Permit CITY ',� `lil l i ®F TIGARD
BUILDING PERMIT
' COMMUNITY DEVELOPMENT Permit #: BUP2009 -00196
TiGff RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11535 SW DURHAM RD C -1
Subdivision: Lot: 0
Project: Liberty Tax
Project Description: Construct wall to separate spaces.
Owner: FEES
HIP WILLOWBROOK LLC Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708 Permit Fee - Additions, Alterations, 10/27/2009 $134.54
PORTLAND, OR 97208 Demolition
PHONE: 12% State Surcharge - Building 10/27/2009 $16.14
Plan Review 10/27/2009 $87.45
Plan Review - Fire Life Safety 10/27/2009 $53.82
Contractor:
PACIFIC CREST STRUCTURES INC
17750 SW UPPER BOONES FERRY RD SUITE
190
PHONE: 503 - 968 -8949
FAX: 503 - 598 -6658
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $3,262
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $291.95
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors: N o
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,OAR 952 -001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4irtisu j (J (t I\ Permittee Signature: ( v
CaII 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.
Building Permit Applica R– 1 1 l id'
- - - -- — v a :. ,, r �-:. + „ . mt r /rA ,7it +s ^ S r,tp e9 +,,, �, `;:i 6,, +, 7 ;
commercial l � �� <" r, , , 0,' ', :.� , . ' �
r ' City of Tigard 01,.j 00 Received
y.) Permit No.. . : t4
/
q 13125 SW Hall Blvd, Tigard, OR 97223 Date /B -:
Plan Revie � ��, S �t�f • I
g ra Phone: 503.639.4171 Fax: 503.5Q�rtQy � '+ , DateB . i , r� Other Permit:
I 4 Inspection Line: 503.639.4175 l 1 ' �: n Date Readw• y: ® See Page 2 for
TI GARD , 8Y
+ I "kr , Internet: www.tigard- or.gov BUILDING
° �J 3V{ � � r� Notified/Method: 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.
Indicate the value (rounded to the nearest dollar) of all
B Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- 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: \\ 535 ,.,,. -- 0,, ,,,,, cke,, C ,,, \ es, e,- 2 New dwelling area: square feet
City /State /ZIP: ~ v .%p an .a v It. Garage /carport area: square feet
Suite/bFdg/*F:-no:: C.. \ Project name: N2��� Ax Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
\70V-•■1 V 9 1 v`_"'y `"k \ ') Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: \,,,i.\ ...A , 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
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 32,(o °.
N Q. � 1•e-- c bQ acc:..1 L- P*4 : o epNeccw� e —
Existing building area: square feet
S►co.
New building area: square feet
❑ . PROPERTY OWNER ❑ TENANT Number of stories:
Name: \-\pNCk. �, ill S.MQ 1-37 . �'' es Type of construction:
Address: \ \ 5.(.,_ Siz Occupancy groups:
City /State /ZIP: cJv1Z \, t t. U\-t. ckTZc5 Existing:
Phone: ( 5,..„) cz - , q op Fax: ( ) New:
r2"APPLICANT. .�- ❑-CONTACT PERSON NOTICE
Business name: �p,, ", C C. k es--: � Ru v� 'C�RC All contractors and subcontractors are required to be
^ licensed with the Oregon Construction Contractors Board
Contact name:
+y\ p .,. ) o under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. if the
applicant is exempt from licensing, the following reasons
City /State /ZIP: -apply:
Phone: ( ) Fax::( )
E -mail: i \ Iii. p o) cLtQSC 4>Qv.Gor•'∎
CONTRACTOR
Business name:—Q .G � V . s • �..• Q, 1...c.......-.17-41..c.... BUILDING PERMIT FEES*
SI e.��b (Please refer to fee schedule)
Address:
\-275c) 54� ��Q� coo aJ p s (ITV
Structural plan review fee (or deposit):
City /State /ZIP: .- V v gNe.‘aa th V SL ck'7 Z, - 2-4
FLS plan review fee (if applicable):
Phone: (I.,*5) ' c-bc=kV1cl Fax: (So3) 5ckg _ 61,,,ei:2,
��� `s Total fees due upon application:
CCB lic.: .,
Authorized signature: L7c1 1
Amount received: &At. cis
( This permit application expires if a permit is not obtained
`\ within 180 days after it has been accepted as complete.
Print name: A\ [1,, V oN r. Date: \ e, - a\ _ te e, * Fee methodology set by Tri- County Building Industry
Service Board.