Permit 1
Building Permit Application EX P I jj R D .-
Fire Protection System RECEIVED I UIt )l l if 1 I tit ll.l l
City of Tigard MAY Received AY 2 9 2009 DateB : 4 Permit No. tilib. .4• ••• A
all
13125 SW Hall Blvd.,Tigard,OR 97223 Pt.r R •
I Phone: 503.639.4171 Fax: 503.598.1 DateB : ,� � i�� Other a
CH Y OF TIGARD ��� �►z•�� �.•.d
T I G A R l) Inspection Line: 503.639.4175 Date ReadyBy: I71 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-and 2-family dwelling El Commercial/industrial
Valuation: $2
❑Accessory building ®Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
q I C2(-) JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:-9406-SW Mandamus Ct gi(o�! G 17L1 9 179 ct t 21 q New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:Bld 8 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: $ 14 to
Existing building area: square feet
New building area: square feet
1ROPERTY 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:
y:
Phone:(503)598-7565 x 101 Fax::( )
E-mail:rlightner@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
FLS plan review(40%of permit fee):
Phone:(503)209-9298 Fax:(503)252-6611 (Due upon application.)
CCB lie.:118073 / Total permit fees:
• ��
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:\Building\Permits\FPS-PermitApp.doc 03/23/06 440-4613T(11/02/COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY
;'1
!t 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
FPS2009-00045 - 9160 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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