Permit CITY OF TIGARD BUILDING PERMIT
1 COMMUNITY DEVELOPMENT Permit #: BUP2011 -00210
-TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 09/28/2011
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16330 SW 72ND AVE B3
Project: A Cut Above Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Restroom addition.
Contractor: DURUS CONTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES
15806 UPPER BOONES FERRY RD ATTN N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 320 -8601 PHONE.
FAX: 503 - 244 -4318
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 09/28/2011 $195.38
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 09/28/2011 $23 45
Stories: 0 Height: 0 ft Plan Review 09/28/2011 $127 00
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 09/28/2011 $78.15
Value: $8,000 Info Process /Archiving - Lg Sheet (over 09/28/2011 $2.00
11x17)
Floor Areas:
Total Area. 0
Accessory Struct: 0
Basement. 0
Carport: 0
Covered Porch 0
Deck: 0
Garage 0
Mezzanine' 0
Total $425 98
Required: Required Items and Reports (Conditions)
Fire Sprinkler 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 C e Those r - e set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 2 19 or 1 800. 2 2344.
. I
Issued By: / ermittee Signature: /
.I.4175 by 7:00 a.m. for the next available inspec Ardate.
This permit card shall .e 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 `
a : FOR OFF,IC E'�USE UNL �- � � '� �,
City of Tigard 94\\ Received ,0 f 740! Permit No C P-jl f --co r
q 13125 SW Hall Blvd , Tigard, • ' 'V 3 a D Plan Review �I
Phone 503.639 4171 Fax. 503.598 lie h 10 Date/B �� 2 g Other Permit
TI'GARD Inspection L Internet. www tigard -or guy me 503.639.4175 `,� � r
G '. \ �f ` T S , ` �� Date Ready t. • ®See Page 2 for
�\ ��(1,l \ ` Noiified/Method L Supplemental Information
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- , ,. -- .. t TYPE' - O F ' i. ; ` -E 5 r•` .. _ E ta` RE £ UII2ED;DATA. =I- AND 2:F AMILX ==DWELLIN ;
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
E Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
;, - a ",': , t ;?, ' >. „, . , .;v _ - -_ °` 1 . " D , 1 - ;,_ Z ;', i "t =`' work indicated on this application.
Et: ;; ' , , a . ' i.CAT ` CONSTRUCT N _ - x ` ` `s :... : - - - -,_ „:tt,';;
'' Valuation: $
❑ 1- and 2- family dwelling nimercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms
❑ Master builder ❑ Other Number of bathrooms
' '%
, =u - ' u V,” , ,TJ B ITE 1NF ' f : floors
' ' _ O - -S OR1VI4TION' . ,
AND L:OGATION - ° = : �r " ;1= , ' ' , '', Total number of
'
Job site address: ! „X./4_, / A. New dwelling area square feet
City /State /ZIP: ' X 'jJ,1 d , /:) 9 C Garage /carport area square feet
Suite/bldg /apt. no.. I Project lime i x C e _/ ,. ?
x"'°' _' Covered porch area square feet
Cross street/directions to job site: /' Deck area: square feet
Other structure area square feet
x' REQuiREDD'ATA := COMMERCIAL TSE CHECKIsIST:'
air - ,: � .z =,_ =..tee,.. _ ....:,... ., z a� m;� :.
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.:
equipment, materials, labor, overhead, and the profit for the
':; :',; ; _;, =; ,, '. i DE 'i , , . work indicated on this application
/ Valuation $ � / ;• 0
Existing building area square feet
New building area square feet
Number of stones.
®'PROPERTY *vOiV ER N ' '` ,V ,It',,' ` ' ®,TENANT h z '
° -` -` f 'y`
Name: PacTrust Type of construction: /%
Address 15315350 SW Sequoia Pkwy., Suite 300 Occupancy groups �/
City/State /ZIP. , Portland, OR 97224 Existing ,g'..2--.'?----- ,J
Phone: (503) 624 -6300 Fax: (503) 624 -7755 New
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a �. ` : IAP.PL >'ICAA' .�'�; = „ . r�_.. '�"� <CONTAC�T- PER5'ON�`b. ;_�` y,r�.a; -�..- ��su
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:” < TILE' a ;.�;t.; =i
Business name PacTrust All contractors and subcontractors are required to be
Contact name: Dennis Pagni licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address. 15350 SW Sequoia Pkwy 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 Fax: : (503) 624 -6300
E -mail. dennisp @pactrust.com
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Business name: / ,�J ;;
�� ” It. L� ,ff BUILDIIVG'aPERMIT *�,`� w ,, , `
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kA 're _.; . y . °: ' r (l reje Aggaii,..&L
w . .g..
Address:
City/State /ZIP Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received: 5 �(F
- Authorized signature. _ This permit application expires if a perm t is not obtained
within 180 days after it has been accepted as complete.
Print name: '"�� Date >9✓
/,J�'� ?ii 11 *Tv/ �°� 0/ * Fee methodology set by Tn -County Building Industry
Service Board
I:\Buildtng\Permits\BUP -COM PermitApp doc 10/01/09 440- 4613T(11/02/COM /WEB)
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: mtm Occu.anc Grou.: Type of Construction: M
*Type of Use: e Occupancy Load: Oregon Specialty Code:
SPECIFICS
Number of Stories: r 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: r±) Fire Alarms. Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $_) FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ —� �(`J , - , J Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 2 3 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 1 07 • "7 Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ `� / Plan Review, Fire Life Safety
$75,000 - $149,999 $160 00 $24.00 $ 2_, ej 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: $ 4Z�j K jTOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; Alter = 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
1 \Building \Forms \OTC -BUP docx 01/13/2011
" Building Division
Development Code Provision Review
TIGA@ Commercial Projects - No Associated Land Use Case
Building Permit No: ()WA 0 PErrpedited Review
Plan Submittal Date: //94 T .
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 fry at 503 -718 i/4 or @tigard- or.gov)
Z oning �� r Permitted Use Yes in` No ❑
Land Use Required: Yes ❑ No Er"
(explain below)
Notes: r-- AA/
Ild Approved ❑ Not Approved Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov)
Notes: A
/,51
Routed back to Building Division Date:
•
•
I. \CURPLN