Permit r � CITY OF TIGARD BUILDING PERMIT
q
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00037
T t G A t, Q 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/04/2010
Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 100
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: Coca Cola
Project Description: TI - demo interior partition, construct new office area.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 03/04/2010 $2,011.95
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 03/04/2010 $241.43
Metro Const. Excise Tax - Commercial 03/04/2010 $300.00
Use
Contractor: Plan Review 03/04/2010 $1,307.77
MATTHEW OLSON CONSTRUCTION Plan Review - Fire Life Safety 03/04/2010 $804.78
5320 SW DOVER LN
PORTLAND, OR 97225
PHONE: 503 - 892 -0066
FAX: 503 - 892 -0067
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $250,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $4,665.93
Required: . Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No Manual Pull Stations:
Accessible Parking: 0
This pep.' is issued subjec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d• e in accordance with app •ve• _ • ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d- , s. ATTENTION: Oregon law r- • uires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in 0
9.2- 001 -0010 through OAR 9 r • -01 r •. Y• may obtain a copy of the rules or direct questions to OUNC by calling 503.246 9 or 1 .332 344.
l sued By: f L # Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business ay.
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 RECEI /' FOR OFFICE USE ONLY �M
City of Tigard D ate / B ed 3 10 Permit No.: 1.1u ro / , riW3 4
Il
u 13125 SW Hall Blvd., Tigard, OR 97223 c Plan Review OM
Phone: 503.639.4171 Fax: 503.598.1960 MAR 0 3 [ ! n 10 Date/13 : r a +\ �' O ther Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Jura: ® See Attached Checklist for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
RUII.DING DIVISION
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
A 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: 'may /3 i� C New dwelling area: square feet
City /State /ZIP: TO , ' -) 0 - v c Garage /carport area: square feet
Suite/bldg. /apt. no.: /o0 I Project name/ C CJ ,/ Covered porch area: square feet
Cross street/directions to job site: Lam' 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.
— .0e/1 C ,. — 1"7 i -� Z 4- 0 .1 ?6" rJ Valuation: $��_� e C)
� � .. eir — / ��� Existing building area: square feet
/�- New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: 11-7,6
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: f�
Existing:
City /State /ZIP: Portland, OR 97224 ,e%' .LJ `7 rejr
rf'
Phone: (503)624 -6300 Fax: (503)624 -7755 New: --e9---
1:0 APPLICANT ® CONTACT PERSON
NOTICE
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: Dennis Pagni licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15350 S.W. Sequoia Pkwy., Suite 300 jurisdiction in which work is being performed. If the
City /State /Z[P: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 624 -6300 Fax: : (503) 624-7755
E -mail: dennisp @pactrust.com
CONTRACTOR
Business name: /1 j 4 L � J ��er�/ BUILDING PERMIT FEES*
Address: / (Please refer to fee schedule
City/State/ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CCB lie.: (1601 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
�� within 180 days after it has been accepted as complete.
Print name: ` //C 4 , ��� Da te�� /J * Fee methodology set by Tri- County Building Industry
✓ Service Board.
1:\ Building \ Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB)