Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00115
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/09/2011
Parcel: 1 S126DCO3300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 240
Project: Advantage Dental Subdivision: LEHMANN ACRE TRACT Lot: 4 -5
Project Description: TI
Contractor: DSF PROPERTIES LLC Owner: ATHERTON REALTY PARTNERSHIP
11200 SW POWELL BUTTE HWY 2100 S WOLF
POWELL BUTTE, OR 97753 DES PLAINES, IL 60018
PHONE: 541 - 360 -1870 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 06/09/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 06/09/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 06/09/2011 $225.80
Stories: 0 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 06/09/2011 $27.10
Value: $10,000 Plan Review 06/09/2011 $146.77
Plan Review - Fire Life Safety 06/09/2011 $90.32
Info Process /Archiving - Lg Sheet (over 06/09/2011 $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 $566.99 -
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes 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. 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 m- = • r . co. • • e rules or direct questions to OUNC by . ling .03.287 or 1.800.332.2344.
Issued By: /� 1111111 ttee- Signature: tome
•
a_.!9.4175 by 7:00 a.m. for the next available insp> tion da e..
This permit c. . shall be kept in a conspicuous place on the job site unt I comple , on of the project.
Approved plans are required on the job site at the time of ea h inspe.tion.
Building Permit Application
Commercial , FOR OFFICE ESE ONLY ,
City of Tigard �� Received I __ Perm No.:
/e4 g Date/B : 9 p 11 /& !- h 17— its
13125 SW Hall Blvd., Tigard, OR 9722) '� Plan Review ► %�.
0 : Phone: 503.718.2439 Fax: 503.594 Date/B :
TIGARD 1h7 Other Permit:
Inspection Line: 503.639 `` Date Ready / o turfs: ® See Page 2 for
Internet: www.tigard- or.gov 0 G � � �O ` Notified/Method:i j� Supplemental Information
TYPE OF WORD ✓�` REQUIRED DATA:.1- AND 2- FAMILY DWELLING
❑ New construction ❑ Deon Permit fees* are based on the value of the work performed.
S7 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.
El 1- and 2- family dwelling ® m
Comercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
'JOB SITE INFORM
NFORMATION AND LOCATION , Total number of floors:
Job site address: 9900 SW GREENBURG RD New dwelling area: square feet
City /State/ZIP: TIGARD, OR 97223 -5454 Garage/carport area: square feet
Suite/bldg. /apt. no.: 240 Project name: ADVANTAGE DENTAL Covered porch area: square feet
Cross street/directions to job site: SW CORAL ST Deck area: square feet
ACROSS FROM THE CRESCENT GROVE CEMETARY/WASHINGTON SQUARE MALL Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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.
INTERIOR TENANT IMPROVEMENT OF EXISITING OFFICE AREA OF Valuation: $$10,000.00
DENTAL SPACE Existing building area: square feet
New building area: N/A square feet
- ❑ PROPERTY' OWNER ® TENANT r Number of stories: 2
Name: JERRY SLAUGHTER Type of construction:
Address: 442 SW UMATILLA AVE Occupancy groups:
City /State/ZIP: .REDMOND, OREGON 9T756 Existing: B
Phone: (541)242.8904 Fax: (541)242.8915 New: N/A
® .APPLICANT ® CONTACT* PERSON BUILDING PERMIT.FEES *'
Business name: CIDA, INC. (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: MYA SABATINO
Address: 15895 SW 72 AVE. FLS plan review fee (if applicable):
City /State /ZIP: PORTLAND, OREGON 97224 Total fees due upon application: .�( G,
Phone: (503) 226.1285 Fax: : (503) 226.1670 Amount received: 91
E -mail: MYAS @CIDAINC.COM PHOTOVOLTAICSOLAR SYSTEM FEES*
. Commercial and residential prescriptive installation of
CONTRACTOR 4 roof -top mounted PhotoVoltaic Solar Panel System.
Business name: DSF PROPERTIES Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 11200 SW POWELL BUTTE HIGHWAY Solar Installation Specialty Code checklist.
City / State/ZIP: POWELL BUTTE, OREGON 97753
Permit fee (includes plan review
$180.00
and administrative fees):
Phone: (541) 360.1870 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: 189471
Total fee due upon application: $201.60
Authorized signature: it Q This permit application expires if a permit is not obtained
C ao �- within 180 days after it has been accepted as complete.
Print name: MYA SAB Date: 06/08/11 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 02 /24/2011 440- 4613T(11/02 /COM/WEB)
I q
Building Division
Over -The- Counter (OTC) Building Permit
TIGARD
Check List
Project Description: 71
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work:T Occupancy Group: Type of Construction: 513 * Type of Use: ccyck Occupancy Load: 2J Oregon Specialty Code: 2_0 ( ri
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: ( i .) �` Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ (.Q FEES DUE
$ 4/1, C0 DC Prov Rvw, COM TI — Ping
$ , 40 DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 2 _ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 2-7, ,.ate 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ , Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ CO � ; 1� ' - 2 _Plan Review, Fire Life Safety
` -
$75,000 - $149,999 $160.00 $24.00 $ 02) 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: $ •j,1 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
II II
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: p c.
/f X / 15 n I✓xpedited Review
Plan Submittal Date: / I L/
To the Applicant: ‘W *& A 4e11 1 f 1/0
> 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 onl if approved.
Plan 'rig Review (contact at 503- 718d4 or ! @ tigard- or.gov)
wail Zoning /j1(/ - / Permitted Use Yes 117No ❑
E Land Use Required: Yes ❑ No Lf (explain below)
Notes: / 7 Y- bi
Approved ❑ Not Approved Date: 6 1
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date:
I: \CURPLN