Permit 9 - A.7 -6 / sak_r c�
BUILDING
"CITY OF TIGARD PERMIT #: BUP2004 -00425
1- _;�
DEVELOPMENT r SERVICES o � 639 -4171 DATE ISSUED: 9/7/2004
SITE ADDRESS: 11565 SW DURHAM RD 120 PARCEL: 2S110DC -02400
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: UNK 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 6,500.00
Remarks: T.I.
Owner: Contractor:
MOODY HOLDINGS MOODY HOLDINGS
5701 NE 105TH # D 5701 NE 105TH # D
PORTLAND, OR 97213 PORTLAND, OR 97213
Phone: 503 - 860 -0235
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 9/7/2004 $110.50 Electrical Permit Required
TAX 8% State Surchar 9 /7/2004 $8 84
Plumbing Permit Required
[TAX] i Framing Insp
[BUPPLN] Pln Rv 9/7/2004 $71.83 Gyp Board Insp
[FLS] FLS Pin Rv 9/7/2004 $44.20 Final Inspection
Total $235.37
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:
Permittee
Signature: 3
Call 639 -4175 by 7 p.m. for an inspection the next business day
/'
Building-Permit Application FOR OFFICE USE ONLY
Received
DateB Pemvt No ( � J i( ' 7 -`^ y
City of Tigard
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503 639.4171 Fax: 503.598 1960 /44040,401, ' i X Date/B . Ot Permit.
Inspection Line: 503.639.4175 ,-1''` Date Ready/By. H See Attached Checklist for
Internet www ci.tigard.or.us Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
,,.a dditton/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
- -. r_ ter~ .e t work indicated on this application.
*,` "A =, `" " s'a , t 4 ,_, ,. . .sin , 45;A'y�,� •;,
- x l � Cy r#T A % O o STR6c ib 'V:` A ' -mss .. -
Valuation $ ® ��
❑ 1- and 2- family dwellmg .[�Commercial/uidustnal �'' ll
�
❑ Accessory building El Multi-family Number of bedrooms
❑ Master builder ❑ Other: Number of bathrooms: ' /
ar„ -'�`� sz�r4 '' �au,^,<}; ;= �ey�r.•r, s.? rt*,'ci ` .,,; "r"�.,,., - "`'`�• - ;•e ` =�''.' "*" 'r /
Y � ' `1.4-- lfei hSITE1, AVai G A'T ° t v ,l Total number of floors:
,. ,•a. . ` `;,,%?-;ts ,.ate ,= :..,,, ,t . .€�ve4 :x r .- .:4 „. n ?; ..;
Job site address: //5 ..$4, ` a / % a. 41..4 New dwelling area: square feet
City/State /ZIP: 77 pi.-•y A q . 2 Garage /carport area: square feet
Suite/bldg. /apt. no.: 4:4! a Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
n 71 4 , Q- i.) A DA,.miwo V1fN R CI A I =L r CI LI ST ;
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 matenals labor overhead and the profit for the
t.Y.?` ; " �xgY'a. , -, "1""z : . >zt� "c>w,': �e,-., ....�,•.taa. "` i�r ,. ' — , *''n' R' S` s � ' ,,: �`
•; ` IO O O� {-Y; work indicated on this application.
._ 1::r^ -- %R. // - f- ,4 0Q /XC Valuation: $
f l! Existing building area: square feet
New building area: square feet
, �. El Or > i _ _'a f, N umber of stones:
Name: 4 � G
� Type of construction:
Address: 9' V if J .v.,,/ p Occupancy groups •
City/State /ZIP: Vvt%A
iI 4 C "A - Existing:
Phone: (3) 5/00 _o -z?� Fax: ( )
New:
'E O ff .,- -- d; s 3 , t in` . IG
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
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 followmg reasons
apply:
Phone: ( ) Fax : ( )
E -mail:
°.,1e �', M -�,=:. ����`� 4., erg- } s , �- �,',, j #., `' � "�� x:, a""
4_ ors`
Business name: t �.... x � .
t,: ;- TI DING "PE•iVIIT' °FEES *`
Address:
Please refer to fee schedule.
City/State /ZIP: `
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.:
Date received.
Authonzed signature: / �� This permit application expires if a permit is not obtained
l/ within 180 days after it has been accepted as complete.
Print name: 4P,/ (,gok- / Date: * Fee methodology set by Tri- County Building Industry
Service Board.
I \Buildtng\Pennas \BUP- PermiiApp doc 12/03 440- 4613T(11 /02 /COM/WEB)