Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00060
TIAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2011
G R
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 306
Project: Advanced Acupuncture & Oriental Medicine Subdivision: TIGARD MEDICAL MALL Lot: 0
Project Description: TI
Contractor: ROBERT TODD CONSTRUCTION INC Owner: MCFADDEN, ARTHUR L
4080 SE INTERNATIONAL WAY 8113 BY ERIC SKLARZ
MILWAUKIE, OR 97222 621 SW MORRISON ST STE #800
PORTLAND, OR 97205
PHONE: 503 - 653 -5704 PHONE:
FAX: 503 - 653 -5729
FEES
Specifics:, Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 03/24/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 03/24/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 03/24/2011 $531.09
Stories: 3 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 03/24/2011 $63.73
Value: $32,000 Plan Review 03/24/2011 $345.21
Plan Review - Fire Life Safety 03/24/2011 $212.44
Info Process /Archiving - Lg Sheet (over 03/24/2011 $4.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,229.47
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: Protected Corridors: Yes
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 da s 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 ' • ' ication Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain - • • • • - rules or direct questions to OUNC by ca e•03.2 2 87 0 .800.33 . •r44.
Issued By i � - Permi . Signature: ,. I i `
TI
Call 7:00 a.m. for the next available inspection • ate.
This permit card shall be kept in a conspicuous place on the job site until corn • :tion of the proje
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FOR OFFICE USE ONLY
I q City of Tigard 13125 SW Hall Blvd., Ti Received Permit No.:
Tigard, 97223 � �� +a � ® � � ��
g Plan Re tie ++
Phone: 503.718.2439 Fax: 503.5' y4`? ��j Date /B : a! Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready ty: Juris: iii l See Page 2 for
Internet: www.tigard or.gov 9 4 fl + Notified/Method: ' e Supplemental Information
TYPE OF WORK �F �j'�S�(� REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction yy v`� Permit fees* are based on the value of the work performed.
` Indicate the value (rounded to the nearest dollar) of all
d dition /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: 5)t v Crp New dwelling area: square feet
City/State /ZIP: `= .g ) 014 - ` t ' Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name:v �� Covered porch area: square feet
Cross street/directions to job site: 1
4 40KI ic, . ,�,..��, it,
j Deck area: square feet
111E Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
roc••_. iikk % a — IL. dpr...RA • i )
Valuation: $ 32 cw
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: 0 ■ ` e' —or - _ _ `a ^ Type of construction:
Address: 6,21 ! }vG�ih"tn (cam i i r !1 5 11 Occupancy groups:
City /State /ZIP: ' 'V 1 7Z Existing:
Phone: 603 3 3171 Fax: , zi 3e.io New:
yLAPPLICANT CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
—
b!l�l l�L Structural plan review fee (or deposit):
Contact name: 1) I i I . \fir } —
�'T FLS plan review fee (if applicable):
Address:
` 0 . � SO x 1` � 20 I Total fees due upon application:
City/State /ZIP: g 4912''
Phone: Z �, CIS /1 Fax: : (,3 Gam 972 l Amount received:
0 o tt / /I r e j i , PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail:
` ,4r - T � RA �
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: Submit two (2) sets of roof plan with connection details
I �� and fire department access, along with the 2010 Oregon
Address: 49E. l )1E. 13'115 Solar Installation Specialty Code checklist.
City /State /ZIP: ,MN 1�� ci Permit fee (includes plait review $180.00
— and a dministrative fees):
Phone: „ 6701 Fax: E53 -1572/ State surcharge (12% of permit fee): $21.60
CCB lie.: get51
` Total fee due upon application: $201.60
Authorized signature: 11, This permit application expires if a permit is not obtained
`'� // ' within 180 days after it has been accepted as complete.
Print name: Fj(L, ' i 't oi i Date: 2.11 MM Z)I` * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building \Permits\BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I 1/02 /COM/WEB)
1 Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: 6 P art h --Quo 5 i IV Ex edited Review
Plan Submittal Date: '-' - .Q- `I - (1 C✓
To the Applicant:
)%' 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 only if approved.
• - 733 Jv g ad l LaKe
Planning Review (contact CAA e rti I Ca ;vie) at 503-718- or ciAertitc @tigard - or.gov)
Zoning M (AC- Permitted Use Yes [ No ❑
� co._ 1.1.5 e.. (!^'t < d : ca t
Li. Land Use Required: Yes ❑ No EZI (explain below)
Notes: S --k'+ w W P K - '-- dc o-C C - is -4;..I r7( -4+ CL SpGGQ •
14 Approved ❑ Not Approved Date: 3 - a 4 - , I
Permit Coordinator R- 'ew (contact Albert Shields at 503 - 718 -2426 or a er ri or.gov)
Notes: =
Routed back to Building Division Date:
/ —
I: \CURPLN
pp ! Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: , t t
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION ' c,1
*Class of Work: - Occupancy Group: Type of Construction:
*Type of Use: e411►.' Occupancy Load: Oregon Specialty Code: 2 (r)
SPECIFICS
Number of Stories: 3 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: 00 Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors: t'?(,
Total Project Valuation: $ 3Z COC. FEES DUE
$ , DC Prov Rvw, COM TI - Ping
$ Q0 DC Prov Rvw, COM TI - LRP
DC Provision Review Fee for COM TI $ ,C Permit Fee - Add, Alt, Demo
Project Valuation Planning LRP $ R 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 2-( Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ ." Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ • •>r 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: $ 1 4 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.
I: \Building \Forms \OTC - BUP.docx 01/13/2011