Permit , ' ��, CITY OF TIGARD
BUILDING PERMIT
n
I C OMMUNITY DEVELOPMENT Permit #: BUP2010 -00004
'.+ Date Issued: 01/05/2010
:T:1 G ARLY 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 01/05/2010 $332.27
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 01/05/2010 $39.$7
Plan Review 01/05/2010 $215.98
Plan Review - Fire Life Safety 01/05/2010 $132.91
Contractor:
BNK CONSTRUCTION INC
45 82ND DR SUITE 53B
GLADSTONE, OR 97027
PHONE: 503 - 557 -0866
FAX: 503- 557 -1085
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $16,885
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $721.03
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: Yes
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 • applicable law. All work will
be do. - n accordance approved plans. This permit will expire if work is not started within 180 days of issuance, or if wo uspended for more the 180
d- . ATTENTION: Oregon law requi •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules - - • • 'n OAR
•-2- 001 -0010 through OAR 952 -0 -0100. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503 • 199 or 1.::i1 #.332.2344.
Issued By: // / / t. / Permittee Si nature: / ,'
_� Call 503.639.4175 by 7:00 a.m. for an inspection that business
This permit card shall be kept in a conspicuous place on the job site until compl , tion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial
REC FOR OFFICE USE ONLY
CI of Ti and Received
Illq ty g / S / i h Permit No.: P -- 0000
° 13125 SW Hall Blvd., Tigard, OR 9722JAN - 5 201 Date / �
Phone: 503.639.4171 Fax: 503.598.1960 Plan Revie Other Permit
Date /B f1i
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Re: ._ y: Juris ® 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 Pe rmit fees* are based on the value of the work performed.
❑ Demolition P
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 CONSTRU TION work indicated on this application.
❑ 1- and 2- family dwelling ommercial /industrial
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: //9 ( 7 5U) ./� A- ve , New dwelling area: square feet
City /State /ZIP: , j; �-7 L..,4-' -/ /. J C) r ' 9 X 24- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: /...-/',Z p/jZ, /-/07 L.-- Covered porch area: square feet
Cross street/directions to job site: 9 3 1Z G� f. r - - p t- Deck area: square feet
/4 - ref?. L',..6 G17()& op 5 Ail) Ave 4 !k -` Other structure area: square feet
*.-') y '( 1 .` 2 ' - e ' : I 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.
Ff -a f 1,-,,g2:.4.- (`',E�'(' - f IJ 7 c-r-
1 T t (4„-(,. Valuation: $ 1 .sB
,i F,_ _+ ° 1 Existing building area: 4,17r 119 , ,Lsquare feet
New building area: /V //�4 square feet
❑ PROPERTY OWNER �ENANT Number of stories: / 2
Name: 1,,, ?ie.1 L'_ :_}- ) £ > rye -!'t QV Type of construction: f / / — r
Address: ZOO U,- { , fire - :. ' 'd r Occupancy groups: P Ff i G6
1
City /State /ZIP: V,..4%-' J , : kik-0 II,- Existing:
Phone: ( - ) 4 ' f ' I /, - Fa (1-15) b k"? -- ;,'/'").
•jC' t,,, New:
> 124PPLICANT ❑ CONTACT PERSON NOTICE
Business name: t ,,i (1_0F r - . ;) C.-11'"; ?._: - All contractors and subcontractors are required to be
Contact name: p-( (/(z% , 1 1 /4J T,) Lf= licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4-li 4 %1Z, , 1 - +'_) .•_i�=-? i`; - jurisdiction in which work is being performed.Ifthe
/ applicant is exempt from licensing, the following reasons
6
City /State /ZIP: 1/k1)-.:7 1 : �, _. . „ Y� apply:
PP >
Phone: (SQ ?)) %,,t , (,,, f I Fax: ( 51iJ,) or ! C', t• t:,
E -mail: S '1o,n .) (i:,, ;`r1, .- ' •-.) i. u-- r) -. .7. e ,
d "�
�-° CONTRACTOR
Business name: . ¶ 4 LA, c AS .1 (0 vii BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address:
Structural plan review fee (or deposit):
City /State /ZIP:
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CCB lic.: (o F F Total fees due upon application:
a� 4 -
Amount received:
Authorized signature: /- This permit application expires if a permit is not obtained
r within 180 days after it has been accepted as complete.
w-, / , it
Print name: r ✓u y Date: ,� -r4 kl� * Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building \Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)
" Building Division
TIGARD Over - The - Counter (OTC) Building Permit
Check List
Description of Project: ['1
GENERAL INFORMATION
Class of Work:" . Floor Areas (sq. ft.): Exterior Wall Construction:
T .e of Use:'r First floor: N: S:
Type of Construction: Second floor: E: W:
Occu.anc Grou.: Third floor: Openings Protected Y /N ?:
Occu. anc Load: irM11 Total sq ft.: N: S:
Stories: Note: Combine total floor area E: E:
for
Hei:ht: all floors above third floor and Roof Construction:
Floor Load: add to the third floor sq. ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: 11.2F"-:4) Handicap access:
Smoke detector: Protected corridors: te f ,
Fire alarm: Parking spaces ( #):
Notes:
Total Valuation: $ C t)
INSPECTIONS _ FEES DUE
Footing /foundation _ Firewall $ 2 ,"Z J Permit Fee
Post /beam structural Smoke detector $ ��r State Surcharge
_ i
Shear wall Misc. inspection $ ....-1.0. � Plan Review Fee
� �
Masonry Approach /sidewalk $ (, 1 FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ _ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ 721,03 Total Fees Due
"OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK: ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls,
signs, awnings or canopies); REP = repair.
I: \Building\Forms \OTC- BUP.doc 08/19/08