Permit C: ' c c-t/, if
,. Building Pi rmit A a i ca ' 0 ..al i' 0 Commercial ' ` a , 1 FOR OF USE-ONLY
City of Tigard A ® ^ Received ¢ I d
`J g l✓ / � � p r r� DateB Ii �IIii / //� Permit No.. . . a �fo G l
13125 SW Hall Blvd., Tigar , OR � �°s. O 6 1+ Plan Review
' - 0 ` Phone: 503.639.4171 Fax: 503.598.1960 \, \N , p� Date/By: Other Permit:
Ti GA RD Inspection Line: 503.639 3`-' .(`tG N ate Ready/By: Jug H See Page 2 for
Internet: www.tigard- or.gov 1C >• tS�S� Notified/Method: 17 Supplemental Information
OF WORK 50 � Q
TYPE � 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
t] Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $
❑ 1- and 2-family g ®Commercial /industrial
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: 677 7 5 t lJ 13 0n t -kit 0).-t3. is 0 i i,z,. New dwelling area: square feet
City/State/ZIP: 7j#xi-K.4 L 9, y Z. 211 Garage /carport area: square feet
Suite/bldg. /apt. no.: to Project name: j 0 / , . D/ S-1—r L J (4 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. •
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the I,
Q DESCRIPTION OF WORK work indicated on this application.
/ d t e i //ILEL./51i1 J , /� /o.t Valuation: $ ® J C O'Q
9
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ' OZI TENANT Number of stories:
Name: 6 ra j i e b ist ri b ' - i nc. Type of construction:
Address: 6117 SVI b 0,11, 40, s , ' i:: b VOC Occupancy groups:
P� Y gr P
City/State/ZIP: % ,� 0,1_4) be_ ci-12p1 Existing:
Phone: ( 54. 5) 7 " fl')3 Fax: (5n) 5 ice '* W4 New:
a ,APPLICANTf ❑ CONTACT PERSON NOTICE
Business name: ) {- gibp// o� All contractors and subcontractors are required to be
Contact name: /7)14/ ___/4/1-41h 9 '/ "v' licensed with the Oregon Construction Contractors Board
v " under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E -mail: /t'L5 tyr'4,Jfei°. , 114.5' .
V / CONTRACTOR
Business name: N A Two BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address:
Structural plan review fee (or deposit): `y,.
City/ State/ZIP: -. Er
FLS plan review fee (if applicable): (i
Phone: ( ) Fax:( )
CCB lie.: Total fees due upon application: Co?
Amount received: (r `a tf
Authorized signature:
This permit application expires if a permit is not obt4ned
Print name: ,�,� �� / Date:v i .�V G ftj within 180 days after it has been accepted as complete.
/� ,1 f 2 S.s9 * Fee methodology set by Tri- County Building Industry
o......:..,, n...._a
Community Development
Request for Permit Action
0 92008
RECEIVED TIGAR,
D
DEC
TO: CITY OF TIGARD
Building Division Services Coordinator CITY of TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING DIVISION
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner n Applicant ❑ Contractor gr City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 6p s. t 5T � �u� � tom
v 1 0 Mailing Address: 1 7 7 7 o�tv�IJt Pb gt- b100
City /State /Zip: l i � f}21 , D 9-2 a a4
/ 5 / i /W Phone No.: 503 - q C S - 17 fit 3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
M . CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
-
Permit #: ' JI.boog -bp (Q3
Site Address or Parcel #: Lp 777 p�t,�7 6.70 r i r- .t 00
Project Name: ,g Pr Lit D (STv ( be
Subdivision Name: 14(1 Lot #: ft
EXPLANATION: J 1 . 0 LM - 1.0,41s 4 l/m l.R - Ti t t )
e 2.o '5 1 r t' e. , APPta P buCEb F1HCk,
Lhl 02.14 t T t5 _r3o ,JCo €2 b_QU. i Otb -
Signature: / ' / Date:
Print Name: � pji� b -,MS
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR .OFFICE"USE „ONLY'
Rte to Sys Admin: Date / f 06 By VIP Rte to Bldg Admin: Date 4Z 4S 1/4 f By
Refund Processed: Date /1747” By , +' • • Invoice Processed: Date %k /sr0� By
Permit Canceled: Date > /S y . - - B ..41.0,r. - Parcel Tat Added: Date f By
Receipt # a'—i fyr Date w /i, Method G (( Amount $
I: \Building \Forms \RegPermitAction. oc / Rev 07/26/07
Jt
CITY OF TIGARD
Building Division
TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503 - 639 -4171
INVOICE
TO: Bradlee Distributors, Inc. Customer ID: C08 -0005
6777 SW Bonita Rd., #100 Invoice No.: INV2008 -00021
Tigard, OR 97224 Invoice Date: 12/15/08
Attn: Mitch Jensen Date Due: Upon Receipt
Case No. ``7 : ite'Addres §' :,v:. y` .Subdivision ;= I o't # oc Project Name• F *A nou'nt
BUP2008 -00193 6777 SW Bonita Rd., #100 Bradlee Distributors
Plan review balance due: $63.45
Invoice Total: $63.45
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: BUP2008 -00193 Customer ID: C08 -0005
Site Address: 6777 SW Bonita Rd., #100 Invoice No.: INV2008 -00021
Project: Bradlee Distributors Invoice Date: 12/15/08
Date Due: Upon Receipt
Invoice Total: $63.45
Amount Paid: $
Office Note: Forward copy of receipt to Dianna Howse for invoice file.
Please mail payment to:
City of Tigard, Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Dianna Howse
I: \Building \Accounting \Invoice.doc 04/06
12/15/2008
CITY OF TIGARD Fees Associated With 8:36:17AM
1 13125 SW Hall Blvd. Case #: BUP2008 -00193
TIGARD Tigard, OR 97223 503.639.4171 _
.:--� _��. --.� � 2 Created. -` •
- - -�� -�. E =���*�_ Revenue i .�, _ ��
:,�:' s; �� ��:<.• - a Due •Starf•
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Fee � F - '
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N�"
Date� -' -� ..,
_�" .Number- -'r� -: - :' -:... .�,.
��� �z ;�' «= rDescri tion_; . >-� F �:}� �,�- :- °�.�;'.Account . r `� - :� .. : �.... � '
� - ;. _g r , il ' rDate `� ;-� � � ;c � F:� I? - , - ` .�c :a^ � " .t, " c,�.' . : " " >._: - _r•: _. .; ..x � � � >.,_- ..e'^�.�. -.. _,_ ._. �_ _. ., ._.- �_ a r_ _ —. - _
7� s: ��� s� .,,_�� -E�, f, ...t = " �:._..._ : �.., • ..: :_
PLCK 1/1/1990 12/31/2020 [BUPPLN] PInRv 245- 0000 - 433000 BLD 6/6/2008 14.36 0.00 -
FIRE 1/1/1990 12/31/2020 [FLS] FLS Pln Rv 245- 0000 - 433020 BLD 6/6/2008 47.88 0.00
PRMT 1/1/1990 12/31/2020 [BUILD] Permit Fee 245- 0000 - 432000 DAN 6/12/2008 119.70 119.70 +
SUR1 12/31/2007 12/31/2020 [ TAX]..1.224- S.tate_,Surcharge 100- 0000 - 207020 DAN 6/12/2008 14.36 14.36
PLCK 1/1/1990 12/31/2020 [ i" PPLN] Pin Rv ' 245- 0000 - 433000 DAN 6/12/2008 63.45 63745
Total Due: $197.51
CaseFees..rpt
Page 1 of l
CITY OF TIGARD 12/2/2008
"�
1 312; sw tlau 13h�d. 1:33:23PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000001944
Date: 06/06/2008 -
Line Items:
Case No Trail Code Description Revenue Account No Amount Paid
13UP2008 -00193 [BUPPLN] Pln Rv 245- 0000 - 433000 14.36
BUP2008 -00193 [PLS] TLS Pln Rv 245- 0000 - 433020 47.88
Line Item Total: $62.24
Payments:
Method Paver User ID Acct. /Check No. Approval No. I -low Received Amount Paid
CreditCard BRADLEY DISTRIBUTORS / BTT 021082 In Person 62.24
MITCI -TEAL JENSEN
Payment Total: $62.24
ekeeeipt rpi I ege I or I