Permit ............ ...
CITY OF TIGARD BUILDING PERMIT
` • COMMUNITY DEVELOPMENT Permit #: BU P2010-00264
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2010
�ARa Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE 250
Project: Diagnostic Male Medical Subdivision: OREGON BUSINESS PARK III Lot: 40
Project Description: TI
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES
5320 SW DOVER LN 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97225 PORTLAND, OR 97224
PHONE: 503 - 892 -0066 PHONE: 503 - 624 -6300
FAX: 503 - 892 -0067
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 12/01/2010 $225.80
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 12/01/2010 $27.10
Stories: 0 Height: 0 ft Plan Review 12/01/2010 $146.77
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 12/01/2010 $90.32
Value: $10,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $489.99
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. ATTENT _ • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules forth in OAR
952 -001- 0 through OA -8 01 00 • • You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 887 •r 1.800.332. 4.
` I
Iss ed By: `—; Permittee Signature: A e d / r ��
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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.
Building Permit Applicatio , ECEIVED FOR OFFICE ON LY a.� � . ,. ;� ,
City Of Tigard 9 2010 Received / PemiitNo. �,a,�/��
y � EC Y Date/By: /i / / % = /CJII�r�s
" 13125 SW Hall Blvd., Tigard, OR 9722
g Plan Revi- ••
Phone: 503.639.4171 Fax: SO3.S9s. Y OF TIGARD DateB : / /" AP Other Permit
TIGAR Inspection Line: 503.639.4175 Date Ready /By: - Juris: a See Attached Checklist for
. ti Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
- TYPE OF lyoRK REQUIRED DATA: 1 AND "2 FAMILY DWELLING
CI 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
" work indicated on this application.
CATEG012Y. ,OF CONSTRUCTION
111 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JO SITE INFORMATION' AND LOCATIONS' Total number of floors:
Job site address: � t f ��� )7 �i !f�/(, ._ New dwelling area: square feet
City /State /ZIP: Ai ,,, ,,� '''7.,V Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 2 ® 4 u /�__ Covered porch area: square feet
Cross street/directions to job site: P if: t Deck area: square feet
Other structure area: square feet
AREQUIRED A CMMERCIAL USE C HECKLIST;'
�.. DATO
e mss. _<
Subdivision: 1 Lot no.: Permit 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
DESCRIPTIONOF WORK 1 work indicated on this application.
I Valuation: $ &
Existing building area: square feet
New building area: square feet
`'erg '® WNER '' t, ® TE NANT
n3 �.. ,1 1,,,, a :�'� -•: .. ,., O F ,.... , , . r es .p ='et ate - ,. , - s , Number of stories: "
Name: PacTrust Type of construction: Jj}
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups:
City /State /ZIP: Portland, OR 97224 Existing: 5::-5-9
Phone: (503)624 -6300 Fax: (503)624 -7755 New: 'Z----.. ,
,! E ,- AP PLICI j . n n z ®`CONTACT PERSON ... tr F .. ' N OTI CE[` ?. . ... . . ... :�
z
r` " _ .�, _, -. _. .e .Asa. a. ., a ., r: _ - z�_. "v._ ,,,,,T YsN a ,. .«, d s°° -' .
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 f
Business name: ./.29/7-121,L......." �.�,.., G C15 BUILDING PERIVIIT FEES* ; ' ` �
Address:
C I fr , - (Plea e efer to. fee schedalg . W to ttii .pit
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
within 180 days after it has been accepted as complete.
Print name: / / /����� - ` � / , Date: ,,,..... f �s * Fee methodology set by Tri- County Building Industry
Service Board.
1:\ Building \ Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(11 /02 /COM/WEB)
I II
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Description of Project: 7
GENERAL INFORMATION
Class of Work:* Floor Areas (sq. ft.): Exterior Wall Construction:
T se of Use:* rOEN. First floor: N: S:
Type of Construction: III� Second floor: E: W:
Occu.anc Grou.: Third floor: Openings Protected Y /N ?:
Occu.anc Load: WrG0111 Total sq ft.: N: S:
Stories: '7i 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
Fire sprinkler: Handicap access:
Smoke detector: Protected corridors:
Fire alarm: Lii4.5 Parking spaces ( #):
Notes:
Total Valuation: $ ( 6 ) COO
INSPECTIONS FEES DUE
Footing /foundation Firewall $ " ' ` Permit Fee
Post /beam structural Smoke detector $ 7r 40 State Surcharge
Shear wall Misc. inspection $ Amer Plan Review Fee
Masonry Approach /sidewalk $ Q 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
$ Hourly Rate. State Surcharge
$ Other:
$ 469%,?? 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.
1: \ Building \ Forms \OTC - BUP.doc 08/19/08