Permit 111 CITY OF TIGARD BUILDING PERMIT
# C OMMUNITY DEVELOPMENT Permit #: BUP2009-00092
Date Issued: 05/28/2009
T j G.A R o 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S135A601004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 120
Subdivision: Lot: 0
Project: Ameriprise Financial
Project Description: TI
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Permit Fee - COM 05/28/2009 $249.31
CALIFORNIA ST 49TH FL 12% State Surcharge - Building 05/28/2009 $29.92
PHONE: Plan Review 05/28/2009 $162.05
Plan Review - Fire Life Safety 05/28/2009 $99.72
Contractor:
RUSSELL CONSTRUCTION INC
20915 SW 105TH AVE
TUALATIN, OR 97062
PHONE: 503 - 228 -4898
FAX: 503 - 228 -2770
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $28,500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $541.00
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: No
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 in accor with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is spended for more
th 80 days. ATTENTION: 0 on req ' es you to follow the rules adopted by the Oregon Utility Notification Center. Thos rules are set forth in OAR
9 2- 001 -0010 rough OAR 952- 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. • 6 -6 - .
Is ued By: . Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business
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 FOR OFFICE USE ONLY
City of Tigard DDaa Received
Permit No. ; r � „ 00
Eri
" 13125 SW Hall Blvd., Tigard OR 2 8 2009 plan Review ` i s
Phone: 503.639.4171 Fax: 503.598.1960 Da : 4 �� r � 2 • '
TIGARD Ins Line: 503.639.4175 CIT ° Ta Date Ready/By:
® See Page 2 for
Internet: www.tigard or.gov DIVISION Notified/Method: Supplemental Information
TYPE OF WORK J IV
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
El Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial/industrial Valuation: S
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 2 Lincoln 10220 SW Greenburg Rd New dwelling area: square feet
City/State/ZIP: Portland, OR 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: 120 I Project name: Ameriprise Financial Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COM IAL [ISE,CHECKLIST
Subdivision: I 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
ii � ,, � ON -O ', WORK _ r work indicated on this application.
Interior Tenant Improvement Valuation: $28,500
Work to include new walls, doors, relites and new casework Existing building area: 1,843 square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 6
Name: Shorenstein Type of construction: I -B
Address: One SW Columbia Street, Suite 300 Occupancy groups:
City/ State/ZIP: Portland, OR 97258 Existing: B
Phone: (503)412 -4906 Fax: (503)412 -4848 New:
•x -.,.j, 1 ' fit' . . 2 .N CONTACT P1 RSON 4 . 4, NOTICE
Business name: Group Mackenzie All contractors and subcontractors are required to be
Contact name: Morgan Roush licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1515 SE Water Ave Suite 100 jurisdiction in which work is being performed. If the
City/ State/ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9560 Fax: : (503) 228 -1285
E -mail: mtoth @grpmack.com
CONTRACTOR
Business name: Russell Construction Btrit PERMIT FEES*
(Please refer to fee schedule)
Address: 20915 SW 105th Ave
Structural plan review fee (or deposit):
City/State/ZIP: Tualatin, OR 97062
FLS plan review fee (if applicable):
Phone: (503) 228 -4898 Fax: (503) 228 - 2770
Total fees due upon application:
CCB lie.: 58918 .
Amount received:
Authorized signature This permit application expires if a permit is not obtained 4
within 180 days after it has been accepted as complete.
Print name: Kim Ford Date: 05/28/09 *
Fee methodology set by Tri-County Building Industry
S ervice B oard.
I:\Building\Permits\BUP -COM PemritApp.doc 2 /23/07 440- 4613T(I1 /02/COM/WEB) '
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Description of Project: --n
GENERAL INFORMATION
Class of Work:* 11/4L Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* (CM First floor: N: S:
Type of Construction: ( If j Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: 1"i Total sq ft.: N: S:
Stories: Note: Combine total floor area for E: E:
Height: all floors above third floor and Roof Construction:
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: VE`_5 Handicap access:
Smoke detector: Protected corridors: kb
Fire alarm: te —_--, Parking spaces ( #):
Notes:
Total Valuation: $ 28 5
INSPECTIONS FEES DUE
Footing /foundation Firewall $ '2_49 , 3 Permit Fee
Post /beam structural Smoke detector $ 2_1' • Y'• " State Surcharge
Shear wall Misc. inspection $ 2 .C95 Review Fee
Masonry Approach /sidewalk $ j , ?Z FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ .541 • CO 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; 01K = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
1: \Building \ Forms \OTC- BUP.doc 08/19/08