Permit CITY OF TIGARD BUILDING PERMIT
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'1 u' COMMUNITY DEVELOPMENT Permit #: BUP2010 -00062
Date Issued: 04/21/2010
AR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101 BC00900
Jurisdiction: Tigard
Site address: 12360 SW HALL BLVD
Subdivision: KNOLL ACRES Lot: 4
Project: The Knoll at Tigard
Project Description: Demo SFR. DEMO CREDITS APPLIED TO BUP2010- 00033.
Owner: FEES
CLICKENER, ROBERT R & PATRICIA A Description Date Amount
8485 SW HUNZIKER Erosion Control 04/16/2010 $26.00
TIGARD, OR 97223 Erosion Plan Review CWS 04/16/2010 $8.45
PHONE: Erosion Plan Review COT 04/16/2010 $8.45
Permit Fee - Additions, Alterations, 04/16/2010 $164.96
Demolition
Contractor: 12% State Surcharge - Building 04/16/2010 $19.80
LMC INC
8324 SW NIMBUS
BEAVERTON, OR 97008
PHONE: 503 - 646 -0521
FAX:
Specifics:
Type of Use: SF
Class of Work: DEM
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $5,294
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $227.66
Required: Required Items and Reports (Conditions)
1 BUP Ersn Cntrl 681 -4444
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / VA_, - Permittee Signature: `J. �e -a-
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.
Building Permit Application
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' r : Ci ty of Tigard ,� Received
II a � � ( l V i Permit No.: • 1 3125 SW Hall Blvd.. Tigard, OR 97223 .' -? 1 i 6 ` Plan Review �� J L� G. O � ,;
\' t7 ., Phone: 503.639.4171 Fax: 503.598.1960 Date /B Other Permit:
TfGAfZD v `�``! Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
ag i 0 ' Internet: www.[igard- or.gov � g Ai Iii, Notified /Method: Supplemental Information
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.
® 1- and 2- family dwelling ❑ Commercial /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: 12360 SW Hall Blvd. New dwelling area: square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: SW Hall Blvd, between SW Knoll Dr and Deck area: square feet
SW Hunziker 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.: 2S101BC00900 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.
Demolition of Single Family Residence Valuation: $ 5 2-1 4 4 O d
Existing building area: / / 3 7 square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: The Knoll at Tigard Apartments, LP c/o Sheila Fink Type of construction:
Address: P.O. Box 23206 Occupancy groups:
City /State /ZIP: Tigard, OR 97281 - 3206
Existing:
Phone: (503)293 - 4038 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
/
Business name: Carleton Hart Architecture All contractors and subcontractors are required to be
Contact name: Ben White licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 322 NW 8' Ave jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 206 -3174 Fax::( )
E - mail: ben.white @carletonhart.com
CONTRACTOR
Business name: LMC Construction BUILDING PERMIT FEES*
Address: 8324 SW Nimbus Ave. (Please refer to fee schedule)
City /State /ZIP: Beaverton, OR 97008 Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: (503) 646 - 0521 Fax:( )
CCB lic.: 161282
Total fees due upon application:
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: Ben White Date: 03/26/2010 * Fee methodology set by Tri- County Building Industry
Service Board.
l: \Building \Permits \BUP -RES PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)