Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00012
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/02/2010
TIGA .R.D 9 ,
Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 9
Project: Veris
Project Description: Install a 12' x 17' concrete pad for outdoor nitrogen tank.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 02/02/2010 $301.85
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 Plan Review 01/22/2010 $196.20
12% State Surcharge - Building 02/02/2010 $36.22
Contractor:
PACIFIC CONSTRUCTION SERVICES
1921 SE 127TH AVE.
VANCOUVER, WA 98683
PHONE: 360 - 910 -9439
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $14,245
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $534.27
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No Manual Pull Stations:
Accessible Parking: 0
This permit is ' - - • • • - • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don= ' accordance with appro - • 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 -. ATTENTION: Oregon law requ e- • ou t• follow the rules adopted by the Oregon Utility Notification Center. Those rules are set fo in OAR
9 001 -0010 through OAR 952 -001 00. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 1.60I/ • 2.2344.
Is= uedBy: _■4 ` / /'/LA.`:L. Perm ittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busine 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
Commercial RECEIVED FOli OFFICE 1,51:: O� \'L.1`
City of Tigard Dat /B : 0 Permit No..I11 ! • • "`
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie '
a 4 Other Permit:
LL Ph one: 503 Fax: 503.598.1960 JAN 2 2 201 Date/13 �;���E�/�
Inspection Line: 503.639.4175 Date Re' ® y: See Page 2 for
n fi u Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: . a U ' a :, ,FM Supplemental Information
DING DIVISION
TYPE OF WOW'
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
® 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: 16640 SW 72 Ave New dwelling area: square feet
City /State /ZIP: Tigard, OR 97224 ' * Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name ttre paeity Y er / C Covered porch area: square feet
Cross street/directions to job site: 1 -5 South to Lower boones ferry. t � Deck area: square feet
At the next light turn right onto 72nd Ave. Veris Industries will be down Other structure area: square feet
1/4 mile 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.
-
wn a 12' X 17' concrete pad for a outdoor Nitrogen Tank. Valuation: $14245.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories:
Name: Veris Industries LLC. Type of construction:
Address: 16640 SW 72" Ave Occupancy groups:
City /State /ZIP: Tigard, OR 97224 Existing:
Phone: (503)670 -1260 Fax: (503 )620 -5678 New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Veris Industries LLC. All contractors and subcontractors are required to be
Contact name: Bryan Johnson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16640 SW 72" Ave jurisdiction in which work is being performed. If the
City /State /ZIP: Tigard, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 670 -1204 Fax::( )
E -mail: Bryan.johnson @veris.com
CONTRACTOR
Business name: Pacific Construction Services, LLC BUILDING PERMIT FEES*
Address: 1921 SE 127th Ave. (Please refer to fee schedule)
City /State /ZIP: Vancouver, WA 98683 Structural plan review fee (or deposit): 1q1, . 2 D
P (360) 910 -9439 Fax: (360) 882 -9439 FLS plan review fee (if applicable): w
Total fees due upon application:
ic.: 145249
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: Date: f f i 2 16 * Fee methodology set by Tri -County Building Industry
Service Board.
l:\Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02/COM/WEB)