor: REA MECH INC Owner: VOIEN, BETH TRUST
30330 SW GRABEL RD. BY VOIEN,BETH TR
HILLSBORO,OR 97124 24 VILLA POINT DR
NEWPORT BEACH,CA 92660
PHONE: 503-969-6252 PHONE:
FAX: 503-640-9344
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 10/03/2013 • $134.48
Plan Review 10/03/2013 $87.41
Type of Use: MF 12%State Surcharge-Building 10/03/2013 $16.14
Class of Work: ALT Info Process/Archiving-Sm$0.50(up to 10/03/2013 $0.50
11x17)
Project Valuation: $5,300.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $238.53
Required Items and Reports(Conditions)
•
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
issu , or if wor ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Ore.n n
U' ty Notification Cente. Tho - • les are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy
r direct questions to OUNC . ailing 50 32.1987 or 1.800.332.2344. i
Issued By: I 6 Permittee Signature: A —S?
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 Application.,CENED
Site Work FOR OFFICE USE()NIA
III City of Tigard 1 "?13 Received
ea .-1p Permit Ni)*:ilT�'QY 3 (�C:6 . +,
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
0: Phone: 503.718.2439 Fax: 503.5V OF TIGARD Date/B : Omer Permit.
I i G n It D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:l-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
aAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El m
1-and 2-family dwelling ❑Comercial/industrial Valuation: $
❑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: j p i 3D e4(,.,.S 1 05Tff f--21-, New dwelling area: square feet
City/State/ZIP: "="7----" A A f) 97ç/ Garage/carport area: square feet
- Suite/bldg./apt.no.: Project name: Cop\J -(0. Covered porch area: square feet
Cross street/directions to job site: tic. fyl c--On(1 � �Pr> < _r( 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.
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.
i ti Valuation: $ 5 3n7=3%
1 ttSTv41., ZS r,p_ z Gi,tic, Fi2.0tM GIT�( Pancitfler7)
IL -1 F--/r S / Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
•
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: V7 - rn�fJA• HC.- All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
v vt.r. AI .1C -1 -64_r-,1"..4--Fa l (L under ORS 701 and may be required to be licensed in the
Address: . -tl s ( e T-fLA.(3 p jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
1-�►U -s�R-a, apply:
Phone:(599 ,3G -iii 75 Fax::( )
E-mail:
CONTRACTOR
Business name: I ,..., I NC_, BUILDING PERMIT FEES*
Address: 7-....z2-39 3 C ��L (Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP:
(—l- t_VtrD ii., OGZ
Phone:(5C3) 73 , -7,f 75 I ( ) FLS plan review fee(if applicable):
Fax:
CCB lic.: )yq,Cf j`7 Total fees due upon application:
• / Amount received: $420):3e.5 5
Authorized signature:-..r ,�`, /
i This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
IPrint name: "+•ati0 /4C3-LEittirQ Lek Date: ,3—is _ * Fee methodology set by Tri-County Building Industry
Service Board.
I:t Building\Permits\SlT-PermitApp.doc 10/01/09 440-46131(11/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14130 SW 105TH AVE 1, TIGARD, OR, 97224
Commercial - Site Work
499 Final inspection
2014-01-27 (null)
SIT2013-00026
PASS - No C of O
Violation Summary:
Inspector Contractor