Permit CITY O BUILDING PERMIT
`$ rf F TIG.ARD
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00141
Date Issued: 06/22/2010
TEGARD 13125 SW Hall. Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 06/22/2010 $2,162.95
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 06/22/2010 $259.55
Metro Const. Excise Tax - Commercial 06/22/2010 $330.00
Use
Contractor: Plan Review 06/22/2010 $1,405.92
BNK CONSTRUCTION INC Plan Review- Fire Life Safety 06/22/2010 $865.18
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: $275,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
•
Total $5,023.60
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Yes Protected Corridors: NO
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permitis issued subject to the regulations contained`in the Tigard Municipal Code, State of OR.,Specialty Codes and all other applicable law. At 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- - 10 throug - OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by call' 3.246.6699 or 1.800.332.2344.
Iss ed By: Permittee ignature:
_ / Lam! �� /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.---
This permit be kept.in a conspicuous place 6 job'site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
N A.I.I45' CITY OF TIGARD BUILDING PERMIT
a `> COMMUNITY DEVELOPMENT Permit #: BUP2010 -00141
Date Issued: 06/22/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 06/22/2010 $2,162.95
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 06/22/2010 $259.55
Metro Const. Excise Tax - Commercial 06/22/2010 $330.00
Use
Contractor: Plan Review 06/22/2010 $1,405.92
PACIFIC REALTY ASSOCIATES LP Plan Review - Fire Life Safety 06/22/2010 $865.18
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300
FAX: 503 - 624 -7755
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $275,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $5,023.60
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 ac ... - ce with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work ' suspended for more the 180
days. A NTION: Ore. • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r s a e set fort. ' • •
952 -001 0010 t rough OAR •52 -0• • 0 You may obtain a copy of the rules or direct questions to OUNC by calling 43.24:.6699 1.800.332. .44.
Issued = • i� 6:144. 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 the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applicav���� FOR OFFICE USE ONLY •
0 N � I
City of Tigard�N � r U � DateB l r' /n �� �� PermitNo.: + 1o Cv ' W �
M ill
° 13125 SW Hall Blvd., Tigard, OR 97 �13 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 10 DateB : Other Permit:
TIGARD Inspection Line: 503.639.4175 O A‘r,VII D a te ReadyBy: Juris. El See Attached Checklist for
` �L
Internet: www.tigard - or.gov 13 9�1� Notified/Method: Supplemental Information
TYPE OF WORK . REQUIRED•DATAri ='AND 2- FAMILY DWELLING
0 New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
:11 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: I/ b ...... 5 ��J 2-2 t 'J � New dwelling area: square feet
City /State /ZIP: • ,-�- 'j TProject � V Garage /carport area: square feet
Suite/bldg. /apt. no.: name: S '-- ,/j iJ Fe 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.
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.
....7.7.... 7f'' � � /' 'FG &7? —�- 0 1— Valuation: $ t .S X.. a
/ /FL I D . - 11-- Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
/
Name: PacTrust Type of construction: 11/—g
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups:
City /State /ZIP: Portland, OR 97224 Existing: ,../:::., 2,J
Phone: (503)624 -6300 Fax: (503)624 -7755 New: --a-
® 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: 7J•c--Tw ,s '71- BUILDING PERMIT FEES*
Address: (P/e'aie refer fo fee schedule)'''
City/State/ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: /5 5 47/ 3 / 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: ..02, ` Date: * 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)
O
11,
a Building Division
Over- The- Counter (OTC) Building Permit
T,i;cf A ii Check List
Description of Project: e. 1
GENERAL INFORMATION
Class of Work:*
L Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* Q l First floor: N: • S:
Type of Construction: Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: l - Total sq ft.: N: S:
Stories: A Note: Combine total floor area for E: E:
Height: all floors above third floor and Roof Construction:
Floor Load: add to the third floors . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED I'T'EMS
Fire sprinkler. Y Handicap access:
Smoke detector: Protected corridors: 1kt)
Fire alarm: y-..> Parking spaces ( #):
Notes:
Total Valuation: $ 27'S X
INSPECTIONS • FEES DUE
Footing /foundation Firewall $ 2_1 LZ, Permit Fee
Post /beam structural Smoke detector $ 2 • 55 State Surcharge
Shear wall Misc. inspection $ , 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:
•%.
rj 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