Permit •
4 CITY OF TIGARD BUILDING PERMIT
"! o COMMUNITY DEVELOPMENT Permit #: BUP2009 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 90
Subdivision: Lot: 0
Project: Island Tan
Project Description: Create new tenant space.
Owner: FEES
13500 PACIFIC CORP Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS Permit Fee - COM 07/28/2009 $282.85
INC, 21500 HAGGERTY ROAD, SUITE 100 12% State Surcharge - Building 07/28/2009 $33.94
PHONE: Plan Review 07/28/2009 $183.85
Plan Review - Fire Life Safety 07/28/2009 $113.14
Contractor:
CREATIVE CONTRACTORS & DESIGN
15357 UNION SCHOOL RD
WOODBURN, OR 97071
PHONE: 503 - 984 -3220
FAX: 503 - 981 -7784
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $35,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $613.78
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: 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 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 -0100. You may ; stain a copy of the rules or direct questions to OUNC by calling 503.246.66 - en ".234 .
Issued By: `_ '1, I , / r I I (` Permittee Signature:
_ Call 503.639.4175 by 7:00 a.m. for an Inspection that bu r/ y
This permit card shall be kept In a conspicuous place on the job site ntil ompletion of the project
Approved plans are required on the job site at the time of each Inspection.
a'
Building Permit Application
Commercial rtlit tlrFlLE tisE tlNt.N
RECEIVEI,i City of Tigard Received , , ^
Date/B : / Permit No. ' `.. - 01 11 0
IN • 13125 SW Hall Blvd., Tigard, OR 97223 JUL 2 3 2009 Plan Revie 11 It. ' `l
C Phone: 503.639.4171 Fax: 503.598.1 960 Date/B : �� � i ` 1A Other Permit:
• T I C i A It D Inspection Line: 503.639.4175 Y CIT Date Ready/By: Ea See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
IF 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 OF CONSTRUCTION work indicated on this application.
❑ 1- and 2 -family dwelling [sit Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 3.S a 0 p ,_ f ; ii„, O New dwelling area: square feet
City/State /ZIP: ; c 0 9. A ;� \-;..., �', 7 ) , ; Garage/carport area: square feet
Suite/bldg. /apt. no.: - C ) Project name: 0 A 1 4 . . . . 4 . . , 0 7 � Covered porch area: square feet
Cross street/directions to job site: Tc C,t c„,,- M / lc .}. PI G G Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. ex
� re... ft A.) Q./.... Te,i-.0,,�.,, I 5,� ce_ Valuation $
! n i 6 L eAs r`c l- ✓� f5 f5,,, t lc( ► I�q Existing building area: /5 square feet
�J J New building area: C , square feet
53 PROPERTY OWNER ❑ TENANT Number of stories: y
Name: Elio if d A-S.,UG;c.. i'Q �cj Type of construction: 1
Address: g 0 1 iv i a, I. c h c r Occupancy groups: 6
City /State/ZIP: PO r + ( , 0 et, ci , 43Z. Existing: 6
Phone: (5 ZZ C{ 6 ( Fax: (5a 3) Z Z 8 7/69' New: 43
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: C, re..4,4 o I Jra.c�Y S L Cle- S V All contractors and subcontractors are required to be
Contact name: -r + licensed with the Oregon Construction Contractors Board
J 0 S k_ C , i (-e... under ORS 701 and may be required to be licensed in the
Address: , 5',3 -'t 0 5G/. ( ( Roc jurisdiction in which work is being performed. If the
City/State/ZIP: 111/0 �� U Q N �O applicant is exempt from licensing, the following reasons
apply: 2 g
Phone: (� G 3) ! $� — 31:2.0 Fax: : (So3) c( 8/�- J )$ y
E -mail: 6 5 .
CONTRACTOR r n_
Business name: L Q2 �,`
't" 1 CA tnd- i LTOrs t a 5 IC. fr ► BUILDING PERMIT FEES"
lJ (Pleme refer to feescheduleej
Address: f 53 5 7 U n t•ok, S c.1.66 1 Ra Structural plan review fee (or deposit):
City/State/ZIP: (, , dc) D l3 u RN Q ?d 7
FLS plan review fee (if applicable):
Phone: (503) `1 g `l _ 3 2 I Fax: ( o3) q ; I — ?78
CCB lic.: j 7 �, 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: s 51, ua1/4. r' .4-+( -e_ Date: 7/2 3/09 • Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PemutApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB)