Permit CITY OF TIGARD BUILDING PERMIT
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COMMUNITY DEVELOPMENT Permit #: BUP2010 -00214
T i GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: Lincoln Heritage
Project Description: TI
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096 Permit Fee - Additions, Alterations, 09/22/2010 $2,766.95
WARREN, MI 48090 Demolition
PHONE: 12% State Surcharge - Building 09/22/2010 $332.03
Plan Review 09/22/2010 $1,798.52
Plan Review- Fire Life Safety 09/22/2010 $1,106.78
Contractor:
R & H CONSTRUCTION CO
1530 SW TAYLOR ST
PORTLAND, OR 97205 -1819
PHONE: 503- 228 -7177
FAX: 503- 224 -3638
Specifics:
Type of Use: SF
Class of Work: ALT
Dwelling Units: 0
Stories: 4 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $375,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $6,004.28
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 • • opted by the • - • on Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA ; - 001 -0100. You may obtain a cop • . . - or di =ct questions to OUNC by calling 503. • 6.6699 or 1.800.332.2344.
Issued By: `L ` • ermittee Signature:
CaII 503. 39.4 y 7:00 a.m. for an inspection that business 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.
Building Permit Application
Commercial FOR OFFICE USE ONLY
111 City of Tigard D ate /B : � � O / Permit No.:
q ►" lV — �
13 125 SW Hall B lvd., Tigard, OR 97223 Plan Revie�e r lOrl
C Phone: 503.639.4171 Fax: 503.598.1960 DateB : J♦ ` Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Read y: ®See Page 2 for
Internet: www.tigard - or.gov Notified/Method: L� Supplementallnformation
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 ® 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: Triangle III, 13221 SW 68th Parkway New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: 100 Project name: Lincoln Heritage 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: 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.
Interior Tenant Improvement Valuation: $375,000.00
Work to include demolition, new walls, ceilings, doors, relites, and cabinetry Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 5
Name: GKTriangle Corp Park III LLC, c/o CB Richard Ellis Type of construction: I -B
Address: 1300 SW 5 Ave. Suite 200 Occupancy groups:
City/State/ZIP: Portland, OR 97201 Existing: B
Phone: (503)221 -1900 Fax: (503)221 -4873
New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Group Mackenzie All contractors and subcontractors are required to be
Contact name: Jane Chambliss licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1515 SE Water Ave Suite 100 jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9560 Fax: : (503) 228-1285
E -mail: jhambliss@grpmack.com
CONTRACTOR
Business name: R & H Construction BUILDING PERMIT FEES*
Address: 1530 SW Taylor Street (Please refer to fee schedule)
Structural plan review fee (or deposit):
City/State/ZIP: Portland, OR 97205
Phone: (503) 228 -7177 Fax: (503) 224 -3638 FLS plan review fee (if applicable):
CCB lic.: 38304 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Jane Chambliss Date: 09/22/10 * 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):. - 1
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IIIII e ° Building Division
Over - The - Counter (OTC) Building Permit
ricnii° Check List
Description of Project: f 1
GENERAL INFORMATION
Class of Work:* % Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* lii % First floor: N: S:
Type of Construction: 1 i p, Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: Total sq ft.: N: S:
Stories: 4— Note: Combine total floor area for E: E:
H ht: _ 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: r Handicap access: A �
Smoke detector: � Protected corridors: NO
r
Fire alarm: T�� Parking spaces ( #):
Notes:
Total Valuation: $ 375 ,
I INSPECTIONS 1 FEES DUE
Footing /foundation Firewall $ ay _ ' Permit Fee
Post /beam structural Smoke detector $ Q tate Surcharge
Shear wall Misc. inspection $ kral'`N"ci lan Review Fee
Masonry Approach /sidewalk $ I V a FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ +50 . CO Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ 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