Permit (22) ' CITY OF TIGARD
BUILDING PERMIT
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= `, COMMUNITY DEVELOPMENT Permit #: BUP2010 -00150
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13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2010
T1rAFl 9 Parcel: 1S136DD05300 •
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 210
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: American Family Insurance
Project Description: TI
7/212010: REPRINTED TO CORRECT SITE ADDRESS: _ j
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 06/29/2010 $195.38
PORTLAND, OR 97224 Demolition
PHONE: 503 -624 -6300 12% State Surcharge - Building 06/29/2010 $23.45
Plan Review 06/29/2010 $127.00
Plan Review - Fire Life Safety 06/29/2010 $78.15
Contractor:
TRIANGLE CONSTRUCTION LLC
35155 NE ROCKY HILL RD
NEWBERG, OR 97132
PHONE: 503 -625 -9194
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 2 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $8,000
.Floor Areas:
Total Area: 0 ,
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $423.98
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: D / 97A Z/ c 7
Call'503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
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.Ruild iig Permit Application RECEIVED
Site Work U 2 y �'L er yiy '�+� '(i rr a �i3u hrat V1lilkta i i�1t7`8'�1 L kj r},+xi;' �bf �. ' i�1 ; r1 1 c „�' t l �a e yi '
x +yt+� s , f 6 - {
; FOR OFF1 0EllJSEONL Y' n tl t
1 N,r 1A.r' t y4
r i 1y3 M is 7' °Lx L. } �y �1� �[,� {� .J1
?CIO i� S L� �8r�.•�f a i IPa I•. li'i�Q T.t�tf�}tM Y{��•�ILW M1 ,�y74M1 �.'�."��/.� .fY! x•Il � � �. ���:Net.�4s.F tC.ly[�,A
: maw 7 Received
a �[Sl City Of Tigard. Date/ i ® Pe rmit No.:
.LP 1 SW HaII,Blvd., Tigard,. OR 97223 .CITY`OFTIGARD 9 �b e P .�o _ et, Pl R i .I
I ° �� Phone 503 .639 4 171 Fax 503.598.1• tjILDING DIVISION
m. .1 Inspection Line: Dat /y: > r � i : ' ('ZS Other Permit:
np 503.639.4175 Date Read ��r
G A`.11' Dr 639 X# ® See Page 2 for
ViSAIV4P'Hagi •lntemet: www tigard=or Notified/Methodi ft . � Supplemental Information
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TYPE OF WORK DA
RE TA I AND 2- FAMJLY D
❑ New construction ❑ .Demolition Permit fees* are based on the, value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
A ddition /alterauion/replaceinent ❑ Other: • equipment, materials labor, overhead, and the profit for the
. CATEGORY OF CONSTRUCTION work indicated on this application. '
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❑ 1- and.2- family dwelling ' CommerciaVindustrial Valuation:
S
❑ 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: i .40gQ S " Gl New dwelling area: square feet
City/State/ZIP: ` 6av / ��J
G( //e9,5 ,=Sub 6 7 �G • Garage /carport area: square feet
Rdg. /apt. no. 'L (p ,) Project name: Aw, tv c ex..,a,, Fn M I h Covered porch area: square 'feet
Cross street/directions tojob'.site: (h T6ar4 ►.eu TL
Deck.area: square feet
C°, + Pav'(c i I $ Pas .'r oWh'j... Other structure,area: square. feet
REQUIRED DATA COMMERCIAI - US E CBECKLIST
Subdivision: Lot no.: Permit fees are based on the.value of the work,performed.
Tax:mapZparcel no:: Indicate the value ( rounded to the.nearest- dollar);of,all
_
W equipment materials, labor,;overhead,,and theprofit for:the
DESCRIPTION OF WORK •' • . work indicated. on this application.
Valuation: $
O
1 I A • 1 l'i't Fa S-iWtt . A-0 - , rt^e a (,.. ( / h. u p i lin,..1� • i ("CV
Exi building, area: 7 square 'feet
New building. area:. 111 ri ' square feet
�ROPERTY OWNER . .• .
. •• � - ❑TENANT Number of stories: •?.
Name: I A GE ..fr` N t') 4: p v -fi'1e, r Type construction: 1 p F,
• Addre G e. 00 svJ ( O
s:4'1., A-1,-c. . Occupancy groups:
City /State /ZIP: oo•
v et-o � Existing: g
Phone: ( ) &Ice,.'3•i eaC Fax: (:. ) New:
. R. APPLICANT , . . •, CONTACT PERSON , . .
NOTICE
Business .name: p��
1�` 1 ( Des i .iiL: - c•_.1.,..0,t, All contractors and subcontractors -are required to be
Contact name: L„1 licensed with theOregon Construction Contractors Board
under ORS 701 and may be required•to be licensed in the
.Address: r( (OCtO -may
,(�.-,( — St ('Lo Jurisdiction in which work is bein performed: If the
City/State/ZIP: is exempt from "'licensing, the followingreasons
" 11 • ci'a -,e
apply:
Phone: (. ) 24 `� Fax::.,.(- )
E -mail: l 4i-ti(a i,,,,,..4 . G. Lc i
. CON •
• Business name: • • f ILD. . m
I'C 0.K l ,i t C � TM C =1�+.: BUILDING PERMIT FEES* . •
3S (G-'5 N. -&-- 0 1--h l t ru �l % 1
L;
i
Swctural.plan revteW fee (or deposit):
City /State /ZJP:,
1�eW. q7 I32 FLS plan review fee (if applicable):
Phone: ( • ) fl ZS . o. 1.°14 Fax: ( )
O - Total fees due upon application:
iB lic.: ` 4A-3
Amount received: d 5 . 9$
Authorized signature: This permit applicatioo expires if a is
=2 >
within 180 days after it has been accepted as complete:
Print name: D
c �' ' Ql u °`- � • L * Fee methodology set, by Tri- County Building Industry
Service Board.
:\ Building \Permits\SIT- PermitApp•doc 12/27/06 440- 4613T(11 /02 /COM/WEB)
Dianna Howse
From: Dianna Howse
Sent: Friday, July 02, 2010 7:47 AM
To: 'betty @mdgpc.corn'
Subject: American Family Insurance
Attachments: AmericanFamilyIn surancePermits.pdf
Good morning Betty,
Thank you for calling me about the site address for this project. I have made the changes to all permits issued to the
correct site address of 11850 SW 67 Ave., Ste. 210. I have attached a copy of the reprinted permits for BUP and FPS
showing the new address and I have faxed a copy of the ELC to the contractor. The inspectors have been informed so
that inspections will be performed as requested.
Please make corrections to your site copy of the plans and any other file documents.
Thanks again and please let me know if there is anything else I can do for you.
Dianna Howse
Building Division Services Supervisor
City of Tigard
503.718.2430
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Building Division . . .
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. - .- . over-The-Counter. (OTC) Buildl Pettiiit •
.:TIGAID
. .- ' _....•:',.. • Cheek List
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- Descriptiori of Project: T1 .. .. . .
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Class of Vetk:* Floor Area (sR ft); 1•7'..'' Extetiol,Viall Construction:
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Type 1.)sei* ,Fir floOK: i.f"-; N. $: . .
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Type of Construction . -,.- :::.'...:' '','...:: Second iloo•r • • - : Ei W . .
Occupancy G-toiv:. ' . ..:',V4'1 Third floor: ' :::.-;---: 5: Openings Protected Y/.NP,':
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Occupancy Load: _ 2,4-;, Total sq ft.: r; .--.; N S:.
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Stories t z",.......... ';'-g,it:`.:. Note Con total , floor area for E a
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Fitight ' - .,-:,,,,,.., all floors above third (loot and . ,,' 4' kbtif :011StikletiOn: .
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Floor .1.,0j.d .',:, ,' .,: add the third floor :sq. ft.. .?”, ',.. 1 ,Fite. Retardant:
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Basement; ' - -+,;..,-. Basement - . ' .'''. - I. :-.',',.-', Area Separation Rated
• Mezzanine: 4;'• Garage: ';1',g4; 'OCcu Sep.aration_Jated:.
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Fire sp.tinklet: , - ' i;t'";--; .. ..... .,.. . . .
— ' •,-. • ' ' Handicap access. .
...StnOke detector: . ._ '. , .- ';.::i' Protected cortidors...; . .
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Fire alarm •: ''-''.':' ''.'' .: Parking spaces
Ntites: . '.. .
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'4,77:71N.,.-7'?7.:::"3.;:';..:.;-IiiZIFIN.:::.$11E4140,N.:'$,R.Var.V.:i.7.:.r.:: . :„,•vr. 'r,','.':. ! -- '71 ; . '-0 "' " r ".! 7" 7 '—' , '' ''''',:- - Fri '
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Footing/foundation :Firewall. $ 45(5, T Permit Fee •
• Post/beam !structural Sint:Ace:defector $ 2,.. .,_ . • Stateuieharge ' • '
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Shear wall • Misc. inspection $ 12-7,,co Plan Review Fee •
Masonry Approach/sidewalk $ — PA 1. FLS PlAnieview
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Framing 3 Additional Permit Fee
Insulation Sprinklerrough-in. ,$ .Additional Plan Review. Fee
Gyp iboarci Fite alatin $ • Metro Construction. Excise 'Tax.
ISuspended,:ceiling Sprinkler final . .$ :School Construction Exci'se. Tax
- Finalinspeeton .
: $' . Misc. Fee
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1.1-Icturly. Rate Fee '
1 .. Hourly Rate State SutOharge
. . $
• • 'Othert:
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' $ 42.3. Total FeeSSDUe;
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