Permit t
4 CITY OF TIGARD BUILDING PERMIT
. - s COMMU DEVELOPMENT Permit a: BUP2009-00178
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/25/2009
Parcel: 2S101ADO1300
Jurisdiction: Tigard
Site address: 12750 SW 68TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 33
Project: Clear Choice Dental
Project Description: TI
Owner: FEES
HAMPTON BUILDING, THE LLC Description Date Amount
75 -796 HIONA ST Permit Fee - COM 09/25/2009 $414.70 •
HOLUAIOA, HI 96725 12% State Surcharge - Building 09/25/2009 $49.76
PHONE: Plan Review 09/25/2009 $269.56
Plan Review - Fire Life Safety 09/25/2009 $165.88
Contractor:
BROCKAMP & JAEGER INC
15796 S BOARDWALK ST
OREGON CITY, OR 97045
PHONE: 503 - 655 -9151
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $60,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $899.90
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th a rules are set forth in OAR
952 - 001 -0010 throw • •AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calli 03 246.6699 or 1.800.332.2344.
Issued By: .�Ar� /l Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busine s 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.
..Budding Permit Application 4 04 1 5g-
•
Commercial FUR OFFICE liSE ()NIA
City of Tigard S E P 2 3 2009 RDeacteived: 0 0 75 di, i�2ip ' G'R'2 -coin
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 ' Phone: 503.639.4171 Fax: 503.598.19611a OF TIGAR 11/ q/ Other Permit:
F I („1 It [) Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: 1 ' El See Page 2 for
Internet: www.tigard -or.gov • •tifie- ethod: w pr/ A / // C Supplemental Information
i. ' . . .
TYPE OF WORK / At QUIRED DA . : - AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are b. q • 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: S
❑ 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: 12750 SW (p8- ANc, New dwelling area: square feet
City /State /ZIP: IC/Alfa) OIL T? Z2.S Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: cuyAg.ctio L Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 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.
M 1 &o . - rrA f 1 M 19. F.MErk i Valuation: $ �p O1Q coo
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: C m t NDE.Z. FlR ft ro& - go l c btt 46 , LLB Type of construction:
Address: 15 7ct i 4I Ora Sr 40i -uA0A Occupancy groups:
City /State /ZIP: M(tU i , NAWki 1 Existing:
Phone: ( 563) 7Otp 07E9 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
‘' ,
City /State /ZIP: applicant is exempt from licensing, the following reasons
N apply:
L Phone: ( ) Fax: : ( )
C^6 E -mail:
CONTRACTOR
� l� Business name: pc "h t J E. . INC, - A64)4 ?Rime � BUILDING PERMIT FEES*
I Address: L s7q( s • $p p pw(�,v._ (Please refer to fee schedule)
V
City/State /ZIP: t . a..� Cdr C7.. 97045 Structural plan review fee (or deposit):
Q Phone: ( 503) 655 115 1 I Fax: ( ) FLS plan review fee (if applicable):
Total fees due upon application:
CCB lie.: 30
Amount received:
Authorized signature: P This permit application expires if a permit is not obtained
�' within 180 days after it has been accepted as complete.
Y P P
Print name: AND 4e C. Date: / * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 2 /23/07 440- 4613T(11 /02 /COM/WEB)
4
1 e .
° Building Division
Accessibility: Barrier Removal Improvement Plan
TIGr \KD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08
1