Permit CITY OF TIGARD BUILDING PERMIT
° COMMUNITY DEVELOPMENT Permit#: BUP2009 -00115
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/17/2009
Parcel: 2S101AA09700
Jurisdiction: Tigard
Site address: 12585 SW 68TH AVE
Subdivision: PP1996 -024 Lot: 1
Project:
Project Description: TI
Owner: FEES
PARAGON PROPERTIES LLC Description Date Amount
12585 SW 68TH AVE Permit Fee - COM 06/17/2009 $232.54
TIGARD, OR 97223 12% State Surcharge - Building 06/17/2009 $27.90
PHONE: Plan Review 06/17/2009 $151.15
Plan Review - Fire Life Safety 06/17/2009 $93.02
Contractor:
LEGACY INNOVATIONS
PO BOX 86756
PORTLAND, OR 97286
PHONE: 503 - 319 -6270
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $26,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $504.61
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: 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. ATTEN ' : Oreg • aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 I through OAR 9 - 001 -01. • • ma .btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. / / Permittee Signature: 4
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
Residential ,�, .-,'\ ---• '; Fc)l c)rric:t. Ls!: (1y1.1
- - ;. •,i
City of Tigard Received _ - i7 e - 7 Permit No.: .
11 • 13125 SW Hall Blvd., Tigard, OR 97223 � �� . I
C Phone: 503.639.4171 Fax: 503.598, Plan Revi 1 7 2009 Dates : �i ��1 I�,r Omer permit:
1 . i G �` �� Inspection Line: 503.639.4175 Date R. ? 7 7 runs: ® 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 (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 0 Com �
merciandustrial Valuation: $
El 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: 12585 68 th Avenue New dwelling area: square feet
City/State/ZIP: Tigard Oregon �IFa1 N tCH (... r' e06/Psd t\, Garage/carport area: square feet
Suite/bldg./apt. no.: n/a I Project name: Teaaat Spa rm rt ement Covered porch area: square feet
Cross street/directions to job site: 72 & 68 th Deck area: square feet
North on 72 from 217 till you come to 68th . At 68 you will take a right. Other structure area: square feet
you will go up to 68 and the office is on your right. REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: tigard triangle Lot no.: 9700 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.
Valuation: $$26,000.00
Interior tenant space improvementto a existing building, new demising walls and
Existing building area: 2693 square feet
demo some electrical wires. also close a door off and add two windows to ext.
New building area: 1346 square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories: 1
Name: Sam Thannical and William J Robinson JR. Type of construction: y
Address: 12585 68 Avenue Occupancy groups:
e ,, 6 City/ State/ZIP: Tigard oregon 97223 Existing: j /, •
Phone: (503)319 -6270 Fax: (n/a) New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Legacy Innovations All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: Kim Drennen under ORS 701 and may be required to be licensed in the
Address: PO Box 86756 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: portland Oregon apply:
Phone: (503) 319-6270 I Fax:: ( )
E -mail: kldrennen @hotmail.com
CONTRACTOR
Business name: Legacy Innovations BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address: PO Box 86756 Structural plan review fee (or deposit):
City/State/ZIP: portland oregon 97286
FLS plan review fee (if applicable):
Phone: (503) 319 -6270 I Fax: ( )
CCB lic.: 186882 /'�4 /// Total fees due upon application:
Amount received:
Authorized signature: '� 6 — /7— al This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Kim Drennen I Date: 6/17/09 • Fee methodology set by Tri-County Building Industry
Service Board.
I: 1Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02/COM/WEB)
; I a Building Division
Over- The - Counter (OTC) Building Permit
T I G A K D Check List .
Description of Project: 17
GENERAL INFORMATION
Class of Work:* Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: N: S:
Type of Construction: 4513' Second floor: E: W:
Occupancy Group: 13' Third floor: Openings Protected Y /N ?:
Occupancy Load: — Total sq ft.: N: S:
Stories: 1 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: Imo— Handicap access:
Smoke detector: Protected corridors: ls. 0
Fire alarm: Parking spaces ( #):
Notes:
Total Valuation: $' CEO
INSPECTIONS 1 FEES DUE
Footing /foundation Firewall $ � 2_, Permit Fee
Post /beam structural Smoke detector $ State Surcharge
Shear wall Misc. inspection $ I Plan Review Fee
Masonry Approach /sidewalk $ Ci'�,c)Z 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:
$ 1 `, 6 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