Permit CITY OF TIGARD BUILDING PERMIT
CO COMMUNITY DEVELOPMENT Permit #: BUP2009-00112
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: TI for portion of existing office space.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 07/16/2009 $243.72
#300 12% State Surcharge - Building 07/16/2009 $29.25
PHONE: Plan Review 07/16/2009 $158.42
Plan Review - Fire Life Safety 07/16/2009 $97.49
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: 2 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $27,832
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $528.88
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: No
Smoke Detectors: Manu 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 ' ccordance . approved plans. This permit will expire if work is not started within 180 days of issuance, or if , ork suspended for more the 180
days TTENTION: Oregon I- . re. - ou to follow the rules adopted by the Oregon Utility Notification Center. Those -s ar set forth in OAR
952 01 -0010 through OAR 95 , 01 -01 r r. may obtain a copy of the rules or direct questions to OUNC by calling • 99 or . • • • . .2344.
Is ued By: 41 i 1 Permittee Signature: & -�
Call 503.639.4175 by 7:00 a.m. for an inspection that busin. 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.
',ling Permit Application
Commercial JUN 1 6 200' I Oli OFFICE IJSE ONLY
City of Tigard Date
CITY OF TIGAR it I U • 14, i •d Permit No.: t 0 • ., • 2
Received B
13125 SW Hall Blvd., Tigard, OR 97223 n Plan Rev' 1
C , `i ' a I i Other Perm
Ph one: 5 Fax: 503.598.1960 a B
BUIL DING DIVISI �� g
C. It D Inspection Line: 503.639.4175 ►a te R ea ' ! El See Page 2 for
T 1
Internet: www.tigard- or.gov N. le thod:7 r a A Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AN l -FA ILY DWELLING
❑ New construction ❑ Demolition Permit fees" are based on the va ue of the work performed.
I Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement Other: OVE o r1.1v I equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling 1!rCommercial/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: ibgas qW - 2ND AVENUE New dwelling area: square feet
City /State /ZIP: PORTLAND t OR 94224 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Li QTR 1T1(1TURL 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.: 2S 113 A13012,61 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.
- iANT ImPRouEmeNr (3,o CO OF A PORTION Valuation: s 77S5
OF AN FX 1571W G COfainneRGIA1, OiliCE Existing building area: 4.1,552 square feet
/ New building area: 44,5s 2 square feet
❑ PROPERTY OWNER I [i TENANT Number of stories: 2
Name: 1,I(cERTY MUTUAL Type of construction: i II ° g
Address: 2000 UJESTUJOOD DRIVE Occupancy groups:
City /State /ZIP: WAUSA U (1)1 g440 2
t Existing: B
Phone: (11S) 842 a012 Fax: (1G) 0433500 New: B
❑ APPLICANT ErCONTACT PERSON
NOTICE
Business name: ,BRBRET + 4 AKA a5 All contractors and subcontractors are required to be
Contact name: rA I A GA LA N& licensed with the Oregon Construction Contractors Board
T -1� under ORS 701 and may be required to be licensed in the
Address: 909 DION- ;` f) N( cr. corm m 2_60 jurisdiction in which work is being performed. If the
City /State /ZIP: SAN - _4NCISGo , C41 94133 applicant is exempt from licensing, the following reasons
r 9 p A / ,q 5�-,4(��o r�
apply:
Phone: (41g) 3 3 4c Fax:: (41.5) 39 32
E -mail: mgal a i 6 b�1�O V1. ant)
)
J J CONTRACTOR
Business name: ('$ BUILDING PERMIT FEES"
Address: ( 0-7 .56 cZ� 14 w y 2_19_
(Please refer lo fee schedule)
City /State/ZIP: CLupte_(� 4-'s U` glol �� Structural plan review fee (or deposit):
Phone: () L5 e – CA LD 4 1 Fax: (1)3) 55 7 -- (0q.5/ FLS plan review fee (if applicable): —
CCB lic.: ( 5 � Total fees due upon application:
� Amount received:
Authorized signatur . . This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: \( —. f J Date: l6 Jv V
'xi * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 2123 /07 440- 4613T(11/02 /COM/WEB)