Permit q
CITY OF TIGARD
PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00178
Tt GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/30/2010
Parcel: 2S110DB01400
Jurisdiction: Tigard
Site address: 11321 SW NAEVE ST
Subdivision: TIGARD COVENANT CHURCH Lot: 1
Project: Tigard Covenant Church Day Care
Project Description: Change of occupancy, from A -3 to E -3.
Owner: FEES
TIGARD COVENANT CHURCH Description Date Amount
11321 SW NAEVE ST Permit Fee - Additions, Alterations, 07/30/2010 $53.27
TIGARD, OR 97224 Demolition
PHONE: 12% State Surcharge - Building 07/30/2010 $6.39
Plan Review 07/30/2010 $34.63
Plan Review - Fire Life Safety 07/30/2010 $21.31
Contractor:
PHONE:
FAX:
Specifics:
Type of Use: COM
Class of Work: OTR
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $115.60
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: Yes Protected Corridors:
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. AT : r flaw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 952 -00 /100. You may obtain a copy of the rules or direct questions to OUNC b ailing 3.2 •.6699 or 1.800.332.2344.
Issu d By: /# ��u �` Permittee Signat =,� /. j ` — / L
Call 503.639.4175 by 7:00 a.m. for an inspection that b - iness day.
This permit card shall be kept in a conspicuous place on the job site ntil completion of the project
Approved plans are required on the job site at the time of each inspection.
Building Permit Application HH l7. , •l0"0(2_9(A
Commercial FOR OFFICE USE ONLY
14 City of Tigard Received - 7 Date /B / (� J Permit No.: oppe c (O .. ao / .7 g
v 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review ��
Phone: 503.639.4171 Fax: 503.598.1960 Date By: ( ` 7 l� Other Permit.
TIGARD Inspection Line: 503.639.4175 Date Ready /By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
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 (rotnded to the nearest dollar) of all
❑ Addition /alteration /replacement ® Other: Change Occup equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ® Other: Church Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11321 SW Naeve St New dwelling area: square feet
City /State /ZIP: Tigard . 6,R . 0( 1 2- 2.4 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Tigard Covenant Church Covered porch area square feet
Cross street/directions to job site: SW Pacific Hwy and Naeve St. Deck area: square feet
11321 SW Naeve St across from King City and Sonic Restaurant Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Willowbrook Farm Lot no.: 9 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Tax :ot 2S1 lODB01400 Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. r)
V
Change of occupancy rating in order to operate a child care on site. Need E -3 Valuation: S
Existing building area 9,000 square feet
New building area: 9,000 square feet
%PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Tigard Covenant Church Type of construction:
Address: 11321 SW Naeve St. Occupancy groups:
City /State /ZIP: Tigard, Oregon 97224 Existing: A 3
Phone: (503)639 -3084 Fax: (503)639 -2224 New: E -.
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Tigard Covenant Learning Center All contractors and subcontractors are required to be
Contact name: Sharon St. Claire licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11321 SW Naeve St. jurisdiction in which work is being performed. If the
City/State/ZIP: Tigard, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503 ) 639-3084 Fax: : (503) 639-2224
E -mail: tcc @tigardcovenant.com
CONTRACTOR
Business name: N/A BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CCB lic.:
Total fees due upon application:
; / / Amount received: �--
Authorized signatt e �'y� ) �I / This permit application expires if a permit is not obtained
lf� ` /K/ bid' vv within 180 days after it has been accepted as complete.
Print name: f�Jl'L S . 1, Date: Lsdl �I
Fee methodology set by Tri- County Building Industry
Service Board.
l: \Building \Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)