Permit ._
'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00029
lii� DEVELOPMENT SERVICES DATE ISSUED: 1/26/2005
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S136AA -01500
SITE ADDRESS: 10313 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: 07 ,27. 6C7
Remarks: Adding (7) heads to existing system.
Owner: Contractor:
LUKE -DORF SIMPLEXGRINNELL LP
10313 SW 69TH 6305 SW ROSEWOOD ST
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
Phone: 503 - 624 -0866
Phone: 503 - 683 -9000
Reg #: LIC 149921
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 1/26/2005 $62.50 Sprinkler Final
[TAX] 8% State Surchari 1/26/2005 $5.00
Total $67.50
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 than 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 these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: ' # `.. _ ` ,h ,
Permittee ��
Signature: * A al CG
Call 6 -4175 by 7 p.m. f nspection the next business day
Building Permit Ap 1' FOR OFFICE: USE ONLY �j Received _ Buildin ,
V, D amnin g / ,, D� Permit No.:�N eoeu
City of Tigard a��1- Planning Approval Other
13125 SW Hall Blvd. 9 6 .615 Date/By:
Plan Review Other
Othe No.:
Tigard, Oregon 97223 .1 1 � Date/By: Permit No.:
o�: Post- Review Land Use
Phone: 503-639-4171 Fax: 503-598 ; �9(�QG,A' ��'ti ^`'l
Internet: www.ci.tigard.or.us ail v ' m : .! !� - L . Date/By: Case No.
ww ,,��;; Contact Juris.: N See Page 2 for
24 - hour Inspection Request: 5013119175 Name/Method:
r Supplemental Information
TYPE OF WORK 1 1 - r:
AgQui r:DAYA
New construction ❑ Demolition f & - 2 FAMIlt:YDWELLING" _
Addition/alteration/replacement ❑ Other:
CATEGORY OF STRUCTION: , - • • • Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building Multi- Family ed
___U Master Builder [=I Other: Valuation $ 727
: • " >d.OB SITE.INFORMATION'and'LOCATION No. of bedrooms: No. of baths:
S(�J Cam rti �E Total number of floors
Job site address: /03f 3 New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: S/ W /i 1 Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
.,: - REQUIRED. DATA
' .• COMMERCIAL = ''USE.CHECKLLg - ::
Subdivision: 1 Lot #: '
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
. DESCRIPTION OF WORK - • the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
/?-f - DIP SEVEN H e/, r-o
-- )65rovU Cysr pt/t Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
a'PROPERTY OWNER . I [] TENANT - - • • Type of construction
Name: S 91, 40vi ✓a-- NO V SE___ Occupancy group(s): Existing:
New:
Address: /03/3 Sri (,Ci 4-(45
City/State /Zip: (,44W oP2_ ?7 2
Phone: Fax: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
E APPLICANT Q CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City/State /Zip:
Phone: Fax: .
E -mail: : - - , BUii DRIG : PERMIT FE ES*
CONTRACTOR Plea e' refer t. fee .- .-_ .. ' •
• Business Name: S /ittA_, � ,t,,t,5 L...<__ Fees due upon application $
Address:60as' sa) / , --1 t bu p S -e -
City/State /Zip: /.444.___ os't,JE 70 o p2 _ ?7o.3._< Amount received $
Phone i3 . G, p,? . 90o0 _ Fax:. 3 .6 7S. (mss 2/ Date received:
CCB Lic. #: / y � q `
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: .j : ,,,, . ,/ Sate: r2--6.--66 180 days after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
(' - ase print name)
i•\Dsts`Permit Forms \BldgPermitApp.doc 01.03