Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00009
,i� DEVELOPMENT SERVICES DATE ISSUED: 1/27/04
'�I I I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09802 SW SHADY LN PARCEL: 1S135BD -01200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: U2 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 900.00
Remarks: Free standing pole sign.
Owner: Contractor:
FORBES, DONALD CAROLYN SIGNCRAFT LLC
BURDICK, DONALD LINDA 9033 SW BURNHAM
434 RIDGEWAY RD TIGARD, OR 97223
LAKE OSWEGO, OR 97034
Phone:
Phone: 503 - 639 -4910
Reg #: LIC 155420
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 1/12/04 $62.50
[TAX] 8% State Surchart 1/12/04 $5.00
[BUPPLN] Pln Rv 1/12/04 $40.63
Total $108.13
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued B
Pe rm ittee
Signature: h �i� A l -
IF i
C all 639 -4175 by 7 p.m. for an inspection the next business day
01/08/2004 11:39 FAX 5035981960 CITY OF TIG. RI 002
7 8492 - sw smor 1.4tve
, .
Building Permit - 00
. FOR OFOCE USE ONLY
'
City of Tigard Daftly: / -/ .3.- 0'7 .„," Permit No.:
13125 SW Han Blvd., Tigard, OR 94 - 1 g Look.. Plan Review
Phone: 503.639.4171 Fax 503.598.1960 '" .-:'11;-',:'111/1" Dataay: Other Pennic
inspection Lute: 503.039.4175 ...._..., Date RudyrBy; hot:. , Fil see Attacked Checklist for
Internet: www.ciligard.or.us NeutediMethod: 7 A/ Supplemental torormatton
OURDING DIVISION
Igl%ttlg;k21'ftiliOi'..*tLiliEitIP.'.T,$r.;r1li;i:A11;1;5r, f,?:1.1........#41.1A,X+iii)1.444,itjktiiiid
0 New construction 0 Demolition Permit fees arc based on the value of the work performed.
Indicate the value (rounded es the nearest dollar) of all
i F. Addition/alterarion/replacement 0 Other .. equipment, materials, labor, overhead, and the profit for the
3' gi.!AVV.4 7.'i:.:'::: :.' ti wark indicated on thin application.
O 1- and 2-family dwelling 0 Cor=ercial/industrial Valuation: $ qien /20 .
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder i0 Other. Number of bathrooms:
4 _
- in, i';:. ',L:, !". , ,..:.,:;;;,,01-. ii:t i :Iti;1 Total number of floors:
kb site address: a( `../02 &AA .9- ,, , r' k ' C. New dwelling arcs: square feet
My/State/ZIP: :11.A.■ On -* • 2- . , Garage/carport area: square the
Suite/bldg./apt. no.: - 2... Project namr.(0 Eli) ti ap eii. - Covered porch area: square feet
Crean street/directicms to job site — r - Deck area: square feet
Other structure area: square feet
4
Subdivision: Lot no.: 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.: equipment, materials, labor, overhead, and the profit for the
pri #00, @Oird'F: work indicatedszthis application.
izit 1.-1041111110 i , • C
C- ---1 e_)-. ') Valuation: $
_
Oa - N X , 1 e l) I KJ C› - C - --A c .1 lal Existing building area: square feet
4 ‘ ..-J. New building area: square feet
r.'e•Jtr '':.'::il.;"ilitVit't-.00?;:.'.;:it.'4.;::d 1.1W _ Number of stones:
Type of eau c on.
Name: / FL ( C../ sou 6 -
Address: 1 4J3 S• ' Oil ■ N f) A Ai \- Oceupaney groups;
—
City/State/ZIP: , 7 2.C> t Existing:
Pholni (663) - 1- - 2Jp - - 2- I 0 "a, Fax: ( - 4----- • New:
iiWt,:ifitf 4 . 4,11 . 1-,7'dr, , ,.5:L .:1 ::; . t .4 ,: ! 401 4 '; 0.00 r 014;Riatia".1.,:'t.''1.5i-::,`.:.-,i.! .: ''..' ' • ''.
Business name: ((.... i Tr..." .
All contractors and subcontractors are required to b c
Contact name: 0 law 0 1 licensed With the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 0 3 1: ' 4 sa..i \ .: - jurisdiction in which worl: is being performed. if the
applicant is exempt from licensing, the following reasons
City/State/ZIP: -.,„,..... (../) 4 aPPIY;
Phone:( er 1 — P1 10 Fax: : ( ) 61 la .1 1 t41 •
&Mail : — C_12.r /C.., 1 2....,C
FigElik.3,.':11 iiiiNt',L1:aii.:',ii'N' ligliViliiitig,,:.,,,,.:.R?,,i'.1..ii.;;-0:ii-,,..:riizileiolip; —
BusineSS name:
Adams: Please refer ID fee schedule.
City/State/ZIP:
Fees due upon application
Phone:( ) Fax: ( ) -
GCB 11c.: *-- 1 4/PTNe ""' -Y) ; Amount received
1/1/AMIF Date received: ..
Authorized signaturetir. _,/ / This permit application wires if a permit is not obtained
...fikArtgliV.1 1 .0., within 180 days after it has been accepted as complete.
Print name.: . l Date: 111911illifira • Fee methodology set by Ye Building Industry - g Indust
_
■ Service Board.
BI)uildipePermit:IBUP-PerenkApp.doc IVO; 440.1611T(1 UM/COM/WEB) ) . ' .'9 •
V • „.....,
-'11' 0A) '