Permit CITY OF TIGARD BUILDING PERMIT
• COMMUNITY DEVELOPMENT Permit #: BUP2010 00203
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 2S101AD00400
Jurisdiction: Tigard
Site address: 6655 SW HAMPTON ST 220
Subdivision: Lot: 0
Project: Data Motion Inc
Project Description: TI
Owner: FEES
HAMPTON OAKS LLC Description Date Amount
6665 SW HAMPTON, 2ND FLOOR Permit Fee - Additions, Alterations, 09/01/2010 $66.83
TIGARD, OR 97223 Demolition
PHONE: 12% State Surcharge - Building 09/01/2010 $8.02
Plan Review 09/01/2010 $43.44
Plan Review - Fire Life Safety 09/01/2010 $26.73
Contractor:
MALIBU PACIFIC
735 NE JACKSON SCHOOL RD
HILLSBORO, OR 97124
PHONE: 503 - 693 -9797
FAX: 503 - 693 -9796
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $820
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $145.02
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This per . • - • . •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • • e in accordance with - • 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
• ays. ATTENTION: Oregon la - qui you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 95 • $1-0111 • u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.3 2.2344.
Issued By: Permittee Signature:
CaII 503.639.4175 by 7:00 a.m. for an inspection that burin d
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.
•
e_ o r 4-2�j ��IED atlon ECE
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414 ices
' � }` '' 1900 SW 4th Avenue, Portland, Oregon 97201 •503- 823 -7310 • 503 -823 •8 • , .port!landoregon.govibds
Type of work • O'i :ce Use Only
❑ New construction Addition /alteration /replacement BV11 -% , • Permit no: mim -
D. - receiv - d:
❑ Demolition ❑ Other: EIMUNL''A A
Category of construction
❑ 1 & 2 family dwelling ,Commercial/industrial ❑ Accessory building Required Data: One and Two Family Dwelling
❑Multifamily 0 Master builder 0 Other: Permit fees' are based on the value of the work per-
formed. Indicate the value (rounded to the nearest dollar)
Job site information and location of all equipment, materials, labor, overhead, and the profit
for the work indicated on this application.
Job no.: Job address: 6,7(.a.Sj S:,(.;-:), 4/1 /- ; v4.) .5-77Q_ # 220 Valuation:
City /State2lP: P 9 22.3
Number of bedrooms:
Suite/bldg. /apt. no.: Z20 'Project name:`--D/4,7-pi. O 770,3 Number of bathrooms:
Cross street/directions to job site: Total number of floors:
New dwelling area: square feet
Subdivision: Lot no. Tax map /parcel no. Garage /carport area: square feet
Description of work Covered porch area: square feet
-AD b ( a vR- G ALL Deck area: square feet
Other structure area: square feet
Required Data: Commercial Use
Permit fees' are based on the value of the work per-
formed. Indicate the value (rounded to the nearest dollar)
of all equipment, materials, labor, overhead, and the profit
for the work indicated on this application.
Permit no.
❑ Reference RS / Combination Valuation: 0 `
�j
• Property owner I/ Tenant
ea Existing building area: square feet
Name: AM) i CI aL f Cam&. "r .Sr/r1PSGrJ
New building area: square feet
Address: 'fijE --g / �, 6 VE ST6 1 1 F Number of stories:
City/State/ZIP: L 0c L. (n �'c' c f - 70 s Type of construction:
Phone: SC2 _. Leg _ (0001 I FAX: Sow (,,Z N Occupancy groups
Owner installation: This installation is being made on property that I own, which is not intended for sale, lease, rent,
Existing:
or exchange. New:
Owner signature: Date: Notice
II Contractor All contractors and subcontractors are required to be
• licensed with the Oregon Construction Contractors Board
Business name: 1`41 its(i rAcArl ._ 45446 (T ,j T 4C l S under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed. If the appli-
Address:
.?S (Li . 6 73:k SG1400 L- pi) cant is exempt from licensing, the following reasons apply.
City /State2lP: pi v3t A (X- f Zq
Phone: Sc5S _6 _9 ? 7 - / FAX: S'03 - (A ` q 79
CCB lic. no. G q S r ' /_
Building Permit Fees*
Authorized signature: i Please refer to fee schedule
Print name: /.7 ! tEj 'AN CAGE Date: f►,. , - 70i 0 Fees due upon application
Applicant MI Contact Person Amount received
Business name: P'�iNUgu / ic �1 i -1 Cpl e=H [.!d ' Date received
Contact name:02111 , f F:NEif+t, This permit application expires if a permit is not
Address: 7 3S N . �fl,c, o�,J ScWoa� obtained within 180 days after it has been accepted
as complete
City /State/ZIP: 1.,1 t (i (Js c ' (% -7 I . ,/ Fee methodology set by Tn-County Building Industry Service Board • 1 1
Phone:S '7 I FAX: SC - (orr3 - q 7 ?( Contractor information can be faxed to 503 - 823 -7693.
E -mail: nn
Authorized signature: (J
Print name: (' reg SA&Id)/�6rS Date: nsp pennitapp building 08/03/10
III B ° Building Division
Over- The - Counter (OTC) Building Permit
T i c n iZ D Check List
Description of Project:
GENERAL INFORMATION
Class of Work:* , Floor Areas (sq. ft.): Exterior Wall Construction:
• Type of Use:* - • First floor: N: S:
Type of Construction: r 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: 0 Handicap access: _
Smoke detector: Protected corridors:
Fire alarm: On Parking spaces ( #):
Notes:
Total Valuation: $ 6 20
I INSPECTIONS 1 I FEES DUE
Footing /foundation Firewall $ , P . Permit Fee
Post /beam structural Smoke detector $ �' OZ State Surcharge
Shear wall Misc. inspection $ i 'Z Plan Review Fee
Masonry Approach /sidewalk $ — 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
(truc________ 6 02_— To tal Fees Due
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial mre.
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