Permit CITY OF TIGARD BUILDING PERMIT
` c - COMMUNITY DEVELOPMENT Permit #: BUP2010 -00162
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/20/2010
Parcel: 1 S136CD01001
Jurisdiction: Tigard
Site address: 11747 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Chevron
Project Description: Demolition of existing building and canopy structures.
Owner: FEES
CAIN PETROLEUM INC Description Date Amount
4512 SW KELLY AVE Permit Fee - Additions, Alterations, 07/20/2010 $271.43
PORTLAND, OR 97239 Demolition
PHONE: 503- 546 -3535 12% State Surcharge - Building 07/20/2010 $32.57
Erosion Control 07/20/2010 $26.00
Erosion Plan Review CWS 07/20/2010 $8.45
Contractor: Erosion Plan Review COT 07/20/2010 $8.45
DOUBLE R PRODUCTS /DEL J INC
901 NW E STREET
GRANTS PASS, OR 97526
PHONE: 541 -476 -1387
FAX:
Specifics:
Type of Use: COM
Class of Work: DEM
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $12,500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $346.90
Required: Required Items and Reports (Conditions)
1 BUP Ersn Cntrl 681 -4444
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
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: i �,%_ Permittee Signature: 4v gi o,O G /G ' 0 . - mod N
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 Application H 4 ► g NOD F- zO, j g
Commercial
t g Received Q o � � �� ��
CI of Tigard DateB : K (d. Permit ` / 0 ,, Q
� ° 13125 SW Hall Blvd., Tigard, OR 97223 PI • . ' c _ _
■ " , Phone: 503.639.4171 Fax: 503.598.196 'a Other Permit:
= MAR 1 1 2013 � -• �"�
I I ,\j)• Inspection Line: 503.639.4175 Date Ready ■ y: Juris la See Page 2 for
Internet: www.tigard or.gov Notified/Method: . . Supplemental Information
TYPE OF V ii1C ` ' ' t '.. r ~' REQUIRED DATA: 1- AND 2- FAMILY. DWELLING
New construction �N�i Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ 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: S
❑ 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: 1 1 741 j t0 +-4 ; i-+ c� New dwelling area: square feet
City /State /ZIP: 1 14GJt St 0 r 9 7 2 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: U ( Project name(' oh e dfo ,l Covered porch area: square feet
Cross street/directions to job site: A T 11,4_, ,3 i Deck area: square feet
l% Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: ( (i C I 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
3 S ( equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application._
D . J.ri v ...e-11-;..ti 6 CQ nip,/ " ► Valuation: $ &� 5�
J Existing building area: square feet
a _-- . - .r:� - -- - a� -c:e Egg .
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name:( ,1 P ray yyt �,J Type of construction:
Address: of 6 e ' I K Occupancy groups:
City /State /ZIP:�O € 4 /ai.n d J O ,�' 7 - 7 3 % Existing:
Phone: (523 ) SQ(, -- 3 S 3S Fax: ( ) New:
lA (CCONTACT PERSON NOTICE
Business name: PD4 All contractors and subcontractors are required to be
: 1 licensed with the Oregon Construction Contractors Board
Contact name
n0 V � � ` o ' — under ORS 701 and may be required to be licensed in the
Address: ( 3 s- S IA ) L, to •T 3.& 2 d ( jurisdiction in which work is being performed. If the
p r- �, �} applicant is exempt from licensing, the following reasons
City /State /ZIP
t [ . t Ci 7 Y apply:
Phone: (S2) ) 3;29 5395' Fax: : 6 ) 1.2 7- t5 4 S 4.
E -mail: rpcil I- L nn n i€ CS/I1r. , 1.1e_
l CONTRACTOR
Business name: ' t (C.., R 4 a � T DD rocs ci.CAS BUILDING PERMIT FEES*
Address: l a , A 1 IL)/-) 1 . (Please refer to fee schedule) n
City /State /ZIP: 'IiV Structural plan review fee (or deposit):
�fce�Tc ru5s t O le_ -•
Phone: (S.k (Al (p ,, t 3 87 Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: 04 4 1 1_'1' Total fees due upon application:
i
64-/- tion expires if a permit is Amount tom' e j L11
Authorized signature: Thi perm applica not obtained J
(tea
'/ c � / within 180 days after it has been accepted as complete.
Print nameT A t i [� I !/n ryl e__( l { ( Date: 3 l ( V * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB)
;� CITY OF TIGARD FEE AND PAYMENT HISTORY
c 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
n:lGARD
BUP2010 -00162 - 11747 SW PACIFIC HWY, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee - Additions, Alterations, 2300000 -43104 $271.43 $271.43 $271.43
Demolition
12% State Surcharge - Building 1003100 -24001 $32.57 $32.57 $32.57
Erosion Control 1003100 -22002 $26.00 $26.00 $26.00
Erosion Plan Review CWS 1003100 -22003 $8.45 $8.45 $8.45
Erosion Plan Review COT 2300000 -43107 $8.45 $8.45 $8.45
Totals for Fees $346.90 $346.90 $0.00 $346.90
Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount
Total Payments: $0.00
ance Due: $346.90