Permit •
CITY OF TIGARD BUILDING PERMIT
• � COMMUNITY DEVELOPMENT
Permit #: BUP2009 -00141
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
T(t Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16600 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I • Lot: 9
Project: Spec Space
Project Description: Demo interior partitions. No plan review required per Dan Nelson.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM • 07/31/2009 $703.90
#300 12% State Surcharge - Building 07/31/2009 $84.47
PHONE:
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: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $130,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $788.37
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 rrnMan e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspe ded for more t
days TENTION: Oreg• -w requi - ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are s: rth in OAR
95 - 001 -0010 through OAR 9 • • , -010• ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6., • 1.800. .2344.
Is ued By: � ` Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that b iness 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
City of Tigard 1l 1 . CEW D R D eceive a te/B : d /J �'1 B PernitNo.: S u °, /r ?"'�/ •
�
13125 SW Hall Blvd., Tigar., O' 97223 4 Plan Review
Phone: 503.639.4171 Fax: 503.59. 19 L 4,•-.4„. ''HI'' Other Permit: • Inspection Line: 503.639.4175 U�° 1 2009 1 D y�g Date Ready/By: la See Attached Checklist for
Internet: www.ci.tigard.or.us , Notified/Method: Supplemental Information
CITY OF TIGARD t / '
BU '1rM bVQ RK REQUIRED DATA:. 1- AND 2- FAMILY DWELLING
❑ N w construction Demolition Permit fees' are based on the value of the work performed.
ja
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.
❑ 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: ,�a/.0f11 ,S'�/ ��,4 ,t7 New dwelling area: square feet
City/State/ZIP: 4P 4/ , ‘ ,„„d OR 97��t� Garage/carport area: square feet
Suite/bldg. /apt. no.: _ I Project nam e e s .,2Pry - s4 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.: Pemtit 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.
,eIr t U / eP /r >IZ 24 i i 4' O � r Valuation: $ ,�� �'�
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: -74,...• 7- ,/ '� ' ./ ./ /- � Type of construction: j
Address: Occupancy groups: 4a
City/ State/ZIP: Existing:
'11—S iL7.
Phone: ( ) Fax: ( ) New: •_,e5;) J
❑ 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 Parkway, 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 I Fax: : (503) 624-7755
E -mail: dennisp @pactrust.com
CONTRACTOR ..
Business name: .4 .0 R f 4:_.. IC BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) I Fax: ) 57
7
fo a3 Amount received
CCB lic.:
Date received:
Authorized This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: J , _ Date: ' 4 /jr — o - • Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Bui ldingWennits \BUP- PemitApp.doc 12103 440- 4613T(II /02/COM/WEB)