Permit CITY OF TIGARD BUILDING PERMIT
27 COMMUNITY DEVELOPMENT Permit #: BUP2012 -00102
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 320
Project: Thenell Law Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: TI
Contractor: DURUS CONTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES
15806 UPPER BOONES FERRY RD ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 320 -8601 PHONE:
FAX: 503 - 244 -4318
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 05/22/2012 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 05/22/2012 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 05/22/2012 $827.34
Stories: 4 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 05/22/2012 $99.28
Value: $62,200 Plan Review 05/22/2012 $537.77
Plan Review - Fire Life Safety 05/22/2012 $330.94
Info Process /Archiving - Lg $2.00 (over 05/22/2012 $4.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,872.33
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. 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 OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calli�: = = or 1.800.332.2344.
Issued By: Permittee Signature:
--
Call 503.639.4175 by 7:00 a.m. for the next available Ins.
This permit card shall be kept In a conspicuous place on the job site un • t.
Approved plans are required on the Job site at the time of eac nspection.
Building Permit Application
Commercial FoR off icy USE ONLY —
City Ti ceived ®�LM=1 /6
`� acct RECEIVED Re
g Re : • �p' -WIQ�
9 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review .
D 2 1 Other Permit:
Ph one: 5 03.718.2439 Fax: 503.598.196 Date/By: fi t
R�I 2 Z 2012
T I G A R D Inspection Line: 503.639.4175 Date Ready : y: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method. Supplemental Information
CITY OFTIGARD
TYPE (HBVULINNti DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X 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 %Commercial/industrial Valuation: $ La- + ��
❑ Accessory building ❑ Multi - family
Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I251O 1 S (,3 L-g3 4 V$ 1,/ 4 3� New dwelling area: square feet
City /State /ZIP: T �, 04 1 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: "' „ ,, Covered porch area: square feet
Cross street/directions to job site: v Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
,V� Yo ev /AA f Valuation: $
a -iut ( e 'shill 17Y taw Existing building area square feet
q (JITI New building area: square feet
PROPERTY OWNER J I ❑ T ENANT Number of stories:
Name: f �(YI L I Q.(�tt j ��c-e S Type of construction:
Address: L & a� go O � ,p ' l,t 4 3 Occupancy groups:
City/State /ZIP: T Q�� 1 0 9 722 J Existing:
Phone: (S3 ) (in_ — L 3etc Fax: (GD3) I Z4 / `& New:
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: � a S v JY,t/ (Please refer to fee deposit):
schedule)
Contact name: ati` M(� _ Structural plan review fee (or deposit):
(� usile FLS plan review fee (if applicable):
Address: /
City/State /ZIP: Total fees due upon application:
Phone: 6---61j) T- - t2 4 I Fax: : ( ) Amount received:
E -mail: ,, U d� Va� V &I- f PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
; Commercial and residential prescriptive installation of
n/ CONTRACTOR(( roof -top mounted Photo Voltaic Solar Panel System.
Business name: OVwS `�(c�(1�1 �� Ci��VI/� Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 1 � Z7 Q� C e.V1r O„/�
w Solar Installation Specialty Code checklist.
City/State /ZIP: / A ,
o
O 62-12,_ 9 -70,93,,s— Permit fee (includes plan review $180.00
( 3 ZO — 51k.33 (SD (,,Q,Q�y- S , and administrative fees):
Phone: F ax: S tate surcharge (12% of permit fee): $21.60
CCB lie.: Total fee due upon application: $201.60
Authorized signature' This permit application expires if a permit is not obtained
� within 180 days after it has been accepted as complete.
Print name: r .��MWA ` Date: ®f - * Fee methodology set by Tri -County Building Industry
I Service Board
I:\Building\Permits :UP -COM PermitApp.doc 02/24/2011 440- 4613T(11/02 /COM/WEB)
III o ° Building Division
Development Code Provision Review
r i c ►i ° Commercial Projects - No Associated Land Use Case
Building Permit No: P go 1 200 tC' E Expedited Review
Plan Submittal Date: '- /1-
To the Applicant: / bO /
> 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 on if approved.
Pla g Review (contact / at 503 - 718 -A 1' ,/
O or @ tigard- or.gov)
le Zoning __,1/7 Permitted Use Yes t No ❑
ld Land Use Required: Yes ❑ No 1E (explain below)
r
Notes: 0.6. 4,001.6
40 i, .4!0a. --
L7 Approved ❑ Not Approved Date: - // /
■Iff V
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes: A
IlL
.a
Routed back to Building Division Date:
•
I: \CURPLN
!NI e ° Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: 11
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: {\(,r Occupancy Group: Type of Construction: 'Zg
*Type of Use: ( ?o"j,( k Occupancy Load: Oregon Specialty Code: _ Z0 i n
SPECIFICS
Number of Stories: 4 t - 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: Fire Alarms: ] Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ �QCG, I FEES DUE
$ � Co DC Prov Rvw, COM TI — Ping
$ - 1 ,co DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ fa Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ "�� 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ `j , if Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $i��'� Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ ,e 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:
Building Staff: ethes,
Date /Time: $ I672 33 TOTAL FE : 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.
I: \ Building \Forms \OTC- BUP.docr 01/13/2011