Permit ,, CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00123
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 250
Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: TI
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SE SEQUOIA PKWY #300
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 06/16/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 06/16/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 06/16/2011 $564.15
Stories: 4 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 06/16/2011 $67.70
Value: $35,000 Plan Review 06/16/2011 $366.70
Plan Review - Fire Life Safety 06/16/2011 $225.66
Info Process /Archiving - Lg Sheet (over 06/16/2011 $8.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,305.21
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 g AR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1 1.800.332 .
I
Issued B • J� Permittee Signature:
r `
�
Call 503.639.4175 by 7:00 a.m. for the next available mspecti ••te.
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 Application
• Commercial pE Fur:, '- .hol:�i. lzoR 1 t si• osI % , t�d .e City of Tigard t vi . � y i eteivea ® Permit No.:
13125 SW HaII Blvd., Tigard, OR 97223 Plan Revie
" � II Phone: 503.718.2439 Fax: 503.598.1960 JUN " 20 . Date/B ��� Other Permit:
Inspection Line: 503.639.4175 Date Ready/BY: Juris. ® See Page 2 for
' I'l`. , ' n spec ne:
' ) t;A,P L J
Internet: www.tigard- or.gov CITY CITY O OF i 4e,1. '! Notified/Method: Supplemental Information
RI111_DING DIVISION
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. > r , 11 - . i Ti''l O a•WO . .' : '; f "rst s + R E UIREI)' DATA - I =. Z•AM 1 i ,r
��� � _� . _ i
..,. _ µ_, , ,_ _ . .. _ .. _., _ . . , . Q . .., . ... . . .. :f,. _ . , .. WELDING
❑ 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 El Other: equipment, materials, labor, overhead, and the profit for the
, - ;; :F= . 4 <tatk; -� t : s ? 't• :- o' - -:� s . _g -.. , r � `
�t' ,= s:t:_ �'� w;r"� tf�R: ! `'�'?��'�i�� �� work indicated on this application.
;�F��.,.fry„ r.v _..,3_. _ .;'. �_a, -. .F._s._�5� ._.. -,. - .�.;. -,._ �.L..a..'•:�_ . " .,� - =y =�,c. .r �sa�3�.. � tri.�..h°,-_.i,.,; s
❑ 1- and 2- family dwelling erctal/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
111 Master builder 111 Other:
Number of bathrooms:
.,:.` r - i_`PS ]$_"s'Ya . P �i#' f�?z` ": 1 !m_i.3Y -•':@�`''A�;`}i� -BSc ..`._. `.'te14,.�,° F'' � i"`w�:€�'s.'•'- a , k'b%�:.�.' - 'u '"�n
_ as %> *41 4ti -:$ ) IN O i t a ._ ? - b s Total number of floors:
: a t>l T10I A a sFIOP� << ,f
Y `l ft. 3 �3;�.. - i?��. a +;rss;�.,� s:g.i.'-•T°:�. €s: f:. ^5 ^'.;;fi_, zti�r'?{ � . ��;.. ��'::ril
Job site address: • __.__( . - r New dwelling area: square feet
City/State /ZIP: " e,z4 - ` �� �23 /�7 Garage /carport area: square feet
Suite/bldg. /apt. no.: ?. 1 J) Pi�ject name: � e) Covered porch area: square feet
Cross street/directions to job site: / �� � � Deck area: square feet
• Other structure area: square feet
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
A ,_ } . - vALL zy; _ equipment, materials, labor, overhead, and the profit for the
&%.,..1104410,1_ r �,
ks * � { ` £ I T; i i1 ,v ,. t . m. ` -7414 w indicated on this application.
✓ Valuation: $ c90
Existing building area: square feet
New building area: square feet
4 . , I. , i - - ':ah � z - " -1!,�,+7= 4: - s_ ""'. - _ `.F : i ' , s =`;IP - ,: 'i:._ _.'(a t- VR �.'' e::C l t i %2:ex -'.0 .:
'` i " X� e a : F' w, Number of stories:
•- T >. .O - - II " ; : - .R, .,,TENFH�Pel;:
G�'i _. ., _ .,r..r >e2 - i ': � ±����a���;;�`' =`. �", �:... ,r.�,,. - ..t: %.x.3 - .. ;ss , vws - .. aR:.,: - �A...3 £....... y �y��^.
Name: PacTrust Type of construction: ! J / "--
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: )
q , 3. '°' 9 i tK - ... r F t �y` [ d � e"z- - , a ` . �.,. - ; , .. g . 4, , _ w , ,.arm ti.va• - `S«J •zf5 z k,, y ` ; •
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
Derini s Pagni 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 I Fax: : ( 503 ) 624 - 7755 .
• E -mail:
Business name:
AP i f �} ,
Address: —} l x - 1' 1 X � `s' �>
City/State /ZIP: Structural plan review fee. (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) I Faxs� )
CCB tic.: Total fees due upon application:
V Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
I Print name: • L . Date: 1 • Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PerrnitApp.doc 09 /09/10 440- 4613T(I1 /02/COM/WEB)
I �
Building Division
Accessibility: Barrier Removal Improvement Plan
TIC;:ARD
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: $
(f) 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 \Permits \BUP -COM PermitApp.doc 06/25/08
If
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: aot lam 13 Expedited Review
Plan Submittal Date: (,P / /lf/I,i
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.
Planning Review (contact U04#1 . C/7 at 503 - 718 -0 or J044 /e7 @ tigard- or.gov)
❑ Zoning /Lt Permitted Use Yes Er No ❑
❑ Land Use Required: Yes ❑ No a (explain below)
Notes: delve- D Dg64
f Approved ❑ Not Approved Date: i9 / s ! " / (
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date:
I: \CURPLN
III Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: T1 •
• APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: ACT Occupancy Group: Type of Construction: 70
*Type of Use: CAt Occupancy Load: Z Oregon Specialty Code: 2010
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: 1? Fire Alarms: 4^i' Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ ?A J FEES DUE
$ r -, CO DC Prov Rvw, COM TI — Ping
$ " 411• DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ w� Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 4 '7C7 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ .ere' Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ 2.2."5,. Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ ii Q) 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: $ t2-4 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