Permit CITY OF TIGARD BUILDING PERMIT
111 11 o COMMUNITY DEVELOPMENT Permit #: BUP2009 -00182
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2009
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE 200
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: CIDA
Project Description: TI of interior partitions.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 09/30/2009 $414.70
PORTLAND, OR 97224 12% State Surcharge - Building 09/30/2009 $49.76
PHONE: 503 -624 -6300 Plan Review 09/30/2009 $269.56
Plan Review - Fire Life Safety 09/30/2009 $165.88
Contractor: Permit Fee - COM 09/30/2009 $168.00
MATTHEW OLSON CONSTRUCTION 12% State Surcharge - Building 09/30/2009 $20.16
5320 SW DOVER LN Plan Review 09/30/2009 $109.20
PORTLAND, OR 97225 Plan Review - Fire Life Safety 09/30/2009 $67.20
PHONE: 503 -892 -0066
FAX: 503 - 892 -0067
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 2 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $95,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,264.46
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 fprmore the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules = - set fo in OAR
952- 001 -0010 rou h OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. • • • ;99 1.800.332. 44.
Issued By: 6l Y ( /1 n V V 11 �� Permittee Signature:
CaII 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
Cit of Ti and Received
y g Re e : J Permit No.: �L • ( Q
` 01
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / � '
_ Phone: 503.639.4171 Fax: 503.598.1960 Date/13 : rt ` OtherPermit:'�
TIGARD Inspection Line: 503.639.4175 Date Ready/By: See Attached Checklist for
Internet: www.tigard - or.gov Notified/Method: r Supplemental information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
I ❑ 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.
El 1- and 2- family dwelling ® Commercial /industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ,...:_ '7 -� �� /v /-P /, New dwelling area: square feet
City /State/ZIP: � j /4N 4 /2 9 7�.Q 9 ? Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: ) t Covered porch area: square feet
Cross street/directions to job site: rf Deck area: square feet
-Irk a _, � . y2 T7 4j (^)4_ Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ / j ®dd
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
r
Name: PacTrust Type of construction:
11/
Occupancy groups:
Address: 15350 S.W. Sequoia Pkwy., Suite 300
City /State/ZIP: Portland, OR 97224 Existing: p
Phone: (503)624 -6300 Fax: (503)624 -7755 New:
® 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 Fax: : (503) 624 -7755
E -mail: dennisp@pactrust.com
CONTRACTOR
Business name: ,L& ,� � -6 act," x / a 4 BUILDING PERMIT FEES*
Address: /7)Z. (Please refer to fee schedule)
Structural plan review fee (or deposit):
City/State/ZIP:
Phone: ( ) Fax: ( )
FLS plan review fee (if applicable):
CCB Iic.:
Total fees due upon application:
Amount received: 1 a (c (
Authorized signature: This permit application expires if a permit is not obtained
"' within 180 days after it has been accepted as complete.
Print name: i ✓ �� , Date: , j�_ /� G fr . Fee methodology set by Tri-County Building Industry
Service Board.
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