Permit CITY OF TIGARD BUILDING PERMIT
a COMMUNITY DEVELOPMENT Permits: BUP2010 -00206
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010
Parcel: 25111 BB01500
Jurisdiction: Tigard
Site address: 10362 SW MCDONALD ST
Subdivision: Lot: 0
Project: Washington County Detox Center
Project Description: Create additional bedroom inside an existing bedroom.
Owner: FEES
WASHINGTON COUNTY FACILITES MGMT Description Date Amount
169 N FIRST AVE MS42 Permit Fee - Additions, Alterations, 09/23/2010 $408.32
HILLSBORO, OR 97124 Demolition
PHONE: 503- 846 -6675 Plan Review 09/10/2010 $265.41
Plan Review - Fire Life Safety 09/10/2010 $163.33
12% State Surcharge - Building 09/23/2010 $49.00
Contractor:
CEDAR MILL CONSTRUCTION COMPANY
19465 SW 89TH AVE
TUALATIN, OR 97062
PHONE: 503 - 885 -9370
FAX: 503 - 885 -9368
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $21,310
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $886.06
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes 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 0 952- 001 -0100. You may obtain Oopy of the _ • or direct_questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By l , Permittee Signature: -
13.639.4175 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 Ume of each inspection.
Building Permit Application
Commercial FOR OFFICE USE ONLY
III • City of Tigard ECE\IE0 D 9 /O /°, PecmitNo.: � / � /D -Gt90
• 13125 SW Hall Blvd., Tigard, OR 23 p� Revie
Phone: 503.639.4171 Fax 503.598.198E? 1 U Lk) 1 U D ate/B y I i k IC) other Permit:
T i G A it D Inspection Line: 503.639 Date Re B � / 0 Juria: ® See Page 2 for
Internet www.tigard or.gov Dl .� D F T�GARD Notified/Meth �6 ' Supplemental Information
} �G D1�1lS1c* pi - .
TYPE O REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
] Addition/alteration/replacement ❑ Other equipment, the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling gl 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: / 03 62... �U M e h 0 h J/- u b New dwelling area: square feet
.z• City /State/ZIP: � 4 J d, 04 Garage/carport area square feet
�► '1
Suite/bldg./apt. no.: Project name: ta (A, De foi Civic - 9,etii`,5 grc, icj/ Covered porch area: square feet
Cross street/directions to job site: inc 0 if $ kJ /03 - Deck area: square feet
. 4 Other structure area: square feet
� I r REQUIRED DATA COMMERCIAL - USE CHECKLIST
Subdivision / r era .,: I 11 e hte,' 1 Lot no.: / Permit fees* are based on the value of the work performed.
Tax map /parcel'fio.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION TION OF WORK work indicated on this application.
n1P„� `36, Uo,. 4. ,,,, ,Ic4 ode • 0� s / bed (vcvr+• valuation: $021,3117,
Existing building area 5 j 9 S square feet
New building area: c square feet
T PROPERTY OWNER , ❑ TENANT Number of stories: /
Name: 1icisS )4, ha c Type of construction: (Jp
, i Address: / g, R it). Frsi- Ave., iiiS /y,2 Occupancy groups: Se.-3
Cit /state/ZIP: / 4/)r, DQ `01,7"1 Existing: 5�.3
Phone: (% 3) S'96-( Fax: ( ) New 5-3
(� APPLICANT 0 CONTACT PERSON NOTICE
j Business name: Cec�c m•�, 6,054rvd,vn Corr "n All contractors and subcontractors are required to be
Contact name: �e(•� SA ; 4 All
with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / y[/( S— s w d9 +l- rep ,iz-
Cit 7;0 41-; !` , a 170‘,9 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
apply:
Phone: (503 ) $$$-1 370 Fax:: (S); ) 5 n
V E -mail: ,e 03 Ce d4iM;lia.,Cone-‘
n CONTRACTOR
4p Business name: 51\ TAE BUILDING PERMIT FEES*
Address: (Please refer raleeschedule)
4 City/State/ZIP: Structural plan review fee (or deposit): 5 el/
v.. FLS plan review fee (if applicable): /6 3 33
Phone: ( ) Fax: ( )
Total fees due upon application:
CCB lic.: l3 /3yS o� /�a7i/
/ n , Amount received: .� $ , ai
qi
./. /A Authorized signature: x I�
This permit application expires if a permit B not obtained
within 180 days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri Building Industry
Service Board.
I :\Building\Pennits\BUP -COM PermitApp.doc 10 /01/09 440- 4613T(11 /02/COM/WEB)