Permit 7 ' CITY OF TIGARD BUILDING PERMIT
7 1 s. q
` r>3 COMMUNITY DEVELOPMENT Permit #: BU P2010-00108
T A
iGRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/26/2010
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: Lot: 0
Project: Spec space
Project Description: TI
Owner: FEES
13500 PACIFIC CORP Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS Permit Fee - Additions, Alterations, 05/26/2010 $453.95
INC, 21500 HAGGERTY ROAD, SUITE 100 Demolition
PHONE: 12% State Surcharge - Building 05/26/2010 $54.47
Plan Review 05/26/2010 $295.07
Plan Review - Fire Life Safety 05/26/2010 $181.58
Contractor:
STEARNS CONSTRUCTION LLC
17256 NE SACRAMENTO
PORTLAND, OR 97230
PHONE: 503 - 255 -3305
FAX: 503 - 255 -3263
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $25,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $985.07
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: 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 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 - „i �euv.. or direct • uestions to OUNC • calling 503.246.6699 or 1.800.332.2344.
ft
Issued B Permittee Signature:
ORM
C WU 75 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 completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial 1 FOR OI 1 IGG.tJSI Or*, 1
III City of Tigard RECEIVED Da e/B 5 I f� Permit No.: �� ^� _00108, ° 13125 S W Hall Blvd., Tigard, OR 97223 2 Plan Review »r , 1 /�
111 .. Phone: 503.639.4171 Fax: 503.598.196 2 6 2010 Date/B i t . �' \lJ Other Permit
T.i GAR - Inspection Line: 503.639.4175 Date Ready /:y: Juns ® See Page 2 for
Internet: www.tigard- or.gov
MY OF TIGARD Notified/Method: i Supplemental Information
TYPE O AVT ING DIVISION
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
® Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ® Commercial /industrial
❑ 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: 13500 SW Pacific Highway, Suite 92 New dwelling area: square feet
City /State /ZIP: Tigard /Oregon /97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: 92 Project name: vinill ell ='�� Gam .., 4 ( 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.
Repair ceiling grid throughought space (ceiling tiles, etc...) demo one non - Valuation: $$25,000.00
bearing wall, remove access ladder inside of space and move to outside location. Existing building area: 1676 square feet
Plumbing permit amd electrical permit New building area: 0 square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Elliott Associates, Inc. Type of construction: Vinilla shell
Address: 901 NE GLISAN STREET Occupancy groups:
City /State /ZIP: PORTLAND /OREGON/97232 Existing:
Phone: (503)224 -6791 Fax: (503)228 -3169 New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Stearns Construction, LLC. All contractors and subcontractors are required to be
Contact name: Derek Jackson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 17256 NE Sacramento Street jurisdiction in which work is being performed. If the
City /State /ZIP: Portland /Oregon /97230 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 255 -3305 Fax: : (503) 255-3263
E -mail: dstearnsconstruc @aol.com
CONTRACTOR
Business name: Stearns Construction, LLC BUILDING PERMIT FEES*
Address: 17256 NE Sacramento Street (Please refer la fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP: Portland /Oregon/97230
Phone: (503) 255 -3305 Fax: (503) 255 -3263 FLS plan review fee (if applicable):
CCB lie.: 154128 Total fees due upon application: ,
Amount received:
Authorized signatur This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Derek Jackson Date: 5/17/2010 * Fee methodology set by Tri- County Building Industry
•
u Building Division
Over- The - Counter (OTC) Building Permit
i c n r Check List
Description of Project: t t .
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: 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: Handicap access:
Smoke detector: Protected corridors: 1
Fire alarm: Parking spaces ( #):
Notes:
Total Valuation: $ (
INSPECTIONS FEES DUE
Footing /foundation Firewall $ 4-63, ''5 Permit Fee
Post /beam structural Smoke detector $ A State Surcharge
Shear wall Misc. inspection $ -- '5 , Q Plan Review Fee
Masonry Approach /sidewalk $ rig ,'�S 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:
$ of D . 07 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