Permit r+ -
14 v CITY OF TIGARD BU ILD PER7
` " ! all. • COMMUNITY DEVELOPMENT Permit #: BUP2009 ING 000 T
Tr. GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/05/2009
Parcel: 25111 BB01500
Jurisdiction: Tigard
Site address: 10362 SW MCDONALD ST
Subdivision: Lot: 0
Project: Washington County Detox Center
Project Description: ADA upgrade to bathroom.
Owner: FEES
WASHINGTON COUNTY Description Date Amount
FACILITES MGMT, 169 N FIRST AVE MS42 Permit Fee - COM 05/05/2009 $141.15
HILLSBORO, OR 97124 Tax - 12% State Surcharge 05/05/2009 $16.94
PHONE: Plan Review 05/05/2009 $91.75
Plan Review - Fire Life Safety 05/05/2009 $56.46
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: $12,780
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $306.30
Required: Required Items and Reports (Conditions)
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 - arrnr ance 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 1 days. ATTENTIO ': Orego• -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 -001 -0010 through OAR • • -001 -1 i I You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.•699 0 1.800.332.2 •4.
Issued By: , / I I Permittee Signature: I
Call 503.639.4175 by 7:00 a.m. for an inspection that business da F ,
r
This permit card shall be kept in a conspicuous place on the job site until comple ion .f the project.
Approved plans are required on the job site at the time of each inspection.
i r .
Building Permit Application ,
Commercial RECEIVED FOR OFFICE USE ONLY
Rec eived I u I J►
City of Tigard D ''1Permit No.. `]
�' g DateB : � •
N 13125 SW Hall Blvd., Tigard, OR 972�y 0 5 2009 Plan DateB Revie : �• -09'��jr`� der Permit:
Phone: 503.639.4171 Fax: 503.598.1 960
-U
T I G A R D Inspection Line: 503.639 Date Ready/By: See Page 2 for
Internet: ww.tigard or .gov CITY OF TIGARD
w Notified/Method: Supplemental Information
T3! (II tlrA,'n T''1'r :!rl
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 IR Other:A nA 6,1-1,,,,,„,,,, vn c, :', -,d equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION 9 work indicated on this application.
El 1- and 2- family dwelling ®. Commercial/industrial Valuation: S
El Accessory building ❑ Multi- family Number of bedrooms:
El Master builder 'Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: o 36 a S tv Nlc ll)co aid Stre e-i New dwelling area: square feet
City /State /ZIP: 0 arcl r r Garage /carport area: square feet
Suite/bldg. /apt.no.: Project name: Wit . car. y Qet CX Ccvit Covered porch area: square feet
Cross street/directions to job site: LA 0A i?)011) roo ?l re mccie l_ Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: I 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.: t_ f A , ( ) 4 (J v, I I � f� c r tS Parce 1 2 equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1 Valuation: $ I2 75D. 00
ADA vllc� ra.l 1 1 es Ire CA, VI ,ir ,+r l et Imo on,
1 -) Existing building area: 5 I q5 square feet
New building area: Rj' square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction: U t t'_ / pe to L,` i I
Address: Occupancy groups: P
S (� - 3
City/State /ZIP: Existing: ifes
Phone: ( ) Fax: ( ) New:
lisT APPLICANT J ❑ CONTACT PERSON NOTICE
Business name: Ce cIa r0,,-,11 e. �1nSi rvAi oh All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
s -S �'''` t il under ORS 701 and may be required to be licensed in the
Address: i q y 6 S S w vi to Ave jurisdiction in which work is being performed. If the
City/State /ZIP: .j 2 ' applicant is exempt from licensing, the following reasons
Tact G I r ,„1, (. 7 /� apply:
Phone: (S0 i s ° 43 ?D Fax: : (5,3) ws-- q s 65
E -mail: : ,-F'-Fs i .c - 1
CONTRACTOR
Business name: ce re' . I I Go II S 1 rt/ct 'e0 ✓1 BUILDING PERMIT FEES*
Address: i Ct y A 5 S w .�+h A„
(Please refer to fee schedule)
v crud Structural plan review fee (or deposit):
City/State /ZIP: 7,,,, I O 2-
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
5o3 lfbs5- c1 370 303 Rg — 936
CCB lic.: 13 i3,45 Total fees due upon application:
Amount received: jjao • 30
Authorized signature: WC, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Se - f c . S m r t I7 Date: H _ 30 _ 09 * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB)