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Permit a CITY OF TIGARD BUILDING PERMIT ft COMMUNITY DEVELOPMENT Permit #: BUP2009 -00150 T 1 G "AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009 Parcel: 1S136DD03800 Jurisdiction: Tigard Site address: 11675 SW 66TH AVE Subdivision: WEST PORTLAND HEIGHTS Lot: 7 Project: City- County Insurance Project Description: TI Owner: FEES CITY COUNTY INSURANCE Description Date Amount 1313 COURT ST Permit Fee - COM 08/05/2009 $510.70 SALEM, OR 97303 12% State Surcharge - Building 08/05/2009 $61.28 PHONE: Plan Review 08/05/2009 $331.96 Plan Review - Fire Life Safety 08/05/2009 $204.28 Contractor: BNK CONSTRUCTION INC 45 82ND DR SUITE 53B GLADSTONE, OR 97020 PHONE: 503 - 557 -0866 FAX: 503 - 557 -1085 Specifics: Type of Use: COM Class of Work: ALT Dwelling Units: 0 Stories: 2 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $80,000 Floor Areas: Total Area: . 0 Accessory Struct: 0 Basement: 0 . Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $1,108.22 Required; Required Items and Reports (Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This • - it is issu - • bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will b- • one in accordance w • 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 • -ys. ATTENTION: Oregon - • 'r- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR •52- 001 -0010 through OA' • - / 100. You may obtain a copy of the rules or direct questions to ON • • • • • :00.332.2344. ssued By: � r Permittee Signature: � ! - =��� . .��. �[�.�i _ - l 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. Building Permit Application Commercial FOR OFFICE USE' ONLY City • Red /��� ( � � Cl` Of Tigard Re ceive : • Pemut No.: F....00 a 13125 SW Hall Blvd., Tigard, O R 97223 Plan Review / — l l� / i other Permit: I Phone: 503.639.4171 Fax: 503.598.1960 Date /B B : `r�rs J .1=1'0 A R1) Inspection Line: 503.639.4175 Date Ready/By: See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Informotion TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING Dew construction 0 Demolition 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. ❑ 1- and 2- family dwelling V'Commercial/industrial Valuation: $ El 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: `i ez,:—/ S G't. ` New dwelling area: square feet City/State/ZIP: Tc� \ a , V. 9 .1oDk�3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: z. � A l _ S .b � � l Deck area: square feet \ 1 %•41ge- Aq4t.s. Vkkek Ta'tia CceA., tuna. ' Ci.e�t�11 Other structure area: square feet Q:6 tv else tS Erg REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: 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. Ces r `kr � c�p�:V: NJ iS° _ Valuation: $ �S � (*NUS . as \14...A.11, CA. C.C.N�i Act kit . t �)6%.s 4r \ c� ta,�M Existing building area: `h`d square feet itAilttt-e.a, s 'i' # C � 4,\,ecc,, New building area: square feet tia PROPERTY OWNER I `' 7 TENANT Number of stories: Name: r *K..4 r al J - 1 — ‘1.x.. QV 0oir.c.9.1 Type of construction: Address: L�t-S Co. +trfi t . Occupancy groups: City /State/ZIP: <t*.hojit-4, ` t*. Existing: Phone: (fit) 1G's — `sT O Fax: ( ) New: lg. APPLICANT CONTACT PERSON NOTICE Business name: lk G,e.. by &wad All contractors and subcontractors are required to be ` licensed with the Oregon Construction Contractors Board Contact name: ~ © .e -3.► S under ORS 701 and may be required to be licensed in the Address: t l jurisdiction in which work is being performed. If the City /State /ZIP: ��++� applicant is exempt from licensing, the following reasons l r� ol.SNI,v.s. ` c . ert 2131 apply: Phone: esta) s _ OeZt Q.. Fax: : (�•) b S ' t.1S'S E-mail: v4,2,t \kv.n.1..n r c c.%ur. CONTRACTOR Business name: ' C ttiv.�e BUILDING PERMIT FEES* Address: �S �0 Q ., �.w�a . SZQ view ereJerlo fee schedule) City/State /ZIP: le) Structural plan review fee (or deposit): �Ls�.,a e�IC g - FLS plan review fee (if applicable): Phone: (.sz2) 'S5 - icz,x6g. Fax: ( ,V 'KS'Z — W5 S Total fees due upon application: CCB lic.: `(5"1 45-s s Amount received: Authorized signature: This permit application expires if a permit is not obtained Print name: c Date: / within 180 days after it has been accepted as complete. �('��Q * Fee methodology set by Tri -County Building Industry Service Board. 1: 1Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB) CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARP Receipt Number: 175199 - 09/14/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID BUP2009 -00150 Miscellaneous Administration Fee 2300000 -43130 $90.00 Total: $90.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1928 STREAT 09/14/2009 $90.00 Payor: BnK Construction Inc Total Payments: $90.00 Balance Due: $0.00 Page 1 of 1