Permit 14 CITY OF TIGARD BUILDING PERMIT
<.•- COMMUNITY DEVELOPMENT Permit #: BUP2011 -00256
13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011
TIGARD . . Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15895 SW 72ND AVE 250
Project: DaVita Nephrology Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: TI
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 892 -0066 PHONE: 503 - 624 -6300
FAX: 503 - 892 -0067
FEES
Specifics:
Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 12/06/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 12/06/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 12/06/2011 $377.90
Stories: 2 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 12/06/2011 $45.35
Value: $20,000 Plan Review 12/06/2011 $245.64
Plan Review - Fire Life Safety 12/06/2011 $151.16
Info Process /Archiving - Sm $0.50 (up to 12/06/2011 $3.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $896.05
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 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. • NTION: • - •on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-151-0010 through OAR • •2 -0. '195 ' o. may obtain a copy of the rules or direct questions to OUNC by calling 503.232. .47 or 1.800.332.2344.
0 Is ued By: k / e! / , Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available in • •ectio• ate.
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.
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Building Permit Application
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Commercial ��� qq tr:O oFFI I' �s oN � vi
City of Tigard � � r t \ \ Re eived /A � '..IV P ermit N o.: �(�� C f / + 'O O o 2
I . 13125 SW Hall Blvd., T OR Q3 l Plan Revie , • .
Phone: 503.718.2439 Fax: 503.598.196(�C §.) Date./13 : � Other Permit:
T 1 ti R Ii Inspection Line: 503.639.4175 ' GG ` 1 J : Date Ready' . Juns: Si See Page 2 for
Internet: wWw.tigard or.gov. O i ��V Notified/Method: Supplemental Information
-: -
- " 4, �?= T 1 'E t y W e a _ _ REQUIRED'DATA i AND - FA M i YYDW },
❑ 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
iar: _?' =Sji f = '''r•` '_ ` t V - _ ;. x S— Iiin work indicated on this a
- . ; : _ _ * >= EE Fes {/i:Q., t- .__.�.�., application.
�§� �"'A3'%:i.,�t -i:', :'- tik,'y Y . � e'���„��r..3 � � �'. w ` t N��.�` �`� �s''
��3� ;'. } r7?.�:,, -.: _# ,:Y sv M� �s -- �.�:4s_ t �.� ? rk ���. -� ly: `. ,:4.r�;ra' >> „r.,,:
El 1 and 2 family dwelling �' Commerciallindustrial
Valuation: $
1:1 Accessory building CI Multi-family Number of bedrooms: .
❑ Master builder ❑ Other: Number of bathrooms:
` _ = O `r
' ` �' -11 `itilig 2 I t }� ";' m Total number o
;:,5- _.3.2 i� ` - -%1 '$1 C - Itb,A'FIbl:;21i ,,1_I� # i '�:.3q .sr : +l: Tl b of floors:
&��� Y; +:- ... a , - - - - ��,' »r ^ .., _.r net+�`a°:.''�'+'.y�. ” s 4 _ - _••- rt��...;,3:4,� � , ,z'Sr?.- }�' t - .� . i,sY, • za
Job site address: _ 9V n.-P 2 e: a 5 ---` a New dwelling area: square feet '
City/State /ZIP: .0,..4 *tor- / At 9'x'7 ay Garage /carport area: square feet
Suite/bldg./apt. no.: Project flame: a� L� . -, ,(jy� , Covered porch area: square feet
Cross street/directions to job site: f � J Deck area: . square feet
Other structure area: square feet
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
- ::�� µxi .�::^�, +° ����r' ;,�.� = s i�z =:� ti^�: rz�":�"s>�I`� ,ttk :; �c� *�;-�:
. ,,.T # 5ri �. , x,11 z i g , W 4 work indicated on
t r m 4i1 E O (� O „s rr o this application.
:r� ^�.`_._ ?a.S } % �" t'= �� .n, .t s . ,�C's;3 c� - rt � , aR. -.r , - � '..¥
,4772p � `��ce�� Xe ^ e�,�. Valuation: $ t�
er,1J ] J � /d Existing building area: square feet
O/ p� ✓ New building area: square feet
'�,5�:' - _ - - ±�c>.::��. �t�e =', °'.a '+s`�' `:;s : "zi`s3- _ : - � 1?fil�_�.Z,s- #'= ;:` z� _
,� s� =_[]. PRQEERTX Il m 0_ A r n x. y . '4 F=g a_;i1ENAI . ,.. Number of stories: /J
��,...- ?a,. >r,. ;. z �. r.. .r,�,�:.��fr_:�i�<,.1 ",,�HV,'== r�f�., �, ,9.� €�- ,��.f.. .h��:A:h. vl
Name: PacTrust Type of construction: 11/---Jr
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups:
City/State /ZIP: Portland, OR 97224 Existing: c.r�
Phone: ( 503 624 - 6300 Fax: ( 503 ) 624 - 7755 New: • --4-- '
E ' vi �Y ury3r ' --.. wp
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
DPnni s Pauli under ORS 701 and may be required to be licensed in the
Address: 15350 S.W. Sequoia Pkwy. , Suite 300 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 I Fax: : ( 503 ) 624 - 7755
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E -mail:
Business name: "2/4.77.-"AL 14 /✓ ,, t—a0a, c./7. . "O1 D t6`,. e ..
Address: '' - � ! L, 6 pia � I -
City/State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: i I Total fees due upon application:
Amount received:
Authorized signature:
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 Tri County Building Industry •
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 09/09/10 440 -4613T(11 /02/COM/WEB)
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v
Building Division
Accessibility: Barrier Removal Improvement Plan
T fdAi D
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area maybe deemed disproportionate to
the overall alteration when the cost exceeds -twenty-five per -cent (25%0)..
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the •
following order:
• (a) Parking $
•
(b) An accessible entrance: $
• (c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(I) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
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I: \Building \Permits \BUP -COM PerrnitApp.doc 06/25/08
Ip
Building Division
Development Code Provision Review
TL,GARD Commercial Projects - No Associated Land Use Case
Building Permit No: L�1" Expedited Review
Plan Submittal Date: WO/
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 o ly if approved. ,,//
Planning Review (contact at 503- 718d or " @tigard - or.gov)
Er / Zoning -"- Permitted Use Yes l No ❑
12 / Land Use Regis red: Yes ❑ No V (explain below)
Notes: f. _i�t.�'/� .f.(i? ,01 c , d-z
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Approved 0 Not Approved Date:
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Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov)
Notes: /
r
Routed back to Building Division Date:
I: \CURPLN
11 . ,
,1 . Building Division
• Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: 1
APPLICATION SPECIFIC INFORMATION
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GENERAL INFORMATION t
*Class of Work: I Occupancy Group: Type of Construction:
*Type of Use: /, Occupancy Load: Oregon Specialty Code: -06in
SPECIFICS
Number of Stories: 7/ 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: (er Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 29 CoC) FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ , OC 5 DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 7,q0 Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ A.5 . "e 12% State Surcharge
Up to $4,999 $0.00 • $0.00 $ :i J Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $256.00 $38.00 $ `, c 1, 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: $ Jgj, 45 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;
IND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
L \Building \ Forms \OTC- BUP.docx 01 /13/2011