Permit ,, CITY OF TIGARD BUILDING PERMIT
;- COMMUNITY DEVELOPMENT Permit #: BUP2011 -00035
Tigard OR 97223 503.718.2439
1 3125 SW Hall Blvd., Ti Date Issued: 02/15/2011
TIGARD 9
Parcel: 2S101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 380
Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot: 0
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 DC Provision Review, COM TI - Ping • 02/15/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 02/15/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 02/15/2011 $164.96
Stories: 4 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 02/15/2011 $19.80
Value: $6,000 Plan Review 02/15/2011 $107.22
Plan Review - Fire Life Safety 02/15/2011 $65.98
Info Process /Archiving - Lg Sheet (over 02/15/2011 $6.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $436.96
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes 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 OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 • : •r 1.800. . - -.
Issued By: // Permittee Signature: '44r-
all 514 • • . ' 75 by 7:00 a.m, for the next available inspectio Pate.
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.
•
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Euildin Permit A lication V 401. r t A V i FOR O ICE ON , r° � "
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" City of Tigard �„,V Received i 5 Permit t 40r p. •
Date/By: IN
13125 SW Hall Blvd., Tigard, OR 9722 '1 11 Plan Review
r Phone: 503.639.4171 Fax: 503.598.1 1 . o Date/B : ��
Other Permit:
,� ;IGARD Inspection Line: 503.639.4175 "\_ . R� Date Ready ;y: turfs. See Attached Checklist for
f kl •
:, : a Internet: www.tigard -ocgov �� .C (1 Cj� \S otified/Method: • (I 5 �J �j, 77 Supplemental Information .
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" * " ,.�,w a.. u.,ee_ z = - �. s -:. .55Ca+ .. �t:.�=�.s., `4L��« - ._.a 3wtr.,�anr '�.a• ,v .3 se` .e +•.`
New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
A Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
k. ,, Q s ” � COTR
° * ' o `' s work indicated on this application.
? , , v e CEGO
A TRYOF NSUCTT , .i - ,
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
s f 3 JOB SITE AND LOCATION I M ,; Total number of floors: •
. .d ; , _ ,�+v., �rax. - ., v,. - _ 1 e -. .,: t �d, - g -0
Job site address: �� �'9,9 'g �r j�v ` New dwelling area: square feet
City/State /ZIP: v r/I �Q11 ,9,..c.,1 � .g.g.02 � P Garage /carport area: square feet
Suite/bldg. /apt. no.: Project natfie: , 4 CA — Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
RRE9 rnE
jJD I) ATA COIVIMFRCIAI" SE d H E CKLIS T
Subdivision: I 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
,�?� �.,, a' <'- „�:`.: sy €t;�' . =;�z 'Ea �yr� >a�r'. �'s ` �:�"�'., Zra.',r. i3c =�, =a _'.,,� . � �•
equipment, materials, labor, overhead, and the profit for the
°3 V. p ,�� '',' `DESCRIPTION) OFD WORKt # ` ' work indicated on this application.
7/s” / Valuation: $ 4r
.,,,r'. CU ,,,,,,'-r '2,c r-7_ wu2 GU kJ c' /
c' Existing building area: square feet
New building area: square feet
x a "
.,,
4 S a � t4litPERTY OWNER s S , - 4` K� - I,7?ENAN = t Number of stories: y
.�c �..��; � -aaS .x �•�` g ,.a_��.y.,�»a� r..b., �i"�`����1._�,. >& _ :. >sM .�� -.a;
Name: PacTrust Type of construction: /1"" -27
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: >?
City /State /ZIP: Portland, OR 97224 .
Existing: /_ ,
Phone: (503)624 -6300 Fax: (503)624 -7755 New: / --------'
• ��-�" � - R "a :e:a -a' :. r,:a_ ,., �, � aa��z, =.:.a �a�-�t . • , .,: Y , +:t r = -�-� n c :� `fl . �,
`,.`464 ,. al 'APPLICANT"" . �.' .. r ° a CONTACTsPERSON� , : <.,, -, -,,
_..a,:,'����r �*-xc ,a,�_Ya � �� m a w s �NOT1C i
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
t - . zr its i ,I« „. CONT'RACT , d . . ._. - ihti
�. __ . - �.� � A.�- ; ter �� ,_
Business name:
BUILD ING PEF�IT MEOW:
Mc
-� :. r a - f ie schedule .
City/State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: Total fees due upon application: i c)lo , 9 (
Authorized signature: , / Amount received: 1 �O t -ICl
--2--- • This permit application expires if a per t is not obtained
within 180 days after it has been accepted as complete.
Print name:
.° /74),5 d ,.�� / ' Date: �G� / C /)./ * Fee methodology set by Tri-County Building Industry
b Service Board.
1:1Building \ Permits \BUP- PermitApp.doc 03/21/06 440- 4613T( I I /02 /COM/WEB)
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: * I!:r<pedited R e i w
Plan Submittal Date: . 9 J'7 //
To the Applicant: / gal *AO
➢ If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
➢ If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left on y if approved. / � f
Planning Review (contact at 503-7181;3 r `� or @ tigard- or.gov)
/L Zoning �� Permitted Use Yes ❑ No ❑
in Land Use Required: Yes ❑ No `E (explain below)
Notes: L►1 WA rilMarili. vlie
/ f r
proved ❑ Not Approved Date: ' 7
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
iid/ 4 -
Routed back to Building Division Date: (9 I V v/
I: \CURPLN
Ili
ti ri ., .- Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: ( t
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: - J Cr Occupancy Group: Type of Construction:
*Type of Use: Occupancy Load: 4- Oregon Specialty Code: 7_Q i("'I
SPECIFICS
Number of Stories: Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS -
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: 'Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access. Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: ` Fire Alarms: If Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 'OnC) FEES DUE
$ r DC Prov Rvw, COM TI — Ping
DC Prov Rvw, COM TI —LRP
DC Provision Review Fee for COM TI $ , (cj . Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ (1, 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ C ®,faZ. Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ 6 , ---,, T 3. Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ to , Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $256.00 $38.00 $ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ " f,9l:, 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.
G \Building \ Forms \OTC- BUP.docx 01 /13/2011