Permit ri,:.. r '°�° � °� SITE WORK PERMIT
1 ll
d COMMUNITY DEVELOPMENT PERMIT #: SIT2007 -00006
451,4 DATE ISSUED : 6/6/2007
irig.G,A4.4ra 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BC -00201
SITE ADDRESS: 10765 SW GREENBURG RD ZONING : C -G
SUBDIVISION: LOT: JURISDICTION : TIG
PROJECT: 7- ELEVEN
Project Description: Repair ADA ramp.
CLASS OF WORK: REP PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 2,400.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
7-ELEVEN Description Date Amount
20819 - 72ND AVE [BUPPLN] Pln Rv -Valu 2/15/2007 $65.59
KENT, WA 98032 [FLS] FLS Pln Rv 2/15/2007 $46.87
[BUILD] Prmt Fee -Valu 6/6/2007 $72.10
Phone: 253 796 - 7111
[TAX] Valu 8% State Surcha 6/6/2007 $5.77
Total $190.33
Contractor:
FLYING TIGER CONSTRUCTION
PO BOX 1803
GRESHAM, OR 97030
Contact #: PRI 503 936 - 3922
FAX 503 - 826 - 1219 REQUIRED ITEMS AND REPORTS
Reg #: LIC 163404
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.
t
Issue y: 1 ' Permittee Signatur :
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.
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,■'.-- Permit Application: .,z ` i 1 ;
1� �- ' Sf,�' �'+ iul � i�tNil u t+HK wa .a: � �i �. .,t. � i � � 1 .
City of Tigard Date/By: i /S a Permit No.: i' / 1 �� ~ t'�(/
;b r 13125 SW Hall Blvd, Tigard, OR 97223 `rr +r�� C 01 Plan R e iew
i ! ® Phone: 503.639.4171 Fax: 503.598.1960 T LD � 20 �� mAV : i - ' t fi � � Permit: Received '
,' Inspection Line: 503.639.4175 �e Ready/By: 1 J/ 3 ® See Attached Checklist for
1 I j �' .4% t ° (" fi �/ 9 a7 � Sapplemeatal laformalioa
r. - : ;� ..�:� Internet www.tigard- or.gov �� y � (�1� j. �aJ- m //
a ?'- r1i11C n
TYPE OF 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
9 ❑ 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 Q-Other: -4T1t-r' ( Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / D 6,s. 310 c f ' M New dwelling area: square feet
City /State/ZIP: Garage/carport area: square feet
Suite/bldg./apt. no.: I Project name: *�S` Covered porch area: square feet
Cross street/directions to 'ob site: Deck area: square feet
• [ ,4 b ?#(ii& 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.
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 WO work indicated on this application.
2 ,i'K /MA / 2 0 Valuation: $ 03696.29
Existing building area: square feet
New building area: square feet
['PROPERTY OWNER I [D- TENANT Number of stories:
Name: 9_67e see l �J Type of construction:
Address: d D S/ % - 12" 4,,, Occupancy groups:
City/State/ZIP: �K+ /rP e� /--- IiC
- J /1 y�Q - - Z �7 Existing:
Phone:AN3) / /�o - 7/1 / Fax: ( 45-3 - /4Q ( New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ` -.21:#5.:4 All contractors and subcontractors are required to be
Contact name: tC�'2 �.e(//� ,g55(_. licensed with the Oregon Construction Contractors Board
Address: /SS - /� f under ORS 701 and may be required to be licensed in the
(� S�''` 4 C , v /�' jurisdiction in which work is being performed. If the
City/ State/ZIP: `� �V Q » applicant is exempt from licensing, the following reasons
// / O / � / apply:
Phone: ( 7 -6 7' !/ / Fax:: (cP� 2c,/6 - o 3 6Y
E -mail: t'O /h 1055e1 .1.-t
a Ahhg 61)tvl
CONTRACTOR
Business name: �—
_ l S \ ` tS�cy.�r�v� BUILDING PERMIT FEES*
Address: \--'. \ '� (Please refer to fee schedule)
��?T --" Structural plan review fee (or deposit):
City/State/ZIP:C Ck' M (t
Phone ) c=t ,.ZC`"�'Z Fax: �L_`'� FLS plan review fee (if applicable):
1, t
iv. 10 Total fees due upon application:
` Amount received:
Authorised signature: This permit application expires permit is not obtained
Pe PP lication P ires if a Pe
within 180 days after it has been accepted as complete.
Print name:
i doe Z 0 r, Date: / 5 D? •Fee methodolo set by Tri County Building Industry
Se Boar
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