Permit �� ". R ' , CITY OF TDGAR® BUILDING PERMIT
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"'Pt ° . COMMUNITY DEVELOPMENT Permit #: BUP2010 00032
tT IG'ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/23/2010
Parcel: 2S 101 AD02800
Jurisdiction: Tigard
Site address: 12665 SW 69TH AVE 100
Subdivision: WEST PORTLAND HEIGHTS Lot: 31
Project: Amedisys
Project Description: TI
Owner: FEES
CEDAR ENTERPRISES LLC Description Date Amount
12665 SW 69TH AVE STE 200 Permit Fee - Additions, Alterations, 02/23/2010 $225.80
TIGARD, OR 97223 Demolition
PHONE: 503- 636 -6657 12% State Surcharge - Building 02/23/2010 $27.10
Plan Review 02/23/2010 $146.77
Plan Review - Fire Life Safety 02/23/2010 $90.32
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: $9,800
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $489.99
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No 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. ATTENTI • ■ • • - .on law requires you to follow the rules adopted by the Oregon Utility Notification Center. T • e ru : are set AR
952 - 001 -0. • through OA' 152-0e ' 00. You may obtain a copy of the rules or direct questions to OUNC by ca ng 503.2 ••.6699 or 1.800.33 .23
Issued By: /1 4 / .lip. / , Permittee Signature:
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_ Call 503.639.4175 by 7:00 a.m. for an inspection that busin • • •4
' 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 Applicatio® cwa`K q'1 2. - 134K co.rst
RECEIVED 4 i c�H , l F 1 5 14() , I ,�
Commercial '; { �_ � r� : A .,,,
_' Ry a Received a
City of '1<'e and a2 S /t) - 'I Permit No.: !C?u l �plQ - OC)32
`J g DateiBv:
'' 1 g Phone: 503.639.4171 Fax: 503.598. 13125 SW Hall Blvd, Tigard, OR 9'2 RK. •I 3 O M� er Permit:
-� Inspection Line: 503.639.4175 Date Re. 11 BI See Page 2 for
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Internet: wwtigard -or.gov CITY OF TIGARD Notifed'51ethod: !O Supplemental Information
BUILDING 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
0 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 CI Multi-family Number of bedrooms:
❑ Master builder ❑ Other. Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12665 SW 69 Ave. New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: 100 Project name: Amedisys Covered porch area: square feet
Cross street/directions to job site: 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.
New interior, non - bearing partition walls Valuation: $59,800.00
Existing building area: 6,882 square feet
New building area: N/C square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 2
Name: Cedar Enterprises Type of construction: VB
Address: 12665 SW 69 Ave Occupancy groups:
City /State /ZIP: Tigard, OR 97223 Existing: B
Phone: (503)636 -6657 Fax: (503)697 -9385 New: N/C
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: NW Precision Design All contractors and subcontractors are required to be
Contact name: Darin Bouska licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 22605 SW Pinehurst Ct. jurisdiction in which work is being performed. If the
City /State /ZIP: Sherwood, OR 97140 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 680 -6444 I Fax: : (509) 695 -6444
E -mail: Darin @NW- Precision.com
CONTRACTOR
Business name: BNK Construction BUILDING PERMIT FEES*
Address: 45 82 Drive, Suite 53B (Please refer to fee schedule)
Structural plan review fee (or deposit):
City!State /ZIP: Gladstone, OR 97027
Phone: (503) 557 -0866 Fax: (503) 557 -1085 FLS plan review fee (if applicable):
CCB lie.: 0107555 Total fees due upon application:
e''3".......=....... Amount received: >� Sq .vy
Authorized sigttatu
This permit application expires if permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Darin Bouska Date: 2/22/10 • Fee methodology set by Tri- County Building Industry
Service Board