Permit CITY OF TIGARD BUILDING PERMIT
< • COMMUNITY DEVELOPMENT Permit #: BUP2011 00230
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/27/2011
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: TI. 11/17/11, reprinted permit for address correction.
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:
FAX: 503 - 892 -0067
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 10/27/2011 $160.00
Class of Work: ALT DC Provision Review, COM TI - LRP 10/27/2011 $24.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 10/27/2011 $1,202.59
Stories: 1 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 10/27/2011 $144.31
Value: $116,000 Plan Review 10/27/2011 $781.68
Plan Review - Fire Life Safety 10/27/2011 $481.04
Info Process /Archiving - Lg Sheet (over 10/27/2011 $8.00
Floor Areas: 11x17)
Metro Const. Excise Tax - Commercial 10/27/2011 $139.20
Total Area: 0 Use
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,940.82
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 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Q(�
Ca 175 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.
CITY OF TIGARD BUILDING PERMIT
I . _. *. C OMMUNITY DEVELOPMENT Pe rmit# BUP2o11 -00230
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/27/2011
Parcel 25101AD03200
Jurisdiction Tigard
Site address 12909 SW 68TH PKWY 300
Project Williston Financial Group Subdivision WEST PORTLAND HEIGHTS Lot 9 -25, PT
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
FAX 503 -892 -0067
FEES
Specifics Description Date Amount
Type of Use COM DC Provision Review, COM TI - Ping 10/27/2011 $160 00
Class of Work ALT DC Provision Review, COM TI - LRP 10/27/2011 $24 00
Dwelling Units 0 Permit Fee - Additions, Alterations, 10/27/2011 $1,202 59
Stories 1 Height 0 ft Demolition
Bedrooms 0 Bathrooms 0 12% State Surcharge - Building 10/27/2011 $14431
Value $116,000 Plan Review 10/27/2011 $781 68
Plan Review - Fire Life Safety 10/27/2011 $481 04
Into Process /Archiving - Lg Sheet (over 10/27/2011 $8 00
Floor Areas: 11x17)
Metro Const Excise Tax - Commercial 10/27/2011 $139 20
Total Area 0 Use
Accessory Struct 0
Basement 0
Carport 0
Covered Porch 0
Deck 0
Garage 0
Mezzanine 0
Total $2,940 82
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, a f work is s ed for more the 180
days • • • • - - • law requires you to follow the rules adopted by the Oregon Utility Notification Ce - Tho rules are set forth in OAR
95 ill-0010 through OAR 95 • i -t0• • You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 • • r 1 332 2344
Issued By: I it. (e, L L Permittee Signature } / c.-7-77
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
Commercial ,_ i ;FOROFFICE)USEr ONLY'
City of Tigard + Date/13 l0 Y7 0 , mutNn / U L4 i If -t o
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131/5 `,AA h OR all Bh d ,Tigard, O 97223 �`I " Plan Rode%
Phone 503 639 4171 fav 503 598 � Received
'AV7 DmeBe 0 (k Oilier Penult
TIGARD Insptehon Line 503 639 4175 °� �V" Dare Ready/h} lcos El See Page 2 fur
Internet sews ❑gold -or gos OC\ � b O � Not fled/Me hod S uppieme ntal In for m 411011
1 TYPE OF WO RKKK 3 � - ' 'REQUIRED , DATA:•`1 -4AND 2M
LFAII;Y DWELLING '
�,�",d ttA� Permit the are based on the value of the work P all ed
❑New construction De} C t
�L- Indicate the value (rounded to of the nearest dollar) of all
Z Addition/alteration/replacement ❑ Other equipment materials labor, overhead, and the profit for the
CATEGORY OF CONSTR ION; ' work indicated on this application
Valuation $
❑ I - and 2- family dwelling 1 Commercial /mdusural
❑ Access(); y building II NIulh- family Number of bedrooms
❑ Master builder 1 ❑ Other Number of bathrooms
JOB SITE' INFORMA'PION AND! , LOCATION - Total number of floors
lob site adds ess _e <4/_Ar" A.e. a M G..e a. ew dwelling area square feet
City/State/ZIP Garage /carport area square feet
Suite/bldg /apt no Pr o)ect name 4 FVVaA/G d r 9 Covered pouch area squat e feet
Cr 35 Su eel/du Ceti ons to job SIB Deck area square feet
Other structure area square feet
REQUIREDIDATA:'COMNtERCIAL -USE CHECKLIST'
Subdivision Lot no Permit fees* are based on the value of the work performed
Tai map /par ccl no Indicate the value (rounded to the nearest dollar) of all
equipment, mater cols labor, overhead and the profit for the
DESCRIPTION OF WORK, work indicated on this application
rill - 1 Valuation $ .,,� '4
,
TC2/ e 2, .72,n .7, d f /.op J
Existing building area square feet
New building area square feet
PROPERTY OWNER ❑ 'TENANT Number of stones
1 Name PatTrrist Type ofeonsuuctton 1/2 Ne
Address t5315350 SW Sequoia Pkwy , Suite 300 Occupancy groups
City/Start /ZIP . Pm Hand, OR 97224 Existing ././ reify'
Phone (503) 624 -6300 Fax (503) 624 -7755
New —
® APPLICANT Z'CONTACT PERSON v'
'NOTICE
Business name Pa c'Trust All contractors and subcontractors are required to be
Contact name Dennis Paget licensed with the Oregon Construction Conti actuis Buard
under ORS 701 and may be required to be licensed in the
Address 15350 SW Sequoia Pkwv Jurisdiction in which work is being performed If the
C. Portland. OR 97224 applicant is exempt from licensing the following reasons
apply
Phone (503) 624 -6300 Fax (503) 624 -6300
Email dennisp@pactrust.com
pactrust.com
CONTRACTOR ` -: ' ir '
rr ,
Business name -�/ y 1 ,r
�1 �C�L 7C/ Li //!JV J , " -rS>7
BUILDING PERMIT FEES' .,.
`*
, Je ( _
Address „ '' ,ti: Please >efe tr o'fe'e'faehe6ule '
� *
4 _ _.
City /State/ZIP Structural plan review fee (or deposit)
Phone ( " ) Fax ( ) FLS plan review fee (If applicable)
CCB lie LPleo70 Total fees due upon application
Amount received
A uthonzed signature
t /9 n f a, 1- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete
Print name Date * Fee methodology set by Tn -County Building Industry
Service Board
1 ABuddingA Permits \ P -COM PermrtApp doe 10/01/09 440- 4613T(I I /02 /COM /WEB)
1 q
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: 5 (4 p?O1( tt n'l�xpedited Review
Plan Submittal Date C
79-P0 ° 2.4.40
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 hsted above the
Planning Review section
Staff: please check items along left only if approved.
Planning Review (contact at 503- 718 -�y�(J or Gtigard -or gov)
Q / Zoning P Permitted Use Yes Eh" No ❑
L7 Land Use Required. a; No 111 below)
r
Notes 4e l
/0 /tea
11<p—proved ❑ Not Approved Date # 41/t
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard- or.gov)
Notes /14—
Routed back to Building Division Date
iVCURPLN
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Descnpuon: " Ti
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work ' Occupancy Group Type of Construction 2�
'Type of Use Occupancy Load Oregon Specialty Code 2010
SPECIFICS A
Number of Stones !y Building Height Mixed Use
Number of Dw Units t 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 Fnewall Separation
N S N S• Occupancy Separation
E W E W Access Parking Spaces
REQUIRED ITEMS
Fire Sprinklers Wiir Fire Alarms `r Smoke Detectors
Parapet Manual Pull Stations Protected Corridors
Total Project Valuation: $ j to ycco FEES DUE
$ 1 O, QO DC Prov Rvw, COM Ti — Ping
$
• i CO DC Prov Rvw, COM Ti — LRP
` DC Provision Review Fee for COM TI $ Kees 'enmt Fee — Add, Alt, Demo
Pro)ect Valuation Planning LRP $ 3 , 12% State Surcharge
Up to $4,999 $0 00 $0 00 $ , ' Plan Review, Structural
$5,000 - $74,999 $64 00 $9 00 $ nr�s1 Plan Review, Fire Life Safety
$75,000 - $149,999 $160 00 $24 00 $ is 1f") Info Proc /Arch, Lg (over 11x17 $2 00)
$150,000 and over $256 00 $38 00 $ Info Proc /Arch, Sin (up to 1 1x17 $0 50)
$ I zer) Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff $ [-Iourly Rate State Surcharge
$ Misc Adimn Fee
Permit Coordinator $ Other
$ Other
Building Staff $ Other
Date/Tune $ 2. 'TOTAL FEES DUE
*OPTIONS:
TYPE OF USE COM = commercial, CMS = commercial manufactured structure
CLASS OF WORK ACS = accessory, ADD = addition. ALT = alteration, IND = foundauon, Dh \I = demo,
END = foundation, FPS = fire protection system, NEW = new, Out = other (use for fences, decks, retaining walls, signs. awnings or canopies),
REP = repair
I \Building \Forms \O 1 C- BUP.doc- 01/13/2011