Permit CITY OF TIGARD BUILDING PERMIT
6 n
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00170
T j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/20/2010
Parcel: 2S 112 DD00400
Jurisdiction: Tigard
Site address: 15912 SW 72ND AVE B17
Subdivision: OREGON BUSINESS PARK I Lot: 17
Project: JOHN CRANE INC
Project Description: TI
Owner: FEES
KAUFMAN, LOTTIE L & Description Date Amount
SUBOTNICK, RUTH ET AL, BY PACIFIC Permit Fee - Additions, Alterations, 07/20/2010 $1,124.07
REALTY ASSOCIATES, 15350 SW SEQUOIA Demolition
PHONE: 12% State Surcharge - Building 07/20/2010 $134.89
Plan Review 07/20/2010 $730.65
Plan Review - Fire Life Safety 07/20/2010 $449.63
Contractor:
DURUS CONTRUCTION LLC
15806 UPPER BOONES FERRY RD
LAKE OSWEGO, OR 97035
PHONE: 503 - 320 -8601
FAX: 503 - 244 -4318
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $103,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,439.24
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: Yes
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 b the Oregon Utility Notification Center. Those rules - - .et forth i ! -
952- 001 -0010 through • 952- 001 -0100. You - • - - - . • o ect.questions to OUNC by calling 503. •.• •99 0 .:00.332.234
Issued 6 . ' = Permittee Signature:
Call 50 .• • . 75 by 7:00 a.m. for an inspection that busin $ 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 Application FOR OFFICE USE ONLY
City of Tigard Received �� O
DateBy: emit No.: 6� `o-
- ° 13125 SW Hall Blvd., Tigard, OR 97223 e Plan Review 4, V
Phone: 503.639.4171 Fax: 503.598.19 DateB ■ +O Other Permit
TIGARD Inspection Line: 503.639.4175 (�o �4�,,,:•..: te Read :y: ® See Attached Checklist for
Internet: www.tigard- or.gov ` \, � G � l cjS otified/Method: Fl • Supplemetal Information
VV
TYPE OF WORK (NS- ���U REQUIRED DATA: 1- AND 2- FAMILY DWELLING
ED New construction ❑ Demolite\' Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
A Addition/alteration/replacement ❑ Other: equipment, materials labor overhead and the profit for the
CATEGORY OF CONSTRUCTION work indicated on i � B V n)
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedroor�l�? L 2 C
❑ Master builder El Other: Number of bat lty: OF TIGARD
JOB SITE INFORMATION AND LOCATION Total numbeeit &DING DIVISION
Job site address: / .<---57),Q 5--C'(./ 2.7 tiD New dwelling area: square feet
City/State/ZIP: ,,p 4_ , CI n 9 9, y Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name:e7.,..i,J ci �P�".., 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: 1 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.
/
S _z1_e_ l�r -�„e — 7 ,d d'J Valuation: $ `� d !J U
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: /i)
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups:
City /State /ZIP: Portland, OR 97224 Existing: g O
Phone: (503)624 -6300 Fax: (503)624 -7755 New: 't'2 - -
® 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: , v 9 LI c BUILDING PERMIT FEES*
N � /vl (Please refer to fee schedule)
Address:
15-F-06, 4 tr e i " '' / 'I - Structural plan review fee (or deposit):
City /State /ZIP:
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature: / This permit application expires if a permit is not obtained
// I within 180 days after it has been accepted as complete.
Printnam
/ En
r within
Date: ,7,/.....c.-//& * Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB)
•
I PII ° Building Division
Over- The- Counter (OTC) Building Permit
ricAizn Check List
Description of Project: T(
GENERAL INFORMATION
Class of Work :* IL_T- Floor .Areas (sq. ft.): Exterior Wall Construction:.
Type of Use:* First floor: N: S:
Type of Construction: '? 8 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 s . ft. Fire Retardant:
Basement: , Basement: Area Separation Rated: "
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: Y • Handicap access: �
Smoke detector: Protected corridors: 1\.i )
Fire alarm: y �� Parking spaces ( #):
Notes:
Total Valuation: $ VS� QC0
INSPECTIONS FEES DUE
Footing /foundation Firewall $ , Permit Fee
Post /beam structural Smoke detector $ 1'?j . State Surcharge ' •
Shear wall Misc. inspection $ "71 35 Plan Review Fee
Masonry Approach /sidewalk $ q, (..,a 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:
$ 2A-S9 , 24- 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; = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP.= repair.
I: \Building \Forms \OTC - BUP.doc 08/19/08 -