Permit Ai ���� OF �����® BUILDING PERMIT
,a, o COMMUNITY DEVELOPMENT Permit #: BUP2010 -00119
-rIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2010
, ; ,, : Parcel: 2S102AA01100
Jurisdiction: Tigard
Site address: 12035 SW PACIFIC HWY A
Subdivision: Lot: 0
Project: Brake Team
Project Description: Relocate existing freestanding sign.
Owner: FEES
TIGARD AUTO STOP PARTNERS Description Date Amount
2829 RUCKER AVE STE #100 Permit Fee - Additions, Alterations, 06/08/2010 $149.75
EVERETT, WA 98201 Demolition
PHONE: 12% State Surcharge - Building 06/08/2010 $17.97
Plan Review 06/08/2010 $97.34
Contractor:
SECURITY SIGNS INC
2424 SE HOLGATE BLVD
PORTLAND, OR 97202
PHONE: 503 - 546 -7114
FAX: 503 - 230 -1861
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 it
Bedrooms: 0 Bathrooms: 0
Value: $5,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $265.06
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This p 1 is issued subjec to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be ne in accordance with appp•ved pl - • . This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
ys. ATTENTION: Oregon law r 1 ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
52- 001 -0010 through OAR 952-0 -0100. Y. • • ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 r). 00 332.2344.
ssued By: _ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of t e project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application I t,l� � i I I u dui l v
City of Tigard , , Rece
e1B d g �D PePermit it No !
!i p (�
13125 SW Hall Blvd., Tigard, OR 97223 ��C Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '' ,_' f Ill i Date/B / �t • Other Permit:
Line: 503.639.4175 -��`
, l ''' Date Readylty: Juris: iii See Attached Checklist for
Internet: www.ci.tigard.or.us , G� 1 otified/Method: Supplemental Information
TYPE OF WORK C� � 4lC l V REQUIRED DATA: 1- AND 2- FAMILY DWELLING
E] New construction ❑ Derti6Mi n Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
V 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 S
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION . AND LOCATION Total number of floors:
Job site address: 107u 5,3 �, r �� 1 t Cq New dwelling area: square feet
City/State/ZIP: �• �.""" Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name:keE Covered porch area: square feet
Cross street/directions to job site: /°)k Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 1 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.
C2pkomAr . e %cf.k
Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Security Signs All contractors and subcontractors are required to be
Contact name: Melissa Hayden licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2424 SE Holgate Blvd jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97202 applicant is exempt from licensing, the following reasons
apply:
Phone: (503)546 7114 I Fax: : ( 503) 2301861
E -mail: Melissa@Securitysigns.com
CONTRACTOR
Business name:
Security Signs BUILDING PERMIT FEES*
Address: 2424 SE Holgate Blvd
g Please refer to fee schedule.
City/State /ZIP: Portland, OR 97202
5 03) 546 7114 I 503) 2301861 Fees due upon application
Phone:( Fax: ( )
Amount received
CCB lic.:122809
Date received:
Authorized signature: This permit application expires it' a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Melissa Hayden Date: * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building1 Permits \BUP•PcnnitApp.doc 12/03 440- 4613T(11/02 /COM/WEB)
Building Division
Over- The - Counter (OTC) Building Permit
T;i c nl,0 , Check List
Description of Project:
•
GENERAL INFORMATION
Class of Work:* 1 L_1 Floor Areas (sq. ft): Exterior Wall Construction:
Type of Use:* COM First floor: N: S:
Type of Construction: ij`� Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: Total sq ft.: N: S:
Stories: Note: Combine total floor area for E: E:
Height: �— 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: Handicap access:
Smoke detector: Protected corridors:
Fire alarm: • Parking spaces ( #):
Notes:
Total Valuation: $
•
INSPECTIONS FEES DUE
Footing /foundation Firewall $ + ;, ` (C Permit Fee
Post /beam structural Smoke detector $ t FI ) State Surcharge
Shear wall Misc. inspection $ Z.... Plan Review Fee
Masonry Approach /sidewalk $ 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:
. $ 2. Total Fees Due
*OPTIONS:
TYPE OF USE: COMMi = 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.
r: \Building \Forms \OTC - BUP.doc 08/19/08