Permit CITY OF TIGARD BUILDING PERMIT
r 14 '.. COMMUNITY DEVELOPMENT Permit#: BUP2021-00160
Date Issued: 8/30/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136CD00101
Jurisdiction: Tigard
Site address: 11675 SW PACIFIC HWY
Project: AFC Subdivision: None Lot: None
Project Description: Interior demolition only. Tenant improvement work under separate permit.
Contractor: JHC COMMERCIAL LLC Owner: COLUMBIA STATE BANK
11125 SW BARBUR BLVD BLD C PO BOX 2156 MS 3300
PORTLAND, OR 97219 TACOMA,WA 98401
PHONE: 503-624-7100 PHONE:
FAX: 503-684-5295
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 07/14/2021 $542.11
Occupancy Grp: OccupancyLoad: Demolition
p y 12%State Surcharge-Building 07/14/2021 $65.05
Dwelling Units: 0 Plan Review 07/14/2021 $352.37
Stories: 0 Height: 0 ft Info Process/Archiving-Lg$2.00(over 07/14/2021 $6.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $32,300
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $965.53
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By: }{0-1,1y Val,ytiDe.Wage Permittee Signature: 0 App tof l
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
Building Permit Application RECEIVED
Commercial 2Q21
City of Tigard JUL 0 Received -1 7/24 ' l
II . Date/By: Permit No � UO a
I II 13125 SW Hall Blvd.,Tigard,OR 97223 'F TIGARD Plan Review v
Phone: 503-718-2439 Fax: 503-598-196 UETY
N Date/By: Related Permit:
Inspection Line: 503-639-4175 �UILDING DIVISION Date Read /B J
TIGARD p Y Yd: 7/ / // a ® Sec Page2for
-, Internet: www.tigard-or.gov Notified/Method:/ 7 'JjJ iQ( � Supplemental Information
'14-/L-- 1.---S.t-f€
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.
❑ 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: 11675 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: AFC Tigard Interior Demo Only Covered porch area: square feet
Cross street/directions to job site: Site is located at the intersection of Deck area: square feet
Pacific Hwy W and SW Pfaffle St Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: 00101-Al Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: 1 S136CD equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Complete the demolition of non-bearing walls within the existing building Valuation: $ 32,300
to prepare for drive through enclosure and tenant improvement, to be Existing building area: 2,593 square feet
permitted separately. New building area: No change square feet
Uv PROPERTY OWNER 0 TENANT Number of stories: 1
Name: Wilsal LLC Type of construction: N/A
Address: 7286 SW Ascot Ct. Occupancy groups:
City/State/ZIP: Portland, OR 97225 Existing: B
Phone:( 503)709-6975 Fax:( ) New: B (Future)
'APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: CIDA, Inc. Structural plan review fee(or deposit):
Contact name: Leslie Jones, RA
FLS plan review fee(if applicable):
Address: 15895 SW 72nd Ave. Suite 200
Total fees due upon application:
City/State/ZIP: Portland, OR 97224
Amount received:
Phone:( 503)226-1285 Fax: :( )
E-mail: lesliej@cidainc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: JHC Commercial, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 11125 SW Barbur Blvd. Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97219 Permit fee(includes plan review $180.00
and administrative fees):
Phone:( 503)624-7100 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB Lie.: 158061 Total fee due upon application: $201.60
Authorized signal This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: 07/01/2021 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) /W$ S 3