Permit .11 CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2012 -00050
T I G AR D 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2012
Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16260 SW UPPER BOONES FERRY RD
Project: Game Day Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: TI
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES LP
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SE 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 03/16/2012 $160.00
Class of Work: ALT DC Provision Review, COM TI - LRP 03/16/2012 $24.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 03/16/2012 $1,299.23
Stories: 1 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 03/16/2012 $155.91
Value: $132,000 Plan Review 03/16/2012 $844.50
Plan Review - Fire Life Safety 03/16/2012 $519.69
Info Process /Archiving - Lg $2.00 (over 03/16/2012 • $10.00
Floor Areas: 11x17)
Metro Const. Excise Tax - Commercial 03/16/2012 $158.40
Total Area: 0 Use
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,171.73
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 issuanc or if work is a ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ' = ter. Th rules e set forth in OAR
952- 001 -00 • rough • • ' 95 -!• You may obtain a copy of the rules or direct questions to OUNC by calling 503 987 or 1 0.332.2344.
Issue . By: /. 1„, I Permittee Signature:
/ f
Call 503.638.4175 by 7:00 a.m. for the next avallabl: nspe . • n 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 0 FOR OFFICE USE ONLY
City of Tigard Received /0 Permit I n
Y Tigard DatcB : � T' / / � d` �D�
13125 SW Hall Blvd., Tigard, •'S 1/S ' " Olt Plan Review - �_ /, rip
Phone: 503 Fax: 50 " • . 1960 �,� Date/I3 : , f ��' f � � Other Permit:
TIGARD
Inspection Line: 503.639 e� 1 Date Rea.• l: runs: ® See Page 2 for
Internet: www.tigard- or.gov A.
� 1 Notified/Method: Supplemental Information
�� ` 5
TYPE OF 0" - REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction *j 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 rcial /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: ���0 4e _fie./ ,/,,, /✓ y 7 4 New dwelling area: square feet
City /State /ZIP: ��, / GJ'vl !� Gara /carport area: square feet
Suite/bldg. /apt. no.: Project dime: ���-- C-- Covered porch area: square feet
Cross street/directions to job site: 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.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
� Valuation: $ j2� /' O
-i •,! vei oe/J f
Existing building area: square feet
?!' T/ 1 • ow( New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: /
Name: PacTrust Type of construction: // ✓�
Address: 15315350 SW Sequoia Pkwy., Suite 300 Occupancy groups:
City /State/ZIP: , Portland, OR 97224 Existing:
Phone: (503) 624 -6300 Fax: (503) 624 -7755 New:
® APPLICANT ® CONTACT PERSON NOTICE
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
Ciry /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
CONTRACTOR
Business name BUILDING PERMIT FEES*
/t7 ,9 Tr /ma i,✓ !� / d .•� .►.s,4—
Address: (Please refer to fee schedule)
City/ State/ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
CCB lic.: 7 v 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: yi /�
�h 9�� n� , J id / 4 7, • Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(l l /02 /COM/WEB)
1 1 1 11 o.
° Building Division
Development Code Provision Review
T I G n R D Commercial Projects - No Associated Land Use Case
Building Permit No: - - . I? -3 5 ,xpedited Review
Plan Submittal Date: ,
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- orr @ tigard- or.gov)
❑ Zoning - C�
- Permitted Use Yes ' No ❑
❑ Land Use Required: Yes L9' No ❑ (explain below)
Notes: A G ty, Are aac.
LK Approved ❑ Not Approved Date: 3 /2
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @ tigard - or.gov)
Notes:
Routed back to Building Division Date:
I: \CURPLN
1 o ° Building Division
Over - The - Counter (OTC) Building Permit
T I G A R D Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: T Occupancy Group: Type of Construction: 0
*Type of Use: CM Occupancy Load: ! P Oregon Specialty Code: 9 ) . _
SPECIFICS
Number of Stories: 1 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 0 _
Fire Sprinklers: y�G Fire Alarms: Smoke Detectors:
Parapet: t Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ (5Z- MO, 3 FEES DUE
$ t k.on, DC Prov Rvw, COM TI — Ping
$ C C-) DCProvRvw,COMTI —LRP
DC Provision Review Fee for COM TI $ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ i ijar K ,,,,I Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ �[� Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ 0. ea 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)
$ j55c • q0 Metro Construction Excise Tax ....r
$ 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: $ /'? 1 3 1 OTAL FEES DUE
171• •7
*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.
l: \ Building \Forms \OTC- BUP.docx 01/13/2011