Permit Building Permit Application .___ `✓` P 1 P C.
Fire Protection System RECEIVED FOR OFFICE USE ONLY
IN . City of Tigard Received
: cij Permit No.: -Fp• arg,.-000
• 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 9 2009 Plan Review ► �
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : �, I1� Other Permit c 604•, r.`
TI c;A R I) Inspection Line: 503.639.4175 C OF.�G�D Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov 1>I\ISI� Notified/Method: `� Supplemental Information
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TYPE OF WORK REQUIRED DATA: I-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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling Valuation: $20
❑CommerciaUindustrial
❑Accessory building ®Multi-family Number of bedrooms:
❑Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9208 SW Mandamus Ct 9 2 12t 921(D,9zz4,9234 92q Z New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:Bld 7 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: 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: $ 01-4 0
Existing building area: square feet
New building area: square feet
J 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 All contractors and subcontractors are required to be
Contact name:Ron Lightner licensed 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 ro fee scked
Business name:Dms Electric,Inc. rrleJ
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 :x: 503 252-6611 (Due upon application.)
CCB lie.:118073 T�,� Total permit fees:
Authorized signature. Amount received:
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.
I\Building\Permits\FPS-PermitApp doc 03/23/06 4404613T(11/02/COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY 1,4
IIa . 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
FPS2009-00044 - 9208 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
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