Permit Site Work g o® SW #u l / .4r
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• iiilUing Permit Application:- FOR OFFICE USE ONLY A .
City of Tigard Received _ 7C co � /, _
Date/By: ,_,../ Li ) Permit No.: t e d u;_ 7 n /.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie ✓
Phone: 503.639.4171 Fax: 503.598.1960 �. ,9g'll`I Date/By: ,34, i 45 Other Permit: r ' d'd�,,dy
Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: �1 ) Supplemental Information
•
•
TYPE OF WORK 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
❑ Addition /alteration/replacement '5 Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY' OF CONSTRUCTION - work indicated on this application.
El 1- and 2- family dwelling ° Commercial/industrial Valuation: $
❑ 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: j( ,) ':11,0 ',(�/ / . � i' r i t ,y � .1 � •o , New dwelling area: square feet
City /State /ZIP: 17,...720(1,,...-:,.- r C`4 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job sie: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
` -' 1 ""�
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
' 3 . • • ' - 1 i • Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
(✓ , . . L ® ii ,,
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application..
( °:'/ —c 1-1 ' i11 -•",;.i i 14f./ ''''- `1 Valuation: $
1 V (:4-14 ! i 1; 1 (_ Existing building area: square feet
New building area: square feet
' ❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: �, �-J 9 Type of construction:
Address: ' l 1,71 , i, t ���- I Occupancy groups:
IP
City /State /Z' ' d ,; '- C
" Existing:
Phone: ( ) A 11.
Fax: ( )
New:
t APPLICANT • a CONTACT PERSON NOTICE
Business name: %1,A All contractors and subcontractors are required to be
Contact name: 7 licensed with the Oregon Construction Contractors Board ' ,f). `� r '� / �� under ORS 701 and may be required to be licensed in the
Address: , 8
, ,.., ,. �_,i ! ii ; jurisdiction in which work is being performed. If the
' 1 r f ., applicant is exempt from licensing, the following e'• 9 i f j , , , Le � 1 ( , , '1 `f _ ,.._,,- PP P g. g reasons
City/State /ZIP: lo
e''''
n ' , apply:
Phone: (1'x .•''3) ; l '2'Z „,, Fax:: r ;) (. g /,.(...(t--41,
E -mail:
• CONTRACTOR
Business name:
� BUILDING PERMIT FEES* -
Address: t""�
City /State /ZIP:
Please refer to fee schedule.
Phone: ( ) Fax:( )
Fees due upon application
CCB lic.: Amount received
/1
C Date y
received:
Authorized signature: 1, �, I e� �` This permit application expires if a permit is not obtained
Print nam 1 i .. 1 i, f1 J -` Y f, ,,. I/ / („f ° J ,. '• I >? ! / within 180 days after it has been accepted as complete.
i �'I�I 1 / 1 C / � ) I Date 1 _ / - * Fee methodology set by Tri -County Building Industry
1 '• Service Board.
i:\ Building Permits
\ IT- PermitApp.doc 12/03 440- 4613T(II /02/COM/WEB)
A to Building Division
Applicant Request for Permit Action
^
City of Tigard
TO: CITY OF TIGARD, BUILDING OFFICIAL
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
FROM: Applicant Name:
7,• �E�".1/./k— Mailing Address:
V O I D City/State /Zip:
Phone No.:
y /VOS Fax No..
PLEASE TAKE ACTION CHECKED ( FOR THE FOLLOWING PERMIT:
® CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES.
Permit No.: BUP2005 -00121
Type of Permit: FPS
Site Address: 8100 SW Hunziker Rd
Subdivision:
Lot No.:
EXPLANATION: Created BUP in error . Replaced by SIT2005- 00008. Please
transfer fees from BUP to SIT.
4/1/05
Signature: / , 2 Date:
Dodie Rossetti
Print Name:
FOR OFFICE USE ONLY
Route to Admin.: Date: y -/ _Q r By: 7i
Permit - Canceled: -Date: ,j /ps By: dr
Refund Processed: Date: « /af By:
Cashier Receipt: Date: / a /DS _#: „looS - /37S Amnt: $ 73 7,2 so
Payment Type: Per:
A/OTE" : QMe� 4 S /T200- 00008 , 4 25 ( ----
i: \Building \Forms \Re miitAction 09 -27 -0 c