Permit Building Permit Application EX P 1 R E i -
Fire Protection System RECEIVED , Olt OI FI( I. I S,: O\l.l
MAY 2 9 2009 Received t P OOQ_OCR 4
City of Tigard Re eiv Permit Not
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie. 'w
. i 1 � � Other Permit. •Phone: 503.639.4171 Fax: 503.598.1960 DateB 4f r worm m F I0q 20
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Rea.y :y: � la See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method. I�t47 Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLLNG
®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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation: $1,
❑Accessory building ®Multi-family Number of bedrooms: �� ))
❑Master builder ❑Other: Number of bathrooms:
934(.01 JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:'9336-SW Mandamus Ct C1350 1 q 354'93,2.../93(08"/ New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 43 7(Q Garage/carport area: square feet
Suite/bldg./apt.no.:Bid 4 Project name:Longstaff Condos 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
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Monitored Fire Alarm System
Valuation: $ 2I-M,0
Existing building area: square feet
New building area: square feet
A PROPERTY OWNER ❑ TENANT Number of stories:
Name:Brownstone at Lincoln Park Type of construction:
Address:7050 SW Clinton Street Occupancy groups:
City/State/ZIP:Portland,OR 97223 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name:RCM Homes,Inc .63/1 o-kktcrowc. fidi er E All contractors and subcontractors are required to be
Contact name:Ron Lightner /2G_7.ilN.STOm/r kE41. Qyivr (T.��/_ s gilrcensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:7050 SW Clinton Street jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)598-7565 x 101 Fax::( )
E-mail:rightner@brownstonehomes.net
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name:Dms Electric,Inc.
Permit fee:
Address:8504 SE Stark ST
State surcharge(12%of permit fee):
City/State/ZIP:Portland,OR 97216 0
FLS plan review(40%of permit fee):
Phone:(503)209-9298 Ar:x: 503)252-6611 (Due upon application.)
CCB lic.: 118073 � Total permit fees:
—rs4��1 Amount received:
Authorized signature: — 4 •
This permit application expires if a permit is not obtained
Print name:Paul Grushevskiy Date:5/26/2009 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:1Building\Pennits\FPS-PermitApp.doc 03/23/06 440-4613T(tt/02/COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY
_ _ - 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
FPS2009-00041 - 9346 SW MANDAMUS CT
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-COM 245-0000-432000 $69.65 $69.65 $69.65
12%State Surcharge-Building 100-0000-207020 $8.36 $8.36 $8.36
Plan Review-Fire Life Safety-COM 245-0000-433020 $27.86 $27.86 $27.86
Totals for Fees $105.87 $105.87 $0.00 $105.87
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $105.87
oacz--,‘opei
-?/.
wcio
�ho0o-6ovL°sd�
,, 297-7-r-T72/cy