FPS2023-00007 Building Permit Application
Fire Protection System RECEIVE a- FOR OFFICE USE OONLLyY�� �j�
City of Tigard atelByd / P� �k -/T/`" .—J
Dan RBye / ��lL� �7 11 Q /
" 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 17 Z022
t . Plan Review ) —,�• ^ , It 602
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Js] --JIJi/I
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: a kris: I ® See Page 2 for
Internet: www.ti ardor. ov CITYOF TIGARD NotiSed/Me/thod:
g g j'O� Supplemental lnformatum
3IJ!LDING DIVISION vv, ,,tell we,
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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling lrcommercial/industrial Valuation: $
❑Accessory building ❑ Multi-family Number of bedrooms:
❑Master builder IIIOther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: loos. /IOc(p9 St ) cps(MJC. AFJC New dwelling area: square feet
City/State/ZIP: Tt G 4Q.A I biz 9'1=3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: -r t46-a0 -rEsLA sire Meg 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: 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.
Valuation:I t TAPA usTRt.t_ L1s�J !4`h7aAas . ItsST..a,l (p-ta c.N T)a J art, ( $c.4 t 0-6p`"'
1ta JMJ1.T, 1,4<rA l.t. 4—I s.1Ctd Fgr..F IV.t„1F -rt. 3 loc. (tOCA..Ovl,.k 1 Existing building area: square feet
. S ,11- R137X, -%eyea') New building area: square feet
[1.PROPERTY OWNER 0 TENANT Number of stories:
Name: lO p t4S 5%4 C.. Lt.( . 3`i A LS-- J Z 13to> LA_P Type of construction:
Address: 64-1V 0 C JitKEYC1 C4 flA-ZA 1 V 15olJru T2,1oN1 5c Sty ,i000 Occupancy groups:
City/State/ZIP:CI 0..LJ-iTt/ kit, LSZ80 Existing:
Phone:(—I 14) crve "Ya53 t,.! Fax:( ) New:
[`APPLICANT 0 CONTACT PERSON
NOTICE
Business name: \,,,‘ESTtU 1 CO JST12,0C310,! $644er c S 1lac, All contractors and subcontractors are required to be
Contact name: �Uo licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2300 C TNnCp l..00P So tre 110 jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
J41,lcOWJ0. i W4 `,$10101 —71 51 apply:
Phone:(31,0) 0oic1_ 5-311 Fax: :( )
E-mail: `�t'1hh--, L.;e.54-e cvlcc.-15--1rOd- oil . Cc.)vil
CONTRACTOR BUILDING PERMIT FEES*
Business name: Neck t t11JTt2.4C'r1„lc, f ‘....1._(... (Please refer to fee schedu
le)
Permit fee:
Address: I tits 5,0 \o,40,3t.s D , jrt. 101
State surcharge(12%of permit fee):
City/State/ZIP: S+16R1„3e 01c) OQ y7 14.
FLS plan review(40%of permit fee):
Phone:(Cfl t) 224—L4 4I Fax:( ) (Due upon application submittal.)
CCB lie.: ion Via Total permit fees:
Authorized signature: __ZajeL,,,Ic.— Amount received:
This permit application expires if a permit is not obtained
Print name: l�lU ` '' within 180 days after it has been accepted as complete.
l411 5. WF 3b Date: i'il'v * Fee methodology set by Tri-County Building Industry
Service Board.
I:1Beilding Pennits'FPS-PermitApp_031016.doe 4404613T(11i02/COM/WEB)