Permit CITY OF TIGARD BUILDING PERMIT
' ° COMMUNITY DEVELOPMENT Permit #: BUP2009-00153
.T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2009
Parcel: 2S 113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Spec Space
Project Description: Alter interior walls
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 08/06/2009 $558.70
PORTLAND, OR 97224 12% State Surcharge - Building 08/06/2009 $67.04
PHONE: 503- 624 -6300 Plan Review 08/06/2009 $363.16
Plan Review - Fire Life Safety 08/06/2009 $223.48
Contractor:
DURUS CONTRUCTION LLC
15806 UPPER BOONES FERRY RD
LAKE OSWEGO, OR 97035
PHONE: 503 - 320 -8601
FAX: 503 - 244 -4318
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $90,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,212.38
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 accordance 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
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.24 9 or 1 0.332.23 .
Issued By: A/IN, / Permittee Signature:
V " h
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.
Building Permit Application • FOR OFFICE USE ONLY
Cit y g of Tigard Received
is DateB Permit No.: e , ^ V U'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
r
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/B
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: RI See Attached Checklist for
Internet: www.tigard - or.gov Notified/Method: 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
AAddition/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: /e
tYl ....� ___<-4, Z i++17 New dwelling area: square feet
City /State/ZIP: r.e )_) , j i f 2, c9 /f"�0 Y Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name:70G iG 8 —Z ' O _pe C_ 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.
Valuation: $ 570 )
id
Existing building area: square feet
a, J e--- iiipl, New building area: square feet
® PROPERT ❑ TENANT Number of stories:
/
Name: PacTrust Type of construction: 14'.0:67
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: Zr/..5-- Z
City /State/ZIP: Portland, OR 97224 Existing: /.....5 c5
Phone: (503)624 -6300 Fax: (503)624 -7755 New: --6:1__
® 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: 1, 22 gus' Cow /� "rre.% T / / C /n 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.:
Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
� 9,.....410.2._ within 180 days after it has been accepted as complete.
Print name: ' Date:
A i a f f jey
* Fee methodology set by Tri-County Building Industry
Service Board.
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