Permit C ITY OF TIGARD SITE WORK PERMIT
° COMMUNITY DEVELOPMENT PERMIT # : SIT2007 - 00025
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 11/14/2007
PARCEL : 2S101AB - 01300
SITE ADDRESS: 07315 SW HERMOSO WAY ZONING : MUE
SUBDIVISION: SHINMEN OFFICE LOT: 003 JURISDICTION : TIG
PROJECT: SHINMEN OFFICE BUILDING
Project Description: Site work for SFR conversion to commercial office use, new parking lot.
CLASS OF WORK: UNK PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 15,000.00
EXCV VOLUME: 240 cy LANDSCAPING ?: Y
FILL VOLUME: 0 cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: 1,365 sf
Owner: FEES
M M SHINMEN, LL Description Date Amount
7315 SW HERMOSO WY [BUPPLN] Pln Rv -Valu 8/17/2007 $101.04
TIGARD, OR 97223 [FLS] FLS PIn Rv 8/17/2007 $62.18
[BUILD] Prmt Fee -Valu 11/14/2007 $155.45
Phone: [TAX] Valu 8% State Surcha 11/14/2007 $12.44
[ERPRMT] Erosion Control 11/14/2007 $80.00
Contractor: [ERPLN] Erosn PIn Rv CWS 11/14/2007 $26.00
[EROSN] Erosn Pln Rv COT 11/14/2007 $26.00
HAL'S PAVING /CONSTRUCTION INC [WQUANT] Water Quantity 11/14/2007 $275.00
20666 S MOLALLA AVE
OREGON CITY, OR 97045 Total $738.11
Contact #: PRI 503 - 656 -4999
REQUIRED ITEMS AND REPORTS
Reg #: LIC 34434
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 direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
��,, } � C 2 .
Issued By: �� °66G Permittee •
Signature `1= r �
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.
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FOR OFFICE USE ONUS .,
City of Tigard
kir Permit 't.- ' '
- .....,..., .. . . . , . . .
Received
Date/13 : . . a A/re ION 11° ,..- A 17 ...e " 49-
II " 13125 SW Hall Blvd., Tigard, OR "•2 1 1 2-Ua
. 2 Phone: 503.639.4171 Fax: 503.598.19W G D Firall Mer Pemi _15',..±1 .i..•/ ( / /
,.
TIGARD
Inspection Line: 503.639.4175 Date Ready y: kirks: i See Page ' or
Internet: www.tigard WI Notified/Method: 1/ /V #7 CR TtGO
Wigka
, Supplemental Information
V310111 D fg,04.4, 14,/
...::;,:::,:-::, :, :...-.. ::•::...:: .j:! ' --: ::: ::.:, Il i* OF WORK .-.::'::::::: : ::. . : .-. . ''.. ! ':. . ::: v4 QuatiOlikr4k:t14 to i-tAi■Oiie DWELLING' .-
0 New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
' 14, Addition/alteration/replacement 12 Other. - equipment, materials, labor, overhead, and the profit for the
CATEGORY ok:coi4sTRuCTION --, , :':' ... - ' .: - : -- :-- ' : . - - .: : , work indicated on this application.
Valuation: $
0 I- and 2-family dwelling 0 Commercial/industrial
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE l*FORMATION: AND LOCATION.. . - : : . Total number of floors:
Job site address: 7 5 5 H. E . A W A..tli ___ New dwelling area: square feet
City/State/ZIP: - it a A i e:r. 0 t z ei 7 - 3 Garage/carport area: square feet
w /
Suite/bldg./apt. no.: Project name: M A, 5 A to tAel ,„1 - Covered porch area: square feet
Cross street/directions to job site: 7Z A .4r p E. KMc SO . WAY . Deck area: square feet
L" Ai'V 00S€ ‘II.DiVk (to AWE A 013 IL) Alt TA SIDE _ Other structure area: :square feet
REQUIRED DATA COMMERCIAL-USE CliECICLIST
Subdivision: I+ e 0 p A lit 1/4‹. I Lot no.: 3 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.: i c , c , . equipment, materials, labor, overhead, and the profit for the
' ' ' : "': '-..•: "::'- '. -.: : : '"
DESCRIPTION OF WORK work indicated on this application.
Si 1 4.) 0 FL it -1 sir : ?Alai< it 4 G .op $ IS; (sot 5 'P ' —T..,
. - ----- -
Existing building area: square feet
14-intlwircuries7-15 , ef - - , :.4 - - - - r
- ZP-te.A.-- -- ev'k_...., • '' - ' ' ' - - , - New building area: square feet
. i,...: . : : ' . :... •I :','i:::- X PROPERTii: OWNER ; ::::' YI !: , 1'' . . : ::-.: 0 TENANT:: ' ..:: .:. 1 : Number of stories:
Name: AA A , 5 ti . r NI m j 1_L (. Type of construction:
Address: -
‘ 747j . S K.) 14-E-_ RIR OS t) (A) OA, Occupancy groups:
City/State/ZIP: Ti 6 ,,,.. p 6 4 9 7 g. v. 3, Existing:
Phone: 6 ) I 2si .. 0 c 1 7 Fax: (3)- (e fr 4 - rci 1 I New:
El APPLICANT ;:;'1: '-:--'..::-;:::::'. '',.:,"0-'''.1'; 0 CONTACT PERSON ::::.:•:'.::'.-::;.: :::: :. NolicE
Business name: CS A llik s A • 4 6 El` All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: TI til1/4 J k .s.) _ S o pt :. 6.1 I I...a a _
under ORS 701 and may be required to be licensed in the
Address: 1 3 it x S 1 ou 72 i jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: ""n G A h OR at 7 .2- 3 apply:
(
Phone: 6th ) 6.-xjf .... 0 I 17 I Fax: : ( 6 ) .67 - Fr, 7 I
E-mail:
COACTO12::: 7
_ Busines name: /...4-aL9 ( yr 41 .:" : : :::: .:,: •::: BUILDING PERMIT FEES* ::. :
• . (Please iejer io fee schedule) " :: ' ' " - ,,,,,___.'
Address: .-2_ /40 LL p .5 yn I o fi tu. ,
Structural plan review fee (or deposit): AO f . C'Y
City/State/ZIP:
FLS plan review fee (if applicable): 6p . i•
Phone: ( ) Fax: ( )
CCB lie.: q 9- Total fees due upon application: J61,.g
Amount received: 01(
Authorized signature: lAt....., 0,.........__________ This permit application expires ifs permit is not obtained
within 180 days after it has been accepted as complete.
Print name: IV\ . Isk .. s- 1 3 1 , A , si ,i I Date: c Az/ 0 7 * Fee methodology set by Tri Building Industry
Service Board:
I:\Building\Permits\BUP-TI-PermitApp.doc 12/27/06 440-4613T(11/02/COM/WEB)
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