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Permit CITY TIGARD SITE WORK PERMIT ". COMMUNITY DEVELOPMENT PERMIT #: SIT2007 -00004 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 4/16/2007 PARCEL: 1S134BC -00100 SITE ADDRESS: 12100 SW SCHOLLS FERRY RD ZONING : C -G SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION : TIG PROJECT: 7- ELEVEN Project Description: Installation of ADA ramp. CLASS OF WORK: OTR PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE:$4 )OQ. DO EXCV VOLUME: cy LANDSCAPING ?: FILL VOLUME: cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: sf Owner: FEES SAUNDERS, WILLIAM W TRUSTEE Description Date Amount 2155 KALAKAUA AVE STE 500 [BUPPLN] Pln Rv -Valu 2/6/2007 $65.59 HONOLULU, HI 96815 [FLS] FLS Pln Rv 2/6/2007 $40.36 [BUILD] Prmt Fee -Valu 4/16/2007 $100.90 Phone: [TAX] Valu 8% State Surcha 4/16/2007 $8.07 Total $214.92 Contractor: DUNCAN CONSTRUCTION 2877 NE GARDEN AVE CORVALLIS, OR 97330 Contact #: PRI 541 - 758 -6379 FAX 541 - 754 -9667 REQUIRED ITEMS AND REPORTS Reg #: LIC 31467 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By Permiftee Signature: L 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. . le X0 /Do se ho//s rry Building Permit Application _ FOR OFFICE USE ONLY C `v �� III City of Tigard 4 VG Da f / 6 ' 'snit N3 1 i e oo a y , • 13125 SW Hall Blvd., Tigard, OR 97223, ^^ A l 1 C) 2(1 Plan Review C: Phone: 503.639.4171 Fax: 503.598.I961rt � 0107 Other Permit: As Date/By: T l G A R D Inspection Line: 503.639 OF tj wt Date Re ad J ® See Page 2 for Internet: www.tigard- or.gov eery I 0% Notifi Q 7 °� 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. �� L /i4epF2.witv'l Indicate the vaur alounded to the eadrest dolla) of o UriJt ❑ Addition/alteration/replacement her: 7 equipment, materials, p erials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El I- and 2- family dwelling El Commercial /industrial Valuation: $ ID Accessory building El Multi-family Number of bedrooms: ❑ Master builder �ther: eRe )4 / Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / /,Vii` 4,7a Wajr5 �n/ � � New dwelling area: square feet City/State/ZIP: ' i Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: 9 / 7 �Yt') - 1 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. /J Valuation: $ 6 MO- A / // X / /� /0 Existing building area: square feet !r , /,C/ x � New building area: square feet PROPERTY OWNER I [ - r tNT Number of stories: Name: ? 6etoVloh Type of construction: Address: 07 - 7 / Ye . Occupancy groups: City/ State/ZIP: Existing: � t ° p i - / / 14.. g Phone:Q53 / / (P . 7/// Fax: (�c 7 % - 70 a New: 12-"KPPLICANT t ONTACT PERSON NOTICE Business name: e-2/-A__ J ��/ // 3' Pate A ic • All contractors and subcontractors are required to be �/� / / licensed with the Oregon Construction Contractors Board Contact name: CI /7 �` 10 i�P C. TT�' ,l under ORS 701 and may be required to be licensed in the Address: / 5 V /��i e jurisdiction in which work is being performed. If the City/State/ : /i .'u e 607/- applicant is exempt from licensing, the following reasons 6' ( 41 / / .3`. apply: 9 Phone: �/� Fax: : c4/�,�) �p - 6, E -mail: L e�,� j , /e 5s- ho.47 -1Q, /60/7'1 CONTRACTOR ( Business name: 64/ 5f cL6,eil,4/ ,�/t2 BUILDING PERMIT FEES* Address: Zg7 /C E 6j4tiebe. J /-/t/ e (Please refer to fee schedule) Structural plan review fee (or deposit): i cy: ,-f Cit State/ZIP: C i ,e,/ 4 S ©K' ?73,30 Phone: ( w) 75 6. 3 Fax ( SCi5 7 qc6 7 FLS plan review fee (if applicable): 4/0 j6 Total fees due upon application: / /J ` CCB lic.: � / �j� 7 l V h / Amount received: Authorized signature: / v � `' This permit application expires if a permit is not obtained Print name: j� ,, i D ate: within 180 days after it has been accepted as complete. / q !7� + Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Permits \SIT - PermitApp.doc 06 /26/06 440- 4613T(l1/02 /COM/WEB)