Permit '�` BUILDING PERMIT
s CITY OF TUGAR®
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ii
° COMMUNITY DEVELOPMENT Permit #: BUP2010 -00098
TiGAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/13/2010
R
Parcel: 2S112DC00201
Jurisdiction:
Site address: 15865 SW 72ND AVE, BLDG# C
Subdivision: Lot:
Project: ChemWest
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 05/13/2010 $759.57
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 05/13/2010 $91.15
Plan Review 05/13/2010 $493.72
Plan Review - Fire Life Safety 05/13/2010 $303.83
Contractor:
MATTHEW OLSON CONSTRUCTION
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: $54,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,648.27
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: No
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 f• •• • - the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rule = : set • in OAR
952 - 001 -0010 through 952- 001 -D100. Y. r may o• al •••.;,y • • -s or direct questions to OUNC by callin • • • or 1.800.332. • -4.
Issued By: - .- Permittee Signature / I �'
►! erg .4175 by 7:00 a.m. for an inspection that busi A day.
This permit card shall be kept in a conspicuous place on the job site until completion of the pro ect.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application FOR OFFICE USE ONLY
City of Tigard Received
�1 Y B Permit No.: ' j U .�
Dee v
Pr
13125 S W Hall Blvd., Tigard, OR 97223 Plan Review e l ®®
Phone: 503.639.4171 Fax: 503.598.1960 Datev: Other Permit:
TIGARD Inspection Line: 503.639.4175 MAY 13 2 M Date Ready/By: Juris: El See Attached Checklist for
Internet: www.tigard - or.gov Notified/Method: Supplemental loformation
CITY OF TIGARD
. TYPE OF V1 f,WING DIVISION REQUIRED DATA: P- 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: V.4 /� 9 ,/_ P , , New dwelling area: square feet
City/State /ZIP: � �� �/3 "? Garage /carport area: square feet
Suite/bldg./apt. no.: (Project name: /7n. te f� Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
c
C a - , / / L p Other structure area: square feet
. REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map/parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
.....■/ Valuation: $ t efe
Existing building area: / square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: / / ._.
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: / 4 '
City /State /ZIP: Portland, OR 97224 Existing:
Phone: (503)624 -6300 Fax: (503)624 -7755 New:
® 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/ZIP: 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: 7)7‘) � L < / f ���
/u B UILDING PE MIT FEES*
Address: - (P.lease refer io fee schedule '
City/State/ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
/,/ O � Total fees due upon application:
CCB lic.: (6
Amount received:
Authorized signature: 2 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �� Date: � --° .9/
Pn/11 r 2. i : `I 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)
1 ® Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Description of Project: f 1
GENERAL INFORMATION
Class of Work:* / F loor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: "7 Total sq ft.: N: S:
Stories: 1 Note: Combine total floor area for E: E:
Height: _ all floors above third floor and Roof Construction.
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: • Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: teS Handicap access:
Smoke detector: Protected corridors:
Fire alarm: Lees Parking spaces ( #):
Notes:
Total Valuation: $ 64
INSPECTIONS FEES DUE •
Footing /foundation Firewall $ "751. 57 Permit Fee
Post /beam structural Smoke detector $ 1 , 1 6 State Surcharge
Shear wall Misc. inspection $ 3, 7z- Plan Review Fee
Masonry Approach /sidewalk $ " 3 ,eT3 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:
$ � �p AS, 2-77 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