Permit CITY OF TIGARD BUILDING PERMIT
1 ! - COMMUNITY DEVELOPMENT Permit #: BUP2011 -00097
-TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/12/2011
Parcel: 2S113AA01100
Jurisdiction: Tigard
Site address: 16580 SW 72ND AVE B11
Project: Surgeline Subdivision: OREGON BUSINESS PARK I Lot:
Project Description: TI
Contractor: PACIFIC REALTY ASSOCIATES LP Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300 PHONE: 503 - 624 - 6300
FAX: 503 - 624 -7755
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 05/12/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 05/12/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 05/12/2011 $195.38
Stories: 1 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 05/12/2011 $23.45
Value: $7,500 Plan Review 05/12/2011 $127.00
Plan Review - Fire Life Safety 05/12/2011 $78.15
Info Process /Archiving - Lg Sheet (over 05/12/2011 $2.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $498.98
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. ATTENTI• . •reg• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 952- 101 -00••. You may obtain a copy of the rules or direct questions to OUNC by callin .232.1987 or 1.800.332.2344.
Issued B / / • Permittee Signatt}te:
Call 503.639.4175 by 7:00 a.m. for the next available inspection d =.
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.
1 , 4
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: ( k
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: " Occupancy Group: i Type of Construction:
*Type of Use: Occupancy Load: j % j Oregon Specialty Code: Zej) C)
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 FOOT AGES
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: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ J� FEES DUE
$ A ;C10 DC Prov Rvw, COM TI — Ping
$ j DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 111 � i Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 2, 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ U227:00 Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ '76 V Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ z,, tYJ) 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: .496.3 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
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: l' a/P Ogl ti r;xpedited Review
Plan Submittal Date: Z9 //('
To the Applicant:
// 8 4
➢ 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 le only if approved.
Planning Review contact at 503 - 718- c /Yar 44L4tigard-or.gov)
V Zoning — L- Permitted Use Yes L!' No ❑
Land Use Required: Yes ❑ No V (explain below)
Notes: j,/,/-f R-1' / ekt d- /4 49
3 ❑ Not Approved Date: / /2 /1'
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov)
Notes:
l
Routed back to Building Division Date:
I:ACURPLN
Building Permit Application
Commercial p f�, FOROH-i�I "
Cl Of Z 1 and I Received Permit No.: ` u A0t l _me)
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
• • Phone: 503.718.2439 Fax: 503.59$4,6 Z 2 2011 DateB : .4 gi Other Permit:
Ti-c.;--A 1t. Inspection Line: 503.639.4175 Date Ready :y: Iuris ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
[9l t6i rlta l et_ nn rtnina e
_.... - `Y- ;.�.::. --' - :,.. ...- ,_ _.:. ,•_, - "_ �:,.,�:.._ : ter.. - - � _ -' _ - ";' s::.:f,1s:_z.�:= tF"F, -�.... �
`; `` , ` - ' ` -�`~ '< IJ :Oi�` ,It) s ` REQUIRED DATA I AN D 2 rAMILYDWELLING
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
V I,Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
^Nf �� - -, �> ==` "' '' work indicated on this a lication. •rz ' ."a _,- „it -TA.I - - :'r=,<Y. s i�. 3x.-l.. ..-,.a' ,.' . A : * ;eF`c` loo > _.;
Ill 1- and 2-family dwelling Valuation: $
y g ❑ Commercial/industrial
ID Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
.:� +�,��, - ;�,' �.. � :tF �~�- ., � ,, sw, - 4 ;
- - c_. 'x J$w r Total number of floors:
" -,x:. ;- a ' „; i, �J )` -S rI` , , ok r 11 ATI0 "A ' O AX 'IOP f,-: ;. ",, -, "
Ai ' "�£•72�.::. _..." %'': -a. _._f > -.. � - ..�;. , ��€ rz - °. -. r. ... a. �r ;_.,�
.^•�s �f�. ar.� =�: « :t. : ��t� tYiT;f
Job site address: 4 1 .T-sO (' /J -/> New dwelling area: square feet
City/State /ZIP: d�-4 t, dfJ 2 i✓ �9 .,05/ Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered -porch area: square feet
Cross street/directions to job site: Deck area: square feet
6�. v e) i.-i �/! cl,,.r , f C 4.-e j c7 ,7_ - 75 ad ,k f Other structure " area: square feet
�r .,a? - .st;r ;*,a a ss . . - ,4: _as..4s ,i '1 a . :4 ' ?g
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
Y wr;: [ h l ,y v4 . ,. — ` ,£jfrt. , _ equipment, materials, labor, overhead, and the profit for the
�- t', � s, ''-i am , $ _ e;+ F QaiQ �} � -. ,.t-S i ,, work indicated on this application.
Valuation: $ 0,- ����ll
Existing building area: !! square feet
New building area: square feet
3`• " - = xt4 -- �< • `g.-7f ,: ;`, j T -t_ 4.u'z_ _ra �« Vil
� s ifid Tl{ OW E'' 1 T a -. 4. Number of stories:
Name: PacTrust Type of construction: /1!
Address: 15350 S.W. Sequoia Pkwy. , Suite 300 Occupancy groups: ` . — .
City /State /ZIP: Portland, OR 97224 Existing:"
Phone: ( ) F ax: ( ) ���
50 624 -6300 503 624-7755 New: ._
6 ° e' s 1 } d ',° c lt g ,
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
Bennis Pau'i 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
applicant is exempt from licensing, the following reasons
City/State /ZIP: Portland, OR 97224 apply:
Phone: (503) 624 - 6300 I Fax:: ( 503 ) 624 - 7755
E -mail:
Business name: . ^°T '
Address: �:� 'Ls �es ! >;
Structural plan review fee (or deposit):
City/State /ZIP:
FLS plan review fee (if applicable):
Phone:( ) I Fax:( )
CCB lie.: otl f du up atin 943.? ,
1 / Amount received: ��
Authorized signature:
��, This permit Ta application eapires on pplica
if a o per
mit is not obtained
within 180 days after it has b een a ccepted as complete.
Print name: e sal, i‘.5 �r - Dat - /Z, // * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 09 /09/10 440- 4613T(11 /02/COM/WEB)
Building Division
GA 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: $
(0 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 \Pemmits \BUP -COM PermitApp.doc 06/25/08