Permit CITY OF TIGARD BUILDING PERMIT
'11 o COMMUNITY DEVELOPMENT Permit #: BUP2009 -00174
• T i G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/18/2009
Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16600 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK 1 Lot: 9
Project: Spec Space
Project Description: Roof strapping
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 09/17/2009 $254.90
#300 12% State Surcharge - Building 09/17/2009 $30.59
PHONE: Plan Review 09/17/2009 $165.69
Plan Review - Fire Life Safety 09/17/2009 $101.96
Contractor:
EMERICK CONSTRUCTION CO
P.O. BOX 66100
PORTLAND, OR 97290
PHONE: 503 - 777 -5531
FAX: 503 - 771 -2933
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units:
Stories: Height: ft
Bedrooms: Bathrooms:
Value: $30,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $553.14
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 i - • •• - • = 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
day • TTENTION: Oreg • • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in • • -
95 - 001 -0010 through OAR • - 001 -0100. .0 - •btain a copy of the rules or direct questions to OUNC by calling 503.24• • • • 9 or :.0.332.23' .
Iss ed By: 0 t 6.11 / A/ , Permittee Signature: 'J
Call 503.639.4175 by 7:00 a.m. for an inspection that busi ess 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.
. - S.
Building Permit Applicati FOR OFFICE USE ONLY
City of Tigard CEIVED Received a a Date/B : (�� " to I
13125 SW Hall Blvd., Tigard, OR Plan Review
Phone: 503.639.4171 Fax: 503.598.1 F 17 2009 Date/B : J _ _a � ® OtherPermit:
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: I See Attached Checklist for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: i Supplemental Information
TYPE (glikpkG DIVISION
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
14Addition/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: /o, 9 �. New dwelling area: square feet
City /State/ZIP: /��,? He. 1 6 -"7e� D 4' Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: �' ') 4C- ei 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.
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.
l Valuation: $ 4 ' ) ` C 1
f� ✓
/ S Y? f1 a ?, ti _ i `
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: c
Name: PacTrust Type of construction:
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: -7,7 , _
Existi
City /State /ZIP: Portland, OR 97224 / - .
ng: /1 i
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: jy , f;0 p j e _,„ � � �o
� 0� W , BUILDING PERMIT FEES'
Address: /, \ (Please refer to fee schedule)
City/State/ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: !07 ,�5 Total fees due upon application:
Amount received: 3. i f
Authorized signature: ✓✓ This permit application expires if a permit is not obtained
�y
� within 180 days after it has been accepted as complete.
f /`
Print name: /� j d✓ wi z, � , , AC Date: J /�
* Fee methodology set by Tri-County Building Industry
Service Board.
1.\ Building \Pcrmits \BUP- PermitApp.doc 03121/06 440.4613T(1I/02/COM/WEB)