Permit •
1a CITY OF TIGARD
SITE WORK PERMIT
COMMUNITY DEVELOP P ERMIT #: SIT2007 -00021
DATE ISSUED : 7/26/2007
T AG - , 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL : 1 S 135CB -00300
SITE ADDRESS: 11445 SW TIEDEMAN AVE ZONING : I -P
SUBDIVISION: LOT: JURISDICTION : TIG
PROJECT: ROOFLIFE OF OREGON
Project Description: Site work for warehouse addition.
CLASS OF WORK: ADD PAVING ?: N RESO. NO:
TYPE OF USE: COM GRADING ?: N VALUE: 2,000.00
EXCV VOLUME: cy LANDSCAPING ?: N
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?:
SOILS RPT REQD ?: N IMPERV SURFACE: 144 sf
Owner:
FEES
TIEDEMAN CROSSING LLC Description Date Amount
11445 SW TIEDEMAN AVE. [TAX] Valu 8% State Surcha 7/26/2007 $5.00
TIGARD, OR 97223 [BUILD] Prmt Fee -Valu 7/26/2007 $62.50
[BUPPLN] Pln Rv -Valu 7/26/2007 $40.63
Phone: 503 - 925 -0125 Total $108.13
Contractor:
COVERT ENTERPRISES INC
979 66TH STREET
SPRINGFIELD, OR 97478
Contact #: PRI 541 - 729 -1649
REQUIRED ITEMS AND REPORTS
Reg #: LIC 82272
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 req ou to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 52 -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: // Ajar Permittee Signature ,;
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.
From:PK MORIN ENTERPRISES 5039259025 07/24/2007 11:17 #114 P.002 /003
Site Work
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Bnlld><ln� Permit Application 1; . . .. r n . ,, k 1.,. . , ' ,
p� C w x B l � v d axigard, OR 97223 JUL 4 200 . 7 all e i Permit /40.: /7-et50 '
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S Phone: 503.639.4171 Fax: 503.598.1960 Dot= . � If `'� Other Permit
, , C Inspection Line: 503,639.4175 C7 : i. P.: D Date Ready/Hy '/ See Page 2 for
t �` � Internet: www.ugard- or.gov p , ° e Supp�tal inform dos
BI,C..,�1i . ,� U1 = -', s maul/Method: D ' �, !�!m i'irif./Airr'J!! rd!
TYPE OF WORK REQUIRED DATA: 1- AND ' FAMIL; D ` '4' LUNG
0 New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
el Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
❑ 1- and 2- family dwelling El 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: 11445 SW TIEDEMAN AVE New dwelling area: square feat
City/State/Z1P: TIGARD, OR 97223 Garage/carport area square feet
Suite/bldg./apt. no.: Project name: ROOFLIFE OF OREGON Covered porch area square feet
Cross street/directions to job site: GREENBERG ST Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: 300 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_ �/�
Remodel warehouse by rebuilding 3 walls and pouring a concrete floor where a Valuation' $ � ' _
raised sub floor is. We are expanding the (Anginal warehouse by 144 square ft Existing building area: 2048 square feet
New building area: 144 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Tiedeman Crossing LLC Type of construction:
Address: 11445 SW TIEDEMAN AVE Occupancy groups:
City/State/ZIP: TIGARD, OR 97223 Existing:
Phone: (503)925-0125 i Fax: (503)214-5185 New:
❑ APPLICANT IN CONTACT PERSON NOTICE
Business name: All contractors end subcontractors am required to be
Contact name Peter Morin licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11445 SW TIEDEMAN AVE jurisdiction in which work is being performed. If the
City/Stet IZIP: TIGARD, OR 97223 applicant is exempt from licensing, the following reasons
y
Phone: (503) 925 -0125 Fax: : (503) 214 -5185
E -mail: moriu9034@botmaiLcom
r �v ., CONTRACTOR
Business name: v � (. / 1 C� BUILDING PERNIIT FEES*
Address: ' ` t7 , lease -I erto sehedal
City /State/ZIP: 'J t ! 00 e f j ) �l ` i 7 --r stnratrra plan review fee (or deposit):
te') 7Z FLS plan review fee (if applicable):
(
Phone: % ' C ` Fax ( )
. '�'� - Total fees due upon application: - �
CCB lie.: QU
Amount received: NMI
Authorized signatrue �/L- This permit applkadon expires if a permit obtained
. ^ � within 180 days after it has been accepted as complete.
Print n Vita-v- � V V1 C11�1 Vt. Date: 7 / • Fee methodology set by Tri- County Building Industry
Service Board.
I:\ Building \Permits\SIT- PermitApp.doc 06/26/06 440- 4613T(11 /02/COM/WBB)