Permit CITY OF TIGARD BUILDING PERMIT
4
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00155
mo ' Date Issued: 07/27/2010
. IGARLj 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 135 BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: TI
Owner: FEES
ROBINSON FAMILY TRUST Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO Permit Fee - Additions, Alterations, 07/27/2010 $1,649.55
BOX 91305 Demolition
PHONE: Plan Review 07/02/2010 $1,072.21
Plan Review - Fire Life Safety 07/02/2010 $659.82
CDC Building Review, COM 07/27/2010 $128.00
Contractor: CDC Planning Review, COM 07/27/2010 $128.00
ROBINSON CONSTRUCTION CDC Planning Review, COM - LRP 07/27/2010 $38.00
21360 NW AMBERWOOD DR 12% State Surcharge - Building 07/27/2010 $197.95
HILLSBORO, OR 97124 -9321 Metro Const. Excise Tax - Commercial 07/27/2010 $228.00
PHONE: 503 - 645 -8531 Use
FAX: 503 - 645 -5397
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $190,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $4,101.53
Required: • Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
Smoke Detectors: No 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 ordance wi - • proved 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. ENTION: Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1 -0010 through OAR 95 • . 1 -0 00. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.3 44.
Issue / 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 Application
\ ''
Commercial ., FOK O1'1'I(:I: 1i 0\1.1. City of Tigard \ 0�0 Received
1, DateB �'r. Permit No.: G Da 1 7
13125 SW Hall Blvd., Tigard, �72 d - Plan Review I�
II 503.639.4171 Fax: 503.598. ; `' DatelB : >l s 0 Other Permit:
i G n it D Inspection Line: 503.639 ,., v . • ` a f?("
. - , ` ' Date Ready /: RI Page 2 for
Internet: www.tigard- or.gov ` , \ " -Y '.., i , ; -'■ Notified/Method: Supplemental Information
s a
" - -
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
® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ 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: 11131 SW Greenburg Rd New dwelling area: square feet
City /State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Sky High TI Phase II Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
NW corner of intersection at SW Greenburg Rd, SW Tiedeman Ave and Other structure area: square feet
SW North Dakota St REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 1100 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 1S135BC 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.
Exterior parking lot modofications and interior tenant improvements Valuation: $$190,000.00
Existing building area: 69017 square feet '
New building area: 0 square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 1
Name: Robinson Family Trust Type of construction: III -B
Address: 21360 NW Amberwood Dr Occupancy groups:
City /State/ZIP: Hillsboro, OR 97124 Existing: M & S -1
Phone: (503)645 -8531 Fax: (503)645 -5357 - New: A -3
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: CIDA, Inc All contractors and subcontractors are required to be
Contact name: Kourtney Strong / Kim Walmer licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15895 SW 72 Ave Suite 200 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) 226 -1285 I Fax: : (503) 226 -1670
E -mail: kourtneys @cidainc.com / kimw @cidainc.com
CONTRACTOR
Business name: Robinson Construction BUILDING PERMIT FEES*
Address: 21360 NW Amberwood Dr (Please refer to fee schedule)
City /State/ZIP: Hillsboro, OR 97125 Structural plan review fee (or deposit):
Phone: (503) 645 -8531 Fax: (503) 645 -5357 FLS plan review fee (if applicable):
CCB lic.: 63147
Total fees due upon application 7
Amount received:
Authorized signature: , a ■ 01' This permit application expires if a permit is not obtained
I within 180 days after it has been accepted as complete.
Print name: Kourtney Strong —' Date: 0630.2010 * Fee methodology set by Tri- County Building Industry
s \B Pk�- P. Service Board.
I:\BuildingWermitP-COM PermttApp.doc 2 /23/07 440- 4613T(11 /02/COM/WEB)