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Permit
CITY OF TIGARD SITE WORK PERMIT 1'7 2 COMMUNITY DEVELOPMENT Permit #: SIT2012 -00001 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012 Parcel: 2S112AD00200 Jurisdiction: Tigard Site address: 6830 SW BONITA RD Project: Clowns Unlimited Subdivision: BONITA GARDENS Lot: 4 Project Description: Installing 25 ft. of underground fire line to building. Contractor: WESTERN STATES FIRE PROTECTION Owner: UNION PACIFIC RAILROAD CO 13896 FIR ST STE B 1700 FARNAM ST, 10TH FL SOUTH OREGON CITY, OR 97045 OMAHA, NE 68102 PHONE: 503 - 657 -5155 PHONE: FAX: 503 - 657 -5182 FEES Description Date Amount Specifics: Permit Fee - Site Work 02/28/2012 $156.00 Plan Review 01/10/2012 $101.40 Type of Use: COM 12% State Surcharge - Building 02/28/2012 $18.72 Class of Work: ALT Info Process /Archiving - Lg $2.00 (over 02/28/2012 $2.00 11x17) Project Valuation: $7,086.00 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: Yes Accessible Parking: Fence: Total $278.12 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 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 -0090. You may obtain a copy of the rules or direct questions to NC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: ! , 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 Site Work ,^� �� - FOR OFFICE USE ONLY � Recei Ci of Ti and . �' \ � Permit No.. IN ty' g � <<� y Date /B : 1 / - i _5 ut • ' a a 40 V 13125 SW HaII Blvd., Tigard, QR 22.3 �O \^t Plan Revie �• 0 Phone: 503.718.2439 Fax: 50.598.1960,` A © Date /B : I ' M Other Permit: 5 t T f G A R D y E Inspection Line: 503.639.4175 ,�. \`� „ N• • y0 � Date Ready . ..7 �. ® See Page 2 for Internet: www.tigard- or.gov W2 a g a r ` Notified/Method: 1- 1_ tii1� Tr Supplemental Information v a 1 '\ :eLf .V 1 cfar catvr•-f/ TYPE OF t WQR -K REQUIRED DATA: 1- AND 2- FAMILY DWELLING ® New construction fit' D emol iti on 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: 6830 SW BONITA RD. New dwelling area: square feet City/State /ZIP: TIGARD, OREGON 97224 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: CLOWNS UNLIMITED 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: I 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. INSTALL APPROX. 25' -0" OF NEW 6" FIRE LINE FROM EXISTING Valuation: $$7,086.00 UNDERGROUND TO I' -0" AFF IN BUILDING 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: WESTERN STATES FIRE PROTECTION CO. All contractors and subcontractors are required to be Contact name: DARRELL FLUIT licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 13896 FIR STREET, SUITE B jurisdiction in which work is being performed. If the City /State /ZIP: OREGON CITY, OREGON 97045 applicant is exempt from licensing, the following reasons apply: Phone: (503) 657 -5155 Fax: : (503) 657-5182 E -mail: darrell.fluit @wsfp :us CONTRACTOR Business name: WESTERN STATES FIRE PROTECTION CO. BUILDING PERMIT FEES* Address: 13896 FIR STREET, SUITE B (Please refer to fee schedule) City/State/ZIP: OREGON CITY, OREGON 97045 Structural plan review fee (or deposit): Phone: (503) 657 -5155 Fax: (503) 657 -5182 FLS plan review fee (if applicable): Total fees due upon application — CCB- Iic.:- 104570 — — — N. 4, 1_4./4 / � Amount received: , (0i, Authorized signature: T his permit application expires if a per t is not obtained within 180 days after it has been accepted as complete. Print name: DARRELL FLUIT I Date: 12 -22 -11 Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits \SIT- PermitApp.doc 10/0 I /09 440 -4613T(I /02 /COM/WEB)