Permit CITY OF TIGARD BUILDING PERMIT
, 2 - COMMUNITY DEVELOPMENT Permit #: BUP2010 -00196
A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2010
T t G R
Parcel: 2S 101 AC00400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: NATIONAL SAFETY BUILDING Lot: 0
Project: Willamette Dental
Project Description: Illuminated monument sign.
Owner: FEES
NATIONAL SAFETY COMPANY Description Date Amount
17010 SW WEIR RD Permit Fee - Additions, Alterations, 08/20/2010 $180.17
BEAVERTON, OR 97007 Demolition
PHONE: 12% State Surcharge - Building 08/20/2010 $21.62
Plan Review 08/20/2010 $117.11
Contractor:
ES & A SIGN & AWNING
89975 PRAIRIE RD
EUGENE, OR 97402
PHONE: 541- 485 -5546
FAX: 541- 485 -5813
Specifics:
Type of Use: COM
Class of Work: OTR
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $6,197
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $318.90
Required: Required Items and Reports (Conditions)
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 t 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 044144X1-4-1 Permittee Signature:
Cali 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 --, OFFICE USE ONLY
_- . , 1
City of Tigard , , ' , � �_,: �, , , . J Rece fell �% Permit 1‘121.14/4) .%�iY7 (/V
II n 13125 SW Hall Blvd., Tigard, OR 97221 i, Plan Review
m . Phone: 503.639.4171 Fax: 503.598.1960 2010 DateB : „ _ k Other Permits��� /O.i iQ •`/
Inspection Line: 503.639.4175 AUG 17 Date Ready :y: ® See Page 2 for
T I G A R D Notified/Method: Supplemental Information
Internet: www.tigard or.gov , , �, `t;
CC\{ u r , -t.,;
'
TYPE OF WO - 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
❑ Addition/alteration/replacement Other: 144,, equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling Commercial /industrial
Number of bedrooms:
❑ Accessory building ❑ Multi- family
Number of bathrooms:
❑ Master builder
❑ Other:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ?DAIS SIB 601,42.A-64r New dwelling area: square feet
City /State /ZIP: ( l p 2 . Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: W Lyr) e - ; 7 , Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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. _
/ Y Valuation: $ 61 q7r'
1 N SO 1( -t.I,, ll,�. & NJ A-ru - MONW /4 r S /lcnl 2 OA*
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ig TENANT Number of stories:
Name: (M WAWA I*T 1 X-14 v Type of construction:
Address: q N 6 -,.; 'i,,,, sr. Occupancy groups:
City /State /ZIP: '1R4 tat Ir a?. i (" 'tfD(Og. Existing:
Phone: ( ) Fax: ( ) New:
21 APPLICANT pir CONTACT PERSON NOTICE
Business name: �S it A. Sl Loki pip ()Iva kr L 1.31 All contractors and subcontractors are required to be
Contact name: 8000,4 -• —1:12-60.4...0 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: S r '] 0,4 L 4), jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: 044,040 t Q 1 2_, Q'/ tic 1. apply:
Phone: (641 ) - 4-94‘, Fax: : (041) cols. 6&i S
E -mail: L' .A e4t,.I'1'ee✓'- ?owe/ 1 e eBQ SI q i1S • C4SYY1
CONTRACTOR
Business name: M* it y (( A, 1 ) AxjN 1 W4 BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address: 641 tic -p p...-- Structural plan review fee (or deposit):
City /State /ZIP: toAtt E .-, o p._ o p-- 1 14 D -
LLb,-. FLS plan review fee (if applicable):
Phone: ( ) kiss. S54'�O Fax: ( ) ,r Ti �"J - G�i 3
140 2i LZ � Total fees due upon application:
CCB lic.: !K p 1
Amount received: 3/f ?&
Authorized signature: d This permit application expires if a permit is not obtained
� within 180 days after it has been accepted as complete.
Print name e `9 .Q h xv(.(1 Date: gi(... /' , /0 * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 10/01/09 440-4613T( 1 1/02/COM/WEB)