Permit �n
CITY OF TIGARD BUILDING PERMIT
1111 i
l:.'. COMMUNITY DEVELOPMENT Permit #: BUP2010 -00262
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2010
TIGARD Parcel: 2S110DCO2400
Jurisdiction: Tigard
Site address: 11565 SW DURHAM RD 110
Project: Dr. Tollenarr Subdivision: Lot: 0
Project Description: TI
Contractor: BRENT HILLMAN & ASSOCIATES INC Owner: MOODY 2005 TRUST
PO BOX 3188 BY PAUL W & LINDA L MOODY TRS
TUALATIN, OR 97062 9811 NE 114TH CIR
VANCOUVER, WA 98662
PHONE: 503 - 209 -1794 PHONE:
FAX: 503 - 590 -8962
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 12/01/2010 $880.05
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 12/01/2010 $105.61
Stories: 1 Height: 0 ft Plan Review 12/01/2010 $572.03
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 12/01/2010 $352.02
Value: $70,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,909.71
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No 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. ATT ON: Or n law re uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 9 - -009 u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or .800.332.2344.
I , F
Issued A I� I Permittee Signature: r /
Call 503.639.4175 by 7:00 a.m. for the next available ins. -c ion date.
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.
d Building Permit Application
Commercial i ^ CEIVED
• F OR OFFICE USEONLY
City of Tigard Received
C 1 2010 DateB : Permit No.: qt , 10/6 13125 SW Hall Blvd., Tigard, OR 97 Plan Date Review '
Phone: 503.639.4171 Fax: 503.598 0 Other Permit:
TIGARD
Inspection Line: 503.639.4175 C OF TIGARD Date Ready /By: Juris: Fa See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION 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
Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
E] 1- and 2- family dwelling Commercial /industrial
Valuation: $
1:1 Accessory building El Multi-family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / / .5" T .S.t,J b 1�i.,� Rai New dwelling area: square feet
City /State /ZIP: Garage /carport area: square feet
Suite/bldg. /apt. no.: i 1 Project name: Die 7 U `F //3.ti) ,„2.k Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
' t Other structure area: square feet
4
`( REQUIRED DATA: COMMERCIAL -USE CHECKLIST'
Subdivision: G�",� 1 9 iI 1 ._ t„ac� •"Z 2 0,1 I O's (s ue 1 Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
n Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
. DESCRIPTION OF WORK work indicated on this application.
t,)„,-,...,_, Valuation $ 7 ct
,,,,,,),) 1:- 6.,,,,4 Existing building area: square feet
• : j� New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1 Name: Dz t 6 r/e . ,-_ Type of construction: 45E2 ' j Address: f`ct, sf.' 5c) a ,e. W�, Occupancy groups:
,. •,i City/State /Z1P: !3 /�
t / �� �,/� Existing: B _
s Phone: ( ) Fax: ( )
New:
' ❑ APPLICANT ❑ CONTACT PERSON NOTICE
� j
B usiness name: l �
��� /��� � /G� } ��5sjt✓ L C_ All contractors and subcontractors are required to be
Contact n ame: Bieg/ l icensed with the Oregon Construction Contractors Board
u nder ORS 701 and may be required to be licensed in the
,1 Address: fy3. l 7 jurisdiction in which work is being performed. if the
�' CityJState /ZIP: �� � applicant is exempt from licensing, the following reasons
� / ,f az rt- — 1 l� apply:
l t Phone: (5 3) o Z - 6'7 —/ 7 9 y F a x : : ( ) 7/ 7_ d6,,, r _
IN
r 0 : E mal: �� �G 7 40, 6") f4#1, — �' C � CONTRACTOR
) � 't . / Business name: ' 1 - �� if!'h y � f , •`•- t = BUILDING PERMIT FEES*
I ) l (Please 'refer to fee schedule)
Address: l2 0- 3/ 9 5 Structural plan review fee (or deposit):
City/State /ZIP: "5> 7 J, -er ,../ c 9 � -
FLS plan review fee (if applicable):
Phone: (563 ) 09 — / 79 eq° rFax: (503) 7/.7 - i_ / S` 3
Total fees due upon application:
CCB lic.: 77er / ` ? 9?
3 ! 9 Amount received: / q0' , '/ r
Authorized signatur` x
_ 7. This permit application expires if a permi not obtained
A mor within 180 days after it has been accepted as complete.
Print name: 9_,37= /' /, I t . /14,-..,,-.-/ Date: /� // ? /L) * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building \Permits\BUP -COM PermitApp.doc • 10/01/09 440- 4613T(11/02 /COM/WEB)
Buildi Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
•
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I: \Building \Permits \BUP -COM PennitApp.doc 06/25/08
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Description of Project: - 1 - 1
GENERAL INFORMATION
Class of Work:* Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: 17,7 Third floor: Openings Protected Y /N ?:
Occupancy Load: Total sq ft.: N: S:
Stories: k Note: Combine total floor area for E: E:
Height: all floors above third floor and Roof Construction:
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fite sprinkler: PCO Handicap access:
Smoke detector: Protected corridors:
Fire alarm: Parking spaces ( #):
Notes:
Total Valuation: $ 70 60c)
INSPECTIONS FEES DUE
Footing /foundation Firewall $ li, 116 Permit Fee
Post /beam structural _ Smoke detector $ ! % s State Surcharge
Shear wall Misc. inspection $ tie Plan Review Fee
Masonry Approach /sidewalk $ ,e) FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ I ourly Rate State Surcharge
$ Other:
•
$ 1 l a' :71 Total Fees Due
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
L \ Building \ Forms \OTC- BUP.doc 08 /19/08