Permit -
C ITY dF TIGARD RD SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SIT2007 -00007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 5/31/2007
PARCEL : 2S102AA -00600
SITE ADDRESS: 12045 SW HALL BLVD 7- ELEVEN ZONING : CBD
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT: 012 JURISDICTION : TIG
PROJECT: 7- ELEVEN
Project Description: Repair ADA ramp.
CLASS OF WORK: -REPQT& PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 2,400.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
7-ELEVEN Description Date Amount
20819 72ND AVE [BUPPLN] Pln Rv -Valu 2/15/2007 $65.59
KENT, WA 98032
[FLS] FLS Pln Rv 2/15/2007 $46.87
[BUILD] Pnnt Fee -Valu 5/31/2007 $72.10
Phone: 253- 796 -7111
[TAX] Valu 8% State Surcha 5/31/2007 $5.77
Total $190.33
Contractor:
DLB CONSTRUCTION INC
190 DILLON AVENUE SUITE F
CAMPBELL, CA 95008
Contact #: PRI 480 - 540 -9734
FAX 480 - 370 -1923 REQUIRED ITEMS AND REPORTS
Reg #: LIC 174865
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 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 copies of these
rules or dire • -stions to • - C by calling 503.246.6699 or 1.800.332.2344.
I
Issu-d By: / 4 I/. J Permittee Signature: mrs 1,,"
F
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.
1 ScJ )4 Q,_L T. 1_ v1). - 7` rL r/.4 ,J
4,-.5f.
., Permit A • • lication
FOR OFFICE USE ONLY f� -1 , t,
74 City of Tigard 1 t ' , 0 2/701 ��t Permit No.: 7
13125 SW Hall Blvd., Tigard, OI 9 Plan Review �'�/
Phone: 503.639.4171 Fax: 503.598.1960 ( Date/B : MAC 3 -1- 6 7 T wit:
TI G r� RD Inspection Line: 503.639.4175 t % ° • , 1, .. t t) ` � � Date Ready/By: Juris: ® See Attached Checklist for
' Internet: www.tigard or.gov L Notified/Method: Supplemental Information
.. a k n ° ':. TYP OF ' e 4 " REQUIRED, DATA:'. 1-t A ND 2 FAMIL DWEL
,11 � 5
' ; �� , ' i o n Permit fees* are based on the value of the work performed.
❑ New construction � -fit .
Indicate the value (rounded to the nearest dollar) of all
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
' ' CATEGORY' OFvCONSTRUCTION `
work indicated on this application.
❑ I- and 2- family dwelling ❑ Commercial/industrial Valuation: $
❑ Accessory building C) Multi-family Number of bedrooms:
❑ Master builder ❑,gier: a, ! Number of bathrooms:
-,.',a: . JOB- SITE INFORMATION, AND LOCATION Total number of floors:
Job site address: J 0y /,c;e // Xit New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bldgJapt. no.: I Project name: a3999 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: 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
, materials p
equipment, labor, profit for the
p overhead, the ro
DESCRIPTION` OF`W RK work indicated on this application.
Valuation: $ a yb6551
Existing building area: square feet
New building area: square feet
,� . p ![0., PROPERTY. OWNEL = I , , .[TENANT . ' Number of stories:
Name: .1-- 1 Type of construction
Address: /2Q V / / ' e Occupancy groups:
City/State/ZIP: aolt.-7 � A 91'0 Existing:
Phone: � ) 774, (O _ 1� I Fax: (Z l 0 ?/ 2 (� New:
• *. 4 4, ` PLICANT L-EONT PERSON ;x -
_. NOTICE
Business name:
G J2t A ll contractors and subcontractors are required to be
Contact name: �iL- /errSGY!! licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: .
/5 ( /04"- e' �p jurisdiction in which work is being performed. If the
V CD T !O
City/ State/ZIP: / �// � //� / / ?/ P
applicant is exempt from licensing, the following reasons
Phone: 16 �� / 7 6 - E��J C apply:
r,, � ,,ll Fax: ( 1-1244,!a t?O Jj ,, yam
E -mail: e he(i.yDsse RJ he
.r:>• CONTRACTOR • ' A ./
Business name: ` . • BUILDINGPERMITFEES* '
Address: "(Please refer toJeeschedule) '
Structural plan review fee (or deposit):
City/ State/ZIP:
Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: Total fees due upon application:
Amount received:
Authorized si u ,, r1 4 �� j I This permit a expires if a permit is not obtained
Print:name: ir , / Date: within 180 days after it has been accepted as complete.
/ A. f �� ' Fee methodology set by Tri -County Building Industry
Service Board.
L' Building \Permits\BUP- PermitApp.doc 03/21/06 440-4613T(1 t /02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION ' PERMIT #: SIT2007.00007
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5131/2007
Phone: (503) 639 -4171 /6 qau iv
Inspection Requests (24 Hrs.): (503) 639 -4175 ��''I:i.. i
INSPECTION WORKSHEET FOR DATE: 6/15/2007 TIME: 7:02AM PAGE: 84
SITE ADDRESS: 12045 SW HALL BLVD 7- ELEVEN CLASS OF WORK:
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 012 TYPE OF USE:
PROJECT NAME: 7-ELEVEN
DESCRIPTION: Repair ADA ramp.
OWNER: 7- ELEVEN, PHONE #: 253796 -7111
CONTRACTOR: DLB CONSTRUCTION INC PHONE #: 480 - 540 -9734
Inspection Request Scheduled For: Date: 6/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 050261 -02 408-540-9734 N
Corrections/Comments/Instructions:
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I7 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IN FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: V(/; Date: to /t y g 1 Phone #: (503) 718 - — 2j/ 2-
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CITY OF TIGARD -
BUILDING DIVISION ' PERMIT #: SIT2007- 00007
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/31/2007
Phone: (503) 639 -4171 V Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 6/1/2007 TIME: 7:02AM PAGE: 64
SITE ADDRESS: 12045 SW HALL BLVD 7 - ELEVEN CLASS OF WORK:
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 012 TYPE OF USE:
PROJECT NAME: 7 - ELEVEN
DESCRIPTION: LRep it ADA`rari?P .
OWNER: 7- ELEVEN, PHONE #: 253-796-7111
CONTRACTOR: DLB CONSTRUCTION INC PHONE #: 480 -540 -9734
Inspection Request Scheduled For: Date: 6/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 049374 -02 408 -540 -9734 N
Corrections/Comments/Instructions:
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n PAS n PARTIAL APPROVAL n CANCEL. I I NO ACCESS
W AIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
t i k.1---
Inspector: Date: Y l \ /0 - 1 Phone #: (503) 718 - 2-Y2-11