Permit CITY TIGARD BUILDING PERMIT
_ COMMUNITY DEVELOPMENT
PERMIT D : BUP 2008
DATE ISSUED: 11/20/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
•
PARCEL: 2 S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 190 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
PROJECT: BENEFICIAL
Project Description: TI.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 38 BASEMENT: sf AREA SEP. RATED:
STOR: 4 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: Y PARKING:
VALUE: $ 20,000.00
Owner: Contractor:
PACIFIC REALTY ASSOCIATES MATTHEW OLSON CONSTRUCTION
15350 SW SEQUOIA PKWY #300 -WMI 5320 SW DOVER LN
PORTLAND, OR 97224 PORTLAND, OR 97225
• Contact #: PRI 503 - 892 -0066
Phone: FAX 503 - 892 -0067
Reg #: LIC 66070
FEES
Description Date Amount
REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 11/20/200E $191.20
[TAX] 12% State Surch 11/20/200E $22.94
[BUPPLN] Pin Rv 11/20/200E $124.28
[FLS] FLS Pln Rv 11/20/200E $76.48
Total $414.90
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 than 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 • .2- 001 -01 . Yo may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
‘,.c :I__4 5 : ;! . - : : : , ,
Issued By P ermittee 471..../
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 FOR OFFICE USE ONLY
City of Tigard N Received d / as._ No.: 0,
° 13125 SW Hall Blvd., Tigard, OR 9 �� P Rev , ' ?Mg � ��'
Phone: 503.639.4171 g
Fax: �503.598.1►96� `�Q� Date/B : . e j ( �� Other Permit:
TIGARD Inspection Line: 503.639.4175 N�� Date Ready :y: See Attached Checklist for
Internet: www.tigard or.gov tv q �(��� � otified/Method: �� Supplemental Information
AI, �� ��
TYPE OF W ik 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
A 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: 9e 9 j < , j.e44.1 ?leC,,v / 9d New dwelling area: square feet
City /State /ZIP: •1/144✓,4 e if�//V 4 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: , /— _ ���_ _ j 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.
Valuation: $
O�`.)e cam e7r�, f'/ 0 ) i �� v
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name: PacTrust Type of construction: /A
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: zr
City /State /ZIP: Portland, OR 97224 Existing:
3,9, 0
Phone: (503)624 -6300 Fax: (503)624 -7755
New: ...."9—.
® APPLICANT ® CONTACT PERSON
NOTICE
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: Dennis Pagni licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15350 S.W. Sequoia Pkwy., Suite 300 jurisdiction in which work is being performed. If the
City /State/ZIP: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 624 -6300 I Fax: : (503) 624-7755
E -mail: dennisp @pactrust.com
CONTRACTOR
Business name: ' i�c� D /larn/ � BUILDING PERMIT FEES*
Address: 5-90 S • ) Apr
Structural plan review fee (or (Please refer to fee deposit): *
City/State/ZIP: schedule)
W w "" � ' dosit): Q v
I � I �v`"'1 FLS plan review fee (if applicable):
Phone: (Cp3 _ 4p� V ,� l ( Q / Fax: ( ) , 16
CCB lie.: � -� U —I l� Total fees due upon application: f y
I� Amount received:
Authorized signature: This permit application expires if a permit is not obtained
40, tom+ within 180 days after it has been accepted as complete.
Print name: Aeu Nit T. W I ! . Date: / f / v • Fee methodology set by Tri-County Building Industry
r / / V1 Service Board.
I:\ Building \Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(11 /02/COMM'EB)
CITY OF TIGARD 0 . , .
BUILDING DIVISION PERMIT #: Bup201aS -00373
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/200008
Phone: (503) 639 4171 'r l Inspection Requests (24 Hrs.): (503) 639 -4175 .__ ' ' L .
, INSPECTION WORKSHEET FOR DATE: 1f61200c TIME: 7:OOAM PAGE: 3
SITE ADDRESS :. 12909 SW 68TH PKWY 190 CLASS OF WORK:
SUBDIVISION: T AR[) TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL
DESCRIPTION 1-1
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: MA1THE:W OLSON CONSTRUCTION PHONE #: 503-892-0066
Inspection Request Scheduled For: Date:. 1/612009 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
299 Final inspection 079416-01 503-956-6290 40
Corrections /Comments /Instructions:
le PAS' NI PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL IA CALL FOR INSPECTION ❑ ADDITION ' .L.FEES ASSESSED
,Inspector: Date: i a 1 _ Phone #: (503) 718 -
-- -- -
CITY OF TIGARD • . • . .
BUILDING DIVISION ... - PERMIT #: BUP2008-00373
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2008
Phone: (503) 639-4171 :420,10,0ktiiiit,
- Inspection Requests (24 Hrs.): (503) 6394175 " .-14 11- .
INSPECTION WORKSHEET FOR DATE: 12119/2008 TIME - 7:00AM PAGE: 1
•
SITE ADDRESS: 12909 SW 68TH PKWY 190 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL
DESCRIPTION: . n .
OWNER: PACIFIC REALTY AssociATEs, PHONE #:
CONTRACTOR: MATTHEW OLSON CONSTRUCTION PHONE #: 503-892-0066
Inspection Request Scheduled For: Date: 1211912008 Pour Time:
Code # Inspection Description , Confirm # Contact # • Mess.. -
, ____,....,...
287 Suspended ceiling 079167-01 503-956-6290
•
Corrections/Comments/Instructions:
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fl PASS 4e, -, RTIAL APPROVAL 0 CANCEL El NO ACCESS
0 FAIL CALL • • 1 • CTION H ADDITIONAL FEES ASSESSED
Inspector: _ A ___ (--------->
0
Date: i 2-- / Phone #: (503) 718-712 67X
CITY OF TIGARD
BUILDING DIVISION PERMIT #: UP2008 00373
13125` SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2008
Phone: (503) 639 -4171 shd4N, e �
Inspection Requests (24 Hrs:) :.(503)'639 -4 =175 41 , .
'INSPECTION WORKSHEET FOR DATE: 12/19/2008 TIME. 7 AM PAGE: 26
SITE ADDRESS: 12909 SW 68TH PKWY 190 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CONIFER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL
DESCRIPTION: TI.
mm S -
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: .
CONTRACTOR: MATT -{qty OLSON CONSTRUCTION PHONE #: 503 -892 -0006
Inspection Request Scheduled For: Date: 12/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact #' Message
275 Framing 079144.01 503710 -6116 N •
Corrections/Comments/Instructions: :
- o(Z-( • -17 GI a6 Glb -hP
•
•
•
•
❑ , PASS / PARTIAL APP.: % �A ❑ CANCEL El NO ACCESS
❑ FAIL •R.INSPECTION ADDITIONAL FEES ASSESSED
Inspector: - Date: I Z Phone #: (503) 718- Z 4/V
CITY OF TIGARD
i
. ,
;BUILDING DIVISION :: PERMIT #: .
BUP2008•00373
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISS 11nol:10o8
. Phone: (503) 639-4171 'ow�
' ��
Inspection Requests (24 Hrs.): (503) 639-4175
�.;
INSPECTION WORKSHEET FOR DATE:. 12/9/2008 TIME: 7 :02AM PAGE: 1
SITE ADDRESS:. 12909 SW 68TH PKWY Igo CLASS OF WORK: .
SUBDIVISION: TIGARD TRIANGLE CENTER • LOT #: TYPE OF USE:
PROJECT NAME: I ;ENEFICI'AL
DESCRIPTION: 1
OWNER :. PACIFIC REALTY ASSOCIATES, . PHONE #:
CONTRACTOR:., MATTHEW OLSON CONSTRUCTION PHONE #: 503 - 892 -0066
Inspection Request Scheduled For: Date: 12/9/2008 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
275 Framing 076909 -01 503. 966-6290 - a
•
Corrections/Comments/Instructions:
i , - - ipp
_; - — i . L.'k .
. I —P r.tr< . c) \f /--C___ . -
•
PASS . p PARTIAL APP' •
f( ❑ CANCEL NO ACCESS
El FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector — Date: 2, 1 70ig Phone #: (503) 718- L
s