Permit CITY OF TIGARD BUILDING PERMIT
0 COMMUNITY DEVELOPMENT Permit#: BUP2009 -00114
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/17/2009
Parcel: 25112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE 190
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Truman Capitol Advisors
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 06/17/2009 $112.55
#300 12% State Surcharge - Building 06/17/2009 $13.51
PHONE: Plan Review 06/17/2009 $73.16
• Plan Review - Fire Life Safety 06/17/2009 $45.02
Contractor:
BNK CONSTRUCTION INC
10730 SE HWY 212
CLACKAMAS, OR 97015
PHONE: 503 - 557 -0866
FAX: 503 - 557 -1085 •
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $8,500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $244.24
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: No Protected Corridors: No
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 expired work is not started within 180 days of issuance, or if work is sus • ded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ar = orth in OAR
952 -0: -0010 throug' •AR 952 -001 -0 • 1. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.24.i. • • • or 1.801. .2344.
Issu • By: / �_ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an Inspection that business • ay.
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.
1
Building Permit Application 4 //I1 < / FOR OFFICE USE ONLY I
City of Tigard J/ / Received Dateiv : - /AT PermitNo.: / ��r� �I
° 13125 SW Hall Blvd., Tigard, OR 97223 JUN Z/ 0 Plan Review / �' s �►,
11 1 I
�Q i �' Other Permit:
Phone: 503.639.4171 Fax: 503.598.1�6Q �9 DateB : s
TIGARD . Inspection Line: 503.639.4175 °' ���' Date Ready /B : ®See Attached Checklist for
Internet: www.tigard- or.gov ;' v J Notified/Method: Mr Supplemental Information
' - •...�
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
A Addi tion/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 0 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: 2.5V75---7,...52‘..) 9j l'47,4) 4 l / 9e New dwelling area: square feet
City/State /ZIP: �U, �-i� f 0 a
- y �/ Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name:T vrn / Ap, ...fret, I Covered porch area: square feet
Cross street/directions to job site: 11 /--() tit 50l ... . Deck area: square feet
1 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: $ __a
.' R-- 7a se-;7 4,,e7A.2s-lop-AL),--- WOO v .' 1•< Existing building area: square feet
/C J New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: l/ /3
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: ��
City /State/ZIP: Portland, OR 97224
Existing: /i71-5,
Phone: (503)624 -6300 Fax: (503)624 -7755 --��
New:
0 APPLICANT 0 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: , }J / C (Jn.J (-.J ' 7 O /L/ BUILDING-PERMIT•6EES *.; . :,.:;
Address: ' (Please - refer to fee schedule) .
City/State/ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: 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: , Q ` Date: •
,
0 Fee methodology set by Tri-County Building Industry
Service Board.
1:\ Building \Permits \BUP- PermitApp.doc 03 /21/06 440- 4613T(II /02/COM/WEB)