Permit CITY OF TIGARD BUILDING PERMIT
I3 COMMUNITY DEVELOPMENT Permit #: BUP2010 00191
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2010
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: TI
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Permit Fee - Additions, Alterations, 08/17/2010 $3,105.19
CALIFORNIA ST 49TH FL Demolition
PHONE: 12% State Surcharge - Building 08/17/2010 $372.62
Plan Review 08/17/2010 $2,018.37
Plan Review - Fire Life Safety 08/17/2010 $1,242.08
Contractor:
RUSSELL CONSTRUCTION INC
20915 SW 105TH AVE
TUALATIN, OR 97062
PHONE: 503 - 228 -4898
FAX: 503 - 228 -2770
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 7 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $430,597
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $6,738.26
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 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- 001 -0010 through OAR 952 - 001 - 0100. You ma o• -in = • •y o i - -s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By:/ // Permittee Signature:
.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 , , FOR OFFICE 11S1: ONLY III City of Tigard �N \� Date/B : DETEM PermitNo.: - /, , 10_ • a
q 13125 SW Hall Blvd., Tigard, OR .02-v " . ,`1. Plan Revi •f',
II 0 .i.�17 Other Permit:
Phone: 503.639.4171 Fax: 5! � 0 � , �� � Dat : , lD
T I G A R D Inspection Line: 503.639.4175 �/- - , '" (� � 4 +`1' � � Date Ready r : ® See Page 2 for
Internet: www.tigard or.gov N,; m �,w Notified/Method: EN Supplemental Information
Z L ,
TYPE OF WOR e REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Denition 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.
❑ 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: / 0 2 ,,i,„,) G/ ,i tk i ,1 1 24 t4 i pz , (.000 New dwelling area: square feet
City /State /ZIP: 1 7A4( / D4. 9 2.23 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: A xi G, Covered porch area: square feet
Cross street/directions to job site: G.t 24 .tl,�,., ge-s i--N Deck area: square feet
L ("A-S r- . .4— .r ✓ t t(t 1 t: v t e) ( tom c-4 L►,, 62,--..r -e-../. 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.
CA � "1-4-v--0-4- r -, Valuation: $ N 1 � .
71taY�1I"�
Existing building area: f 1,3yL square feet
New building area: No U, a ,, e p square feet
PROPERTY OWNER ❑ TENANT Number of stories: '7 f
Name: .i R,i,tI. cn/;�S - Type of construction: 1_D
Address: O c.,„„) C t t,�,.,ikj,' 0, l ,Z' W. 3O Occupancy groups: S
City /State /ZIP: 'W,,..t.. o f 04_ '7 2S"S' Existing: s e
Phone: ( 93) W 1 Z _ v{ Sob Fax: (S H IT Nff g1y New: S/.t ,
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ASS t Ce1ti GN _ All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
h St v"irekr.+ Vim' under ORS 701 and may be required to be licensed in the
Address: 7 lc 50 i OVA-L AAA_ jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: ' tA+i r) '_ e)"1 D (' apply:
p q pp Y:
Phone: (9) ) S 19 — ( (6, Fax: : (Stiff) ( 1....1 00
E -mail: ,„_, ,, „ „_,,- c ruSTt,v, cU'"\S}t/H , . CA rw
CONTRACTOR
Business name: 12,,,,S5 (AA cNyLL,H M BUILDING PERMIT FEES*
(Please refer to
Address: 01 lS LA) S l Qc - �1. N , - deposit):
schedule)
2
Structural plan review fee (or deposit):
City /State /ZIP: 644” 0 R, c l 3 0 6,2
FLS plan review fee (if applicable):
Phone: (SZ3 51 6901. 0 Fax: (y�3 (chi 2 - lays,
.J
Total fees due u application: ¢'6 f ' ?. � �
S Q I g
CCB lic.: 1
Amount received:
Authorized signature:. y > ��X, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �,,..1„ <-f-in 141 V4,r1 t.- Date: 11— 14,— i 0 * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM /WEB)
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1 e - Building Division
Over- The - Counter (OTC) Building Permit '
i c A ii ° Check List
Description of Project: 1
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GENERAL INFORMATION •
Class of Work:* hr Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* * First floor. N: S:
Type of Construction: ' or Second floor E: W:
Occupancy Group: j2 Third floor: Openings Protected Y /N ?:
Occupancy Load: "-'C Total sq ft.: N: S:
Stories: 7 7 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: tees Handicap access:
Smoke detector: Protected corridors:
Fire alarm: Q� j Parking spaces ( #):
Notes:
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Total Valuation: $
5 air Al ii
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INSPECTIONS 1 . FEES DUE
Footing /foundation Firewall 3 i (5, 11 .$ - - -J„,- ' , Permit Fee
Post /beam structural Smoke detector 3 - D-10) , - $ 1 � State Surcharge
Shear wall Misc. inspection a0I7,37 $ , Plan Review Fee ,
Masonry Approach /sidewalk hat4. tiMir 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:
I s G V • 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. ,
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I: \Building \Forms \OTC - BUP.doc 08/19/08