Permit ■
City of Tigard, Oregon a • 13125 SW Hall Blvd. o Tigard, OR 97223
Ne
a4.1 ARD
May 12, 2009
Devland, Inc.
2100 SW River Pkwy
Portland, OR 97201
Re: Permit No. SUB2007 -00005
Dear Sir /Ms.:
The City of Tigard has processed a refund for the deposit of fees on the above referenced
permit for the following:
Site Address: 15760 SW 76 Ave.
Project Name: Knauss Subdivision
Job No.: N/A
Refund: ® Check #62952 in the amount of $264.00.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Extension not required as final plat was already submitted to the City. Refund 100%
of extension fees paid.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
I \Building\ Refunds\ Administration \I . trItefund- Deposit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov . TTY Relay: 503.684.2772
i.
III u
City of Tigard
T I G A R D Accela Refund Request
- This form is used for refund requests of land use, engineering and building application fees.
Receipts; documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Devland, Inc. DATE: April 14, 2009
2100 SW River Pkwy
Portland, OR 97201 REQUESTED BY: Dianna Howse
CAC
TRANSACTION INFORMATION:
Receipt #: 2009 -29 Case #: SUB2007 -00005
•
Date: 1/5/09 Address /Parcel: 15760 SW 76th Ave.
Pay Method: Check Project Name: Knauss Subdivision
EXPLANATION: Extension not required as final plat was already submitted to the City. Refund 100% of
extension fees per Cheryl Caines.
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[LANDUS] Approval Extension 100 - 0000 - 438000 $230.00
[LRPF1 LR Planning Surcharge 100 - 0000 - 438050 34.00
•
•
TOTAL REFUND: $264.00
APPROVALS:
• If under $500 Professional Staff •
If under $7,500 Division Manager • 4_� ' r
If under $22,500 Department Manager 0/ .- � ei •'
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
Sfaget: ,ti. _AY1 � " °•F Rt�A - - - 1VI- - - - ,_ N ... ;,.;� - �_�,.. . ;Y��
;� ®'- CCKI SYSTTEM A I 1,$, �RiA�r 4 � '
Refund Request Reviewed: Date: // / 0 9 By: �ii
Case Refund Processed: Date: S /O ? By: 4. 145,/--
I: \Building \Refunds \RefundRequest.doc 04/13/09
CITY OF TIGARD RECEIPT
a
. 5 . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 173447 - 05/07/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SUB2007 -00005 $- 264.00
Total: $- 264.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 62952 DHOWSE 05/07/2009 $- 264.00
Payor: Devland, Inc.
Total Payments: $- 264.00
Balance Due: $12,415.00
Page 1 of 1
CITY OF TIGARD 1/5/2009 •
13125S1\ 3:34:39PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200900000000000029 D ,e/Girtlr¢�
Date: 01/05/2009
Line Items:
Case No Tran Code Description . Revenue Account No Amount Paid
SUB2007 -00005 [LANDUS] Approval Extension 100- 0000 - 438000 230.00
SUB2007 -00005 [LRPF] LR Planning Surcharge 100- 0000 - 438050 34.00
Line Item Total: $264.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Check DEVLAND, INC. CAC 001650 By Mail 264.00
Payment Total: $264.00
•
cReccipi.rpt Page I of I
0
Community Development
TIGARD
• Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name: Devland, Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 2100 SW River Parkway
City/State /Zip: Portland, OR 97201
Phone No.: 503 - 223 -6663
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
❑ CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: SUB2007 -00005
Site Address or Parcel #: 15760 SW 76t Ave.
Project Name:
Subdivision Name: Knauss Subdivision Lot #:
EXPLANATION: The applicant /owner requested an approval extension when one was not
necessary. A final plat had already been submitted to the City. Please refund 100% of extension
fee.
Signature: eCU....A.Q,A) Date: 1/6/09
Cheryl aines
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fcc which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fcc when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date B Rte to Admin: Date S /2/0, By /"1'
Refund Processed: Date / /S /Oy B) Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
v CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2007 -00005
° COMMUNITY DEVELOPMENT DATE ISSUED: 1/5/2007
TIGAR9 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110AD -90049
SITE ADDRESS: 14936 SW 109TH AVE ZONING: R -
SUBDIVISION: CANTERBURY WOODS CONDOMINIUM LOT: 049 JURISDICTION: TIG
Project Description: Canterbury Woods Condos - Replace deck sheeting and guardrails.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: MF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,000.00
Owner: Contractor:
CONDO MANAGEMENT CMI J & R MAINTENANCE & PAINTING INC
2105 SE 109TH AVE 14845 SW MURRY SCROLLS DR #1 10
PORTLAND, OR 97214 PMB 306
BEAVERTON, OR 97007
Phone: 503 - 445 -1222 Contact #: PRI 503 - 579 -6564
FAX 503 - 579 - 5234
Reg #: LIC 165104
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 1/5/2007 $62.50
[TAX] 8 %, State Surchari 1/5/2007 $5.00
[BUPPLN] Pin Rv 1/5/2007 $40.63
[FLS] FLS Pln Rv 1/5/2007 $25.00
Total $133.13
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 than 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 -0100. You may obtain a copy of these rules or direct questions
to OUNC by calling 503.246.6699 or 1.800.332.2344. /
- sued By: i y t i Permittee Signature:
r
/ �
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
\ lc; - )
Buildine Permit Applicatr4G roll OFFICE l'SE ONLY
City of Tigard Received
O DateB . !O4 7 Permit No.: u -0400
° 13125 SW Hall Blvd., Tigard, OR 97223 • I \ t :) 7. O1 Plan Review
' . Phone: 503.639.4171 Fax: 503.598.1960.1 DateB Other Permit:
T I G n R D Inspection Line: 503.639 � � rj Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov , `�' it 0- 1t rtl i •tified/Method Supptemeotal Information
TYPE O r 1'L T REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction Demoliton 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 applicat-
Valuation: $ C9 ? 0 , 00
❑ 1- and 2 -family dwelling ❑ Commercial /industrial
❑ 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: ....5 ,e9 9 r� x7/ e /,ig New dwelling area: square feet
City /State/ZIP: h t, > ,: D4' `9 7 221. Garage /carport area: square feet
Suite/bldg. /apt. no.: / Project name:` Covered porch area: square feet
Cross street /directions to job site: e :4 °
/ 7! /74,1e Deck area: square feet
Other structure area: square feet
7 REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 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.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Z L cs / Valuation: $
/ / Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: er, A y e?,ppr„, ep7 /� Type of construction:
Address: Ala , a ,-- z - /n 9 �` �Z Occupancy groups:
e
City /State /ZIP: 7' d2,>' 9 7 /Y Existing:
Phone: (Ski") . / l'- Z L Fax: ( ) New:
❑ APPLICANT / ❑ CONTACT PERSON NOTICE
Business name: `ia' . tilyrc'ti p , A All contractors and subcontractors are required to be
Contact nam�;� ��,yy_ {',/rte / licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / >/j - J'<) I"77.r : .(c ISO? ) c 521. , //4 r9,/ , ,) jurisdiction in which work is being performed. If the
City /State /ZIP:��/...ve. ,, 914)0 7 applicant is exempt from licensing the following reasons
i / ` apply:
Phone: (Sc, j ), <:".., X Fax::.rd3 ) 3 SeJ
E -mail:
CONTRACTOR -�(
Business name: _1�''� /�r1//r,/� ��,1 /s'l/ / % e_ BUILDING PERMIT FEES*
44.-1?- �J (Please rejermJee schedule) view fee (or deposit):
Address: 5/ /,j—j -4.), � f��lv' j',il / eJ� "14 S tructural plan re
City /State /ZIP:��.iy ar2t 1 c f ' 9 z ee? f
Phone: (�0'� y < Fax: (5a.,3 )�' ' FLS plan review fee (if applicable):
Total fees due upon application:
CCB lic.: /c 5 '
Amount received:
Authorized signature: . ____.. _ _ _ ,
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: l Date: /� 1 s Fee methodology set by Tri County Building Industry
Service Board.
I:\Building\Permits\BUP -TI- Permit " oc 03/23/06 44046 I 3T(11/02/COM/WE B)
CITY OF TIGARD - A -,
BUILDING DIVISION PERMIT #: BUP2007-00005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/512007
Phone: (503) 639-4171 /40k1\
1
,. :44/0 i
Inspection Requests (24 Hrs.): (503) 639-4175 ..-_,- '
INSPECTION WORKSHEET FOR DATE: Via/2007 TIME: 7:03AM PAGE: 12
SITE ADDRESS: 14936 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: CANTERBURY WOODS CONDOMINIU LOT #: 049 TYPE OF USE:
PROJECT NAME: CANTERBURY WOODS CONDOS
DESCRIPTION: Canterbury Woods Condos - Replace deck sheeting and guardrails.
OWNER: CONDO MANAGEMENT CMI, L// PHONE #: 503-445-1222
CONTRACTOR: J & R MAINTENANCE & PAINTING INC PHONE #: 503.579.6564
Inspection Request Scheduled For: Date: 1/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # MeSsage
275 Framing 041979-01 503-579-6564 N
Corrections/Comments/Instructions:
Ilb 'al t 1 i If ■ CAO, 4
•
■
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1 6 Kt -
PASS n PARTIAL APPROVAL 0 CANCEL NO ACCESS
1 FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector:
illiq 14 i 1
L. ll 1.1
Date: . Phone #: (503) 718-
NV car cuvo VO.4o I-HA OV �z;J 8884 COMMUNITY MANAGEMENT INC a 003/003
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