Permit n CITY OF TIGARD BUILDING PERMIT
' COMMUNITY DEVELOPMENT Permit #: BUP2011 -00202
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 09/20/2011
Parcel: 1S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 1180
Project: NSKB, LLC Subdivision: METZGER, TOWN OF Lot: 9
Project Description: TI
Contractor: RUSSELL CONSTRUCTION INC Owner: LINCOLN CENTER LLC
20915 SW 105TH AVE BY SHORENSTEIN PROPERTIES LLC
TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 228 -3413 PHONE:
FAX: 503 - 228 -2770
FEES
Specifics:
Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 09/20/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 09/20/2011 $9 00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 09/20/2011 $498.03
Stories: 11 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 09/20/2011 $59.76
Value: $28,457 Plan Review 09/20/2011 $323 72
Plan Review - Fire Life Safety 09/20/2011 $199 21
Info Process /Archiving - Lg Sheet (over 09/20/2011 $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 $1,161.72
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 . = • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 101 -0010 through O' : 952 -001 -1190 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1 or 1 800 332 2344
sued By: i � , ' Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 ..,,,
P
Commercial \''''' FOR OFFICE USE ONLY
City of Tigard it A ` 1Q\\ Received 6 Permit per[ No • ` _ . QQ
III
- a _ _ /f
13 125 SW Hall Blvd ,Tigard, OR.9ZQ23 69 ® Plan Review
Phone: 503.639 4171 Fax: 503.598.196_0`Q f � i ��•!!! ; \ Date/B . Other Permit T I G A RD t �'i
C ,
Inspection Line: 503.639.4175 JJ -, S , 0 • t~Oy�` Date Ready /By tuns ® See Page 2 for
Internet. www.tigard- or.gov c Notified/Method Supplemental Information
C\
TYPE OF W OR K '° • REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
CI 1- and 2- family dwelling ® Commercial /industrial Valuation: $
1=1 Accessory building El Multi-family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: Lincoln Tower - 10260 SW Greenburg Road New dwelling area: square feet
City /State /ZIP: 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 1180 Project name: NSKB, LLC Covered porch area: square feet
Cross street/directions to job site: SW Locust Street Deck area: square feet
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.
Valuation: $$28,457.00
Existing building area: 11290 square feet
New building area: square feet
® PROPERTY OWNER - TENANT - Number of stories: 12
Name: Shorenstein Realty Services Type of construction: II-FR
Address: 5335 Meadows Road, Suite 300 Occupancy groups:
City /State /ZIP: Lake Oswego, Oregon 97035 Existing: B
Phone: (503)619 -3200 Fax: (503)619 -3210
New: B
® APPLICANT . ❑ CONTACT PERSON NOTICE
Business name: GBD ARCHITECTS All contractors and subcontractors are required to be
Contact name: Whit Middlecoff licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1120 NW Couch Street, Suite 300 jurisdiction in which work is being performed. if the
City /State /ZIP: Portland, Oregon 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9656 Fax: : (503) 299-6273
E -mail: whit @gbdarchitects.com
. CONTRACTOR
Business name: Russell Construction BUILDING PERMIT FEES*
Address: 20915 SW 105 Avenue (Please refer to fee schedule)
City /State /ZIP: Tualatin, Oregon 97062 -9511 Structural plan review fee (or deposit):
Phone: (503) 228 -3413 Fax: (503) 228 -2770 FLS plan review fee (if applicable):
CCB lie.: 58918
Total fees due upon application:
Amount received: $
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Whit Middlecoff, AIA Date: 9/20/2011 * Fee methodology set by Tn- County Building Industry
Service Board.
L \Building \Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(I 1 /02 /COM /WEB)
•
IN
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: A LT Occupancy Group: r2) Type of Construction: j
*Type of Use: CUlAA Occupancy Load: i it Oregon Specialty Code: g i 0
SPECIFICS 1
Number of Stories: 1 / 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. a Fire Alarms: '-f S Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ FEES DUE
•
$ (3 l DC Prov Rvw, COM TI — Ping
$ Ci ` DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ Plan Review, Structural
$5,000 - $74,999 $64.00 $9 00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ 11 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: $ 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 Residential Projects
Building Permit No: ,A �?2;t
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A g
Routed Plans:
Original Plan Submittal Date:
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked ( ✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact � �'4�'t Plo at 503-718- ()--5 or 0 4�, � i @tigard-or.gov)
Land Use Case No. Name
❑ Zoning Ail-
❑ Setbacks:
Front — Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
Notes: /VO CAdew)c i,+ Act, 4dL
Original Plan: Approved Not Approved ❑ Date: 41-1,2 40—/i
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2