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Permit CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit #: BUP2010 -00189 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9416 SW WASHINGTON SQUARE RD K08 Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project: GNC Project Description: TI Owner: FEES PPR WASHINGTON SQUARE LLC Description Date Amount 2235 FARADAY AVE STE #O Permit Fee - Additions, Alterations, 09/30/2010 $2,615.95 CARLSBAD, CA 92008 Demolition PHONE: Plan Review 08/20/2010 $1,700.37 Plan Review - Fire Life Safety 08/20/2010 $1,046.38 12% State Surcharge - Building 09/30/2010 $313.91 Contractor: Metro Const. Excise Tax - Commercial 09/30/2010 $420.00 ALLEGHENY DESIGN MANAGEMENT INC Use 1154 PARKS INDUSTRIAL DR VANDERGRIFT, PA 15690 -9666 PHONE: 724 - 845 -7336 FAX: Specifics: Type of Use: COM Class of Work: ALT Dwelling Units: 0 Stories: 1 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $350,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $6,096.61 Required: Required Items and Reports (Conditions) Fire Sprinkler: Yes Parapet: Fire Alarm: Yes 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. Those rules are set forth in OAR 952 - 001 -0010 throug • r 952- 001 -0100. You ma o • ain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By f / Permittee Signature: 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. • / / i- - 1 t , iilding Permit Application Commercial �`��� O R O FFICF USE O1I l �ijj City of Tigard � Received � 14 Date /B : f it Permit No.: C I Rye).- `` oy V 13125 SW Hall Blvd., Tigard, OR 97223 1 2 ( '' Plan Review '• 111 . C Phone: 503.639.4171 Fax: 503.598.1960 WI) Date /B • : ��' I (O Other Permit: T I G A R D Insp Line: 503.639.4175 C �l(�} �R Date Ready /By: ®See Page 2 for Internet: www.tigard- or.gov � O " l SW Notified /Method: l r if /Q 44 MI Supplemental Information Cy LOV • Vfrili - g70.6 TYPE OF W o '. REQUIRED DATA: 1 AND 2 FAMILY DWELLING ❑ New construction Er 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 ap ❑ 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: g i/ / (p �p�t� S 1- l !' .crioN 67 New dwelling area: square feet — City/State /ZIP: -7, yo al ©/t T 7 a a-• 3 Garage /carport area: square feet Suite/bldg. /apt. no.: ,�..- pe Project name: 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. l fc :td•C f ,, t 40.0, � / cl� / ,/I,c Valuation: $ 35 prA tot s S Nie / I11,1 At 46.6 17 f1 I/., Existing building area: square feet g 7O �Ai/T t ,( New building area: square feet D( 70 15 OWNER TENANT Number of stories: / Name: 4 l AQ ( I,",,,/,., ti 4 ‘9 0 Type of construction: Address: /gyp 6 et Occupancy groups: City/State /ZIP: A ` 4 A /5a �, Existing: .6 7 a Phone: ( /2) oZ��"[/t Fax: (t/ ), ) 371r - 7 ¥ 7 � New: ,?-1.) 7 b v APPLICANT 0 CONT PERSON NOTICE Business name: a tiL Q,�t el � X,9 e 7 ' All contractors and subcontractors are required to be Contact name: O,Cj�a�iCJr�(C� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 67' 7J� jurisdiction in which work is being performed. If the City/State /ZIP: // 1; 4 ,Q /5 .2...3-c9- apply: is exempt from licensing, the following reasons pPly: Phone: ( , ( 4 / � _ - ) 337 y , , 7 . 5 ° Fax: : ( 1 / / � 3 5 7 - - - . 5 7 7 7 1 , E- mail:�'L If — 4itav ijcie wee- - 6Op , vi CONTRACTOR Business name: l eftiy �tciN , - Art • TIC . BUILDING PERMIT FEES* / t! S L P / y kJ N �� {� r ` 2 ' `/n „p Y/ (Please refer to fee osit): /e) • Address: City /State /ZIP: 1 ` (J " Structural plan review fee (or deposit): 1100 a •3 7 l/aN I I � q 6,66 156 90 — • Phone: (7 ► 1.15 F ax: ( ) FLS plan review fee (if applicable): i Ot./f . y CCB lic.: 1 ),S3 70 Total fees due upon applicatior ��(� ' 1 D Amount received: Authorized signature: This permit application expires if a permit is not obtained { ) within 180 days after it has been accepted as complete. f 1 Print name: 9 oh 4 p S c y Date: * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits \BUP - COM PermitApp.doc 10 /01/09 440- 4613T(11/02/COM /WEB) 7. 5 N 90-ky ALLEGHENY DESIGN MANAGEMENT INC 1154 PARKS INDUSTRIAL DRIVE VANDERGRIFT PA 15690 -9666 CCB LICENSE 125370 CONSTRUCTION CONTRACTORS BOARD BOND AMOUNT: $15,000 LICENSE NUMBER: 125370 MINIMUM INSURANCE AMOUNT: $1,000,000 EXPIRATION DATE: 01/01/2012 1NDEP. CONT. STATUS: EXEMPT LICENSE TYPE: General Contractor /AII RMI: JOHN STEVEN KURUC ENTITY TYPE: Corporation ALLEGHENY DESIGN MANAGEMENT INC 1154 PARKS INDUSTRIAL DRIVE VANDERGRIFT PA 15690 -9666 STATE OF OREGON CONSTRUCTION CONTRACTORS BOARD LICENSE CERTIFICATE LICENSE NUMBER: 125370 This document certifies that ALLEGHENY DESIGN MANAGEMENT INC 1154 PARKS INDUSTRIAL DRIVE VANDERGRIFT PA 15690 -9666 is licensed in accordance with Oregon Law as a General Contractor /AII Structures. License Details: EXPIRATION DATE: 01/01/2012 ENTITY TYPE: Corporation INDEF. CONT. STATUS: EXEMPT BOND AMOUNT: $15,000 MINIMUM INSURANCE AMOUNT: $1,000,000 RMI: JOHN STEVEN KURUC . ..