Permit CITY OF TIGARD BUILDING PERMIT
2' COMMUNITY DEVELOPMENT Permit#: BUP2022-00040
Date Issued: 5/23/2022
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD02900
Jurisdiction: Tigard
Site address: 12755 SW 69TH AVE 100
Project: WSH&B Law Subdivision: WEST PORTLAND HEIGHTS Lot: 33
Project Description: Minor interior modifications proposed including new walls, new stair railing and treads,and finishes.
Contractor: GSI BUILDERS Owner: BERMAN, DANIEL&MELINDA LIV TRUST 2010
1750 SW SKYLINE BLVD STE 105 HENNING, STEPHEN &STACEY LIV TRUST
PORTLAND, OR 97221 2008
SMITH, KEVIN &JILL FAMILY TRUST ET AL
9333 FAIRWAY VIEW PL STE 200
RANCHO CUCAMONGA, CA 91730
PHONE: 971-407-4436 PHONE: •
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 04/27/2022 $4,794.45
Occupancy Grp: B Occupancy Load: 20 Demolition
12%State Surcharge-Building 04/27/2022 $575.33
Dwelling Units: 0 Plan Review 03/24/2022 $3,116.39
Stories: 0 Height: 0 ft DC Provision Review,COM TI -Ping 04/27/2022 $434.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 04/27/2022 $1,917 78
Value: $750,000 Info Process/Archiving-Lg $2.00(over 04/27/2022 $38.00
11x17)
Info Process/Archiving-Sm$0.50(up to 04/27/2022 $16 50
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $10,892.45
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 .800.332.2344.
Issued By: Permittee Signature: i,'01
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept Ina 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 E5- 2/S/22—
v FOR OFFICE USE ONLY
Commercial RECEIVED 9,��,n �-yr�
City of Tigard Received/ 09.022 I " Permit No.:13UP2O22- O
13125 SW Hall Blvd.,Tigard,OR 97223 FEB 03 2022 Plan Review
0 Phone: 503-718-2439 Fax: 503-598-1960 Date/By: a..- 1 7^ D,.2._ Related Permit:
Inspection Line: 503-639-4175 CITY OF TIGARD to Ready/By: / / i .4r ya_ El See Page 2 for
Ttc nRl) g g BUILDING DIVISION efed/Method• �� ) )` I/ Supplemental Information
Internet: www.ti azd-or. ov /
Si? i�—r`,
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
ISI Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12755 SW 69th Ave New dwelling area: square feet
City/State/ZIP: Tigard, Ore on 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name:WSH&B Tenant Improvement Covered porch area: square feet
Cross street/directions to job site: 69th and Hampton Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Minor interior modifications proposed including new walls, new Valuation: $750,000.00
stair railings and treads, and finishes. Existing building area: 1,992 square feet
New building area: N/A square feet
Is PROPERTY OWNER 0 TENANT Number of stories: 2
Name: Fairway View Group, LLC Type of construction: V_B
Address: 10960 Wilshire Blvd Occupancy groups:B
City/State/ZIP:Los Angeles, California 90024 Existing:
Phone:(310)756-7105 Fax:( ) New: B B
0 APPLICANT Sf CONTACT PERSON BUILDING PERMIT FEW
(Please refer to fee schedule)
Business name: HBX Studio
Structural plan review fee(or deposit): 31l fv.39
Contact name: Melissa Skiles
FLS plan review fee(if applicable):
Address:2505 SE 11th Ave
Total fees due upon application:
City/State/ZIP:Portland, Oregon 97202 •
Amount received:
Phone:(317)430-8145 Fax::( )
E-mail: melissa@hbx-studio.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: GS I Builders Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 1750 SW Skyline Blvd #105 Solar Installation Specialty Code checklist.
City/State/ZIP:Portland, Oregon 97221 Permit fee(includes plan review $180.00
g and administrative fees):
Phone:(971)407-4436 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: 2 a /7/.2-2- Total fee due upon application: $201.60
Authorized signal e: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: * 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)
City of Tigard
ligCOMMUNITY DEVELOPMENT DEPARTMENT
Tlcne D Building Permit Review — Commercial - No Land Use
Building Permit #: BuRZ.022_ -0004-0
Site Address: 12 Sr StA) 6 H A114' Suite/Bldg#:
Project Name: h1 Ct-I * g rev,A n r in^f tt.'-e,r,r
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: /t urne.1 04 it'1 oP(PI CAT'/OYtJS TZ) (U(X.. . (--c,SS )/
Existing Business Activity: !/A
Proposed Business Activity:
Terify site address/suite#exists and active in permit system.
0 River Terrace Neighborhood: ❑ Yes icl No
2" oning: TM L)
Permitted Use: 1`---es ❑ No ❑ Spec Space
2-Confirm no land use required.
I Business License:
Exists: ❑ Yes ❑ No,applicant was provided a business license application
Notes:
Approved by Planning: yt --- Date: 2�� �2�_
Revisions(after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
ram, -
Building Permit Submittal
Original Submittal Date: O2/O/2O2Z
Site Plans: # .3
Building Plans: # 3
Building Permit#: CIEnter building permit#above.
Workflow Routing: [R.-Planning ❑ Permit Coordinator [ Building
Workflow Sign-off: lie-Sign-off for Planning(include notes from planning review)
Route Application Documents: [Puilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: O.2/O9/21722—
l:1Bui lding\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Applicant
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes E N/A
Tigard Trans SDC: ❑ Yes E N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
1:1Building\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx