Permit CITY OF TIGARD BUILDING PERMIT
°'1 =` COMMUNITY DEVELOPMENT Permit #: BUP2011 -00232
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 11/01/2011
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 320
Project: Professional Eye Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: TI
Contractor DURUS CONTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES
15806 UPPER BOONES FERRY RD ATTN N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 320 -8601 PHONE 503 - 624 -6300
FAX: 503 - 244 -4318
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 11/01/2011 $64 00
Class of Work: ALT DC Provision Review, COM TI - LRP 11/01/2011 $9 00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 11/01/2011 $377 90
Stories: 3 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 11/01/2011 $45 35
Value: $20,000 Plan Review 11/01/2011 $245 64
Plan Review- Fire Life Safety 11/01/2011 $151 16
Info Process /Archiving - Lg Sheet (over 11/01/2011 $6.00
Floor Areas: 11x17)
Total Area 0
Accessory Struct 0
Basement 0
Carport: 0
Covered Porch: 0
Deck' 0
Garage: 0
Mezzanine. 0
Total $899 05
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 cor.a 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 TENTION. Ore. , n law requires you to follow the rules adopted by the Oregon Utility Notification Ce i r Those r - are -t forth in OAR
952 -f 11 -0010 through OAR 9 2 -001 -r.90 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 7 or 1 800 2344
Issue By: 10
j // / r Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspe io ,
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 ��
RECEIVED r f "` s o , n
s t , 1�-- -,-;- FO R O ,
FFIC ON , n
. ' ,
Commercial `a r � � ?:n:,,
x;.' City of Tigard Date Received ed i% / �� Permit No r II I0 ,
" � 13125 SW Ball Blvd , Tigard, OR 972 QU 0 1 2011 P lan Review `f ia„.1 \ i �S/ Other Permit
i
Phone 503 639 4171 Fax 503 598 1960 Date /Bv 41..." r /lJ 1 l
T - r^ r I nspection Line 503 639 4175 See Page 2 for
.cnRn CITY OF TIGARD Date Ready /By Jul iuiis
ir•..,.. Internet www tigard -or gov BUILDING DIVISION Notified/Method Supplemental information
.,K - ";�.�,', ry »k�s;�d'�, .,� r?i" .�.,�;�; - " € b + „� �:`'`. r�'?Fi _ _ - . �iY ;x'�,.,� „.,� "- v {caxt� °,s„ •s�,�. - "4'� .> a. r,- , , i:,� :;, 7,°, _. �l
r ' - -= ' ' ' '''' ' t' : ' ' , - "s°-. - ' : PE. < Ft: tk'IC-.1 "t, mss. € ,. t: '' E4 < .:°RE DIRE • °D T :' = _ N 2= -'- DW
. ,, - Q T Y �`OO Q, A A A , ,1 .A , D _F - AIVIILY ELLI
. � ' " &a.,'�, . m� o-..` °x� - v�r;,'s� ? "=��t,_ x ,e...�.eL$af�!a.'� *sF��* ��.. - n> .cs � �^ a., '� �'_
- „fur t >:,,tc�'�"�6': .zd,TMt ;�� -��� �' -�. "t, =`�, '.� �.» , `.a, .
❑ 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
' - -. ..,fin,. " , -,- ”' 't , „ . TV
CA T , EG O e ._ R . Y .,3 ' ",'" i CONSTR s- r `" - Sig... work indicated on this application
[1] 1- and 2- family dwelling Valuation $
❑ C ommercial /industrial
❑ Accessory building El Multi-family Number of bedrooms
❑ Master builder ❑ Other- Number of bathrooms
' JOB 7SIT ExINFORMATION *AND:; LOCATION•; �_ ° ` -' Total number of floors
Job site address ,_...‹V New dwelling area square feet
City /State /ZIP. ? j- -i ,,.. O) Garage /carport area square feet
Sutte/bldg /apt no Project name z:; C1` � .f ; �/0 r � r1 t' am, /� Covered porch area. square feet
G
Cross street/chiections to job site Deck area square feet
Other structure area square feet
"RE UIRED" DATA ;COl11MERGIAL-USECHECKLIST-
Subdiviston• Lot no ' Permit fees* are based on the value of the work performed
hidicate the value (rounded to the nearest dollar) of all
Tax map /parcel no equipment, materials, labor, overhead, and the profit for the
. -` a DES CRIPTION OF WORK E , r -,' work indicated on this application
._77:-. 'N r7 /,--) rr 7/9-1? . -- -S �--
Valuation $ �// ��v
.
r /1_ C /0 41' Existing building area: —�// square feet
New building aiea: square feet
❑
,11
PRO.„ , , „ ' R 01YNE ' n ° '•' T” ,❑ 'TENANT • Number of stones
Name PacTrust Type of construction ) /-- Z
Address 15315350 SW Sequoia Pkwy., Suite 300 Occupancy groups
City /State /ZIP , Portland, OR 97224 Existing /9 02
Phone (503) 624 -6300 Fax (503) 624 -7755 New. -Q_ _
` APPLICANT "` "" i4CO PER € ,
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 woik 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
''; � :3 , _>'.',CQNTACTOR.'' , -',- ..w , , „
Business name: Iii 7e �� 7- src= 71F ,
/� � BUiLDI1VG ;'PERMITFEES *.Y;m.`� _'4�;�;t: _'
Address. `- _ :s to fee ' sc tiedule , `psi' n i ,x -'' ; ` ,., ,`r'.
City/State /ZIP. Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone ( ) - ' Fax:( )
CCB lie / g O / — Total fees due upon application:
i Amount received.
Authorized signature. �j � -
This permit application expires if a permit is not obtained
`.S within 180 days after it has been accepted as complete.
Print name �� 6s /� y/ Date: /�/ �1 * Fee methodology set by Tn- County Building Industry
/ �� Service Board
I -COM PermitApp doe 10/01/09 440- 4613T(11/02/COM /WEB)
115,35 .6e4)Lto -f Kwy 5
Ure__ — /1-Lg.-5 '/4
111..
Building Division co PM
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: E 'Exp edited Review
Plan Submittal Date: f I / f /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 ./4) at 503 718 N'k or A @ti or.
Zoning / Permitted Use Yes [ No ❑
C" 1Land Use Required: Yes ❑ No (explain below)
Notes: ile- ee .4J�020 - 7e / flO 'Li�v ,C�
IJ Approved ❑ Not Approved Date: /01/
/
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov)
Notes:
4,/
Routed back to Building Division Date:
I \ CURPLN
IM Ill Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description:
APPLICATION SPECIFIC INFORMATION .
GENERAL INFORMATION
*Class of Work. IV F Occupancy Group: . t j 'Type of Construction.
*Type of Use: '1i\ Occupancy Load. 2> Oregon Specialty Code: 2610
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: y.7 Fire Alarms. ter) Smoke Detectors:
Parapet: Manual Pull Stations. Protected Corridors:
Total Project Valuation: $ 2-9 FEES DUE
$ ((4. 0 DC Prov Rvw, COM TI – Ping
$ ' „ de, DC Prov Rvw, COM TI – LRP
DC Provision Review Fee for COM TI $ 77, ' 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 $ 151 , C ( Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24 00 $ (c),. QC) 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: 9 e :
Date /Time: A $ $' , FEES DUE
1
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = coinme cial manufactu -_ -ructure
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; END = foundation; DEM = demo,
END = 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