Permit 44 CITY OF TIGARD BUILDING PERMIT
• ;!1, ' COMMUNITY DEVELOPMENT Pe rmit #: BUP2011 -00234
Date Issued: 11/03/2011
TIGARD, 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 350
Project: Cornett PC 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 11/03/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 11/03/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 11/03/2011 $301.85
Stories: 3 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 11/03/2011 $36 22
Value: $15,000 Plan Review 11/03/2011 $196.20
Plan Review - Fire Life Safety 11/03/2011 $120 74
Info Process /Archiving - Lg Sheet (over 11/03/2011 $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 $734 01
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 ATTEN •, •regon law requires you to follow the rules adopted by the Oregon Utility Notification Ce• er Those are set forth in OAR
952-001-001% through OA' , 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 23 •:7 or 1 332 2344
Issued B 1 6 Permittee Signature:
` .�'v...- 4.i_
Call 503.639.4175 by 7:00 a.m. for the next available in .ection 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 RECE r ' � , OROFFICE.USE ONLY ° s ,.1- , -,1 ,'
Cit y Tigard �I a1(� Rece Date /t t/�/l p
ed C j Permit No - 1 u%// -- 1/Vv2.�
246
+1 ° 13125 SW Hall Blvd , Tigard, OR 97 �1�V ® 3
Permit
�n Plan Review OtherPert
, TIGA'R'D Phone 503.639 4171 Fax 503 598 196
CITY OF T IGARD el Date /t3 OE
M1
Ins Line 503 639 4175 Date ReadyBy Jens ® See Page 2 for
• .. _ Internet www tigard-or goy I t Notified/Method Supplemental !animation
BUILDING DIVISto s
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''�TYPE „'®F : . •.. ` ` ; - 1,,r:= ` - -- ,, 4 - - - : -;' -_ 'REQUIRED D TA :'tl - AND,2;FAMIL-'Y, -D S ING
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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
® Addition /alteration/replacement ❑ Other. equipment, materials, labor, overhead, and the profit for the
'CATEGORY' �" , .' JC ^ � `. n - , ' � : -i` work indicated on this application.
: OF.CONS I RUCTIOIVr ,` ^ ` f :.• a ` . - ' "� ' :.
Valuation $
❑ 1- and 2- family dwelling mrercial/industnal
❑ Accessory building ❑ Multi - family Number of bedrooms
El Master builder 111 Other
Number of bathrooms.
t.'= .JOB SITEINFOR MATION=:ANDs'L'OCATION = Total number of floors
Job site address• . '�� 3J�`d 4���7 <", , / #41-- - 44.�� - 4} New dwelling area square feet
City /State /ZIP 12r,/j#4ft,e/ Garage /carport area • square feet
Suite/bldg. /apt no • Project name. 6021007-- i°, C.. Covered porch area. square feet
Cross street/directions to job site Deck area: square feet
Other structure area square feet
' ;REOUIREI)DATA.:;COM�MERCIAL ¢ 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
� . -_ _ _ •• -,.�- - - work indicated on this application
° DESCRIPTIOM.OF WORK^ ' c . pp
- Valuation $ �� c/
J c .„,-/,..,- 1 r'l ix .�„ �f /� Existing building area square feet
�� New building area• square feet
❑, PROPERTY 'OWNF, ': : =f , ii TENANT; ' ' • Number of stones
Name PacTrust Type of construction
Address 15315350 SW Sequoia Pkwy., Suite 300 Occupancy gioups: OP
City /State /ZIP , Portland, OR 97224 1e ff ,/ 7
Existing.
Phone. (503) 624 -6300 Fax. (503) 624 -7755
New:
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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
_,:, -•. CONtT ;x" ' ; 1 A 3i - ,it «;; -.'
__ .. 1 , . <., <. -,.... � ;,.2:,.r..,s�,.a =� ���b ff .dam; „+ °z= �• :��� '•,"��>` s: :r
Business name: , °, z ^
U � vs- F = °gip` X; x `� BUlI:DING PERM11' °FEES *s °�:'- ..rE�?
Address- 4 + 3't:',u` ifP ee schedule)a_„, , .. ,.,, � . :'
City/State /ZiP: Structural plan review fee (or deposit)•
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable).
CCB lie Total fees due upon application:
Amount received.
Authorized signature This permit application expires if a permit is not obtained
. ..,7e12-- , ..-.t
within 180 days after it has been accepted as complete.
Print name .,,23:1, LS <�L/ /- Date: ��-� �,,. * Fee methodology set by Tri- County Building Industry
-�/ Service Board
I \Building \Permits\BUP -COM PermitApp doc 10/01/09 440- 4613T(1 i /02 /COM /WEB)
/5550 5c quoi-Pkw/
I I Building Division C° Q ��� p �
Development Code Provision Review Ore,
IT gA11) Commercial Projects - No Associated Land Use Case
Building Permit No: 6uS l —OO 2 I 'E xpedited Review
Plan Submittal Date: il/5//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 at 503-718- or @tigard- or.gov)
IkE Zoning 1-e Permitted Use Yes Ud' No ❑
l( Land Use Required: Yes ❑ No (explain below)
. Notes: 4 44 412. kz.o
/Approved ❑ Not Approved Date: I / / , /ii
Permit Coordinator Review ontact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
-1*
Routed back to Building Div`. ion Date:
I: \CURPLN
III
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: I
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: N.( Occupancy Group: Type of Construction:
*Type of Use ('..05 L Occupancy Load: '2C....) Oregon Specialty Code: 17....0 AC)
SPECIFICS
Number of Stories: .3 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: OeZ, Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ ( -. FEES DUE
$ �" ,Y DC Prov Rvw, COM TI — Ping
$ f 0 0 DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ , e'J Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ E „ Z2 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ i 76. 20 Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ 10",. —Plan Review, Fire Life Safety
$75,000 - $149,999 $160 00 $24.00 $ C..' ,,CC) 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: $ ` 0 ( 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.
1. \ Building \ Forms \ OTC-BUP docx 01/13/2011