Permit CITY OF TIGARD BUILDING PERMIT
a.. COMMUNITY DEVELOPMENT Permit #: BUP2012 -00135
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07110/2012
T I G A.R. D 9 Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: OR Community Credit Union Subdivision: WINDSOR PLACE Lot: 32
Project Description: Remove.interior, non - structural, partition walls
Contractor: MIKE SMITH CONSTRUCTION & PLUMBING INC Owner: FW OR- GREENWAY TOWN CENTER LLC
455 N 10TH STREET PO BOX 790830
ST. HELENS, OR 97051 SAN ANTONIO, TX 78279
PHONE: 503 - 397 -7749 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee - Additions, Alterations, 07/10/2012 $77.00
Demolition
Occupancy Grp: E Occupancy Load: 12% State Surcharge - Building 07/10/2012 $9.24
Dwelling Units: 0 Plan Review 07/10/2012 $50.05
Stories: 1 Height: 0 ft Plan Review - Fire Life Safety 07/10/2012 $30.80
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Lg $2.00 (over 07/10/2012 $2.00
Value: $1,200 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0 -
Total $169.09
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: 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 No ca u. Center. Those rules = = set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by - ing 503.2 2.1987 or 1.600.332.! 4
Issued By: Permittee Signature:
Call 503.839.4175 by 7:00 a.m. for the next available inspec +on 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 RECI'/ED 1-0R 1-0R t,r r � 0\1,1
i< �: I �_
,
City of Tigard Da Received — Permit No.
11 1 RI 13125 SW Hall Blvd., Tigard, OR 97223 JUL 1 u 2012 Plan Revie ( Of t
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
� - i i , i Inspection Line: 503.639.4175 CITY OF TIGARD �re DateBy: Rey y' ® see Pege 2 for lnformatlou
Internet: www.ti -ar. ov BUILDING DIVISION Notified/Method:
1 l Supplem
TYPE OF WORK 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
® Addition/alteration/replacement ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El I- and 2- family dwelling ® Commercial mdustrial 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: 12280 SW Scholls Ferry Rd. New dwelling area: square feet
City / State/ZIP: Tigard OR 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: d e_ IX)jL{ I.(. 02eD (j v t Covered porch area: square feet
Cross street/directions to job site: Greenway Town Center 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.
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.
Remove interior, non - structural, partition walls Valuation: $$1,200.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories: 1
Name: Regency Centers Type of construction: VB
Address: 5335 SW Meadows Occupancy groups:
City/ State/ZIP: Lake Oswego OR 97035 Existing: B
Phone: (503)603 -4700 Fax: ( ) New N/C
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: NW Precision Design (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: Darin Bouska
Address: 22605 SW Pinehurst Ct.
FLS plan review fee (if applicable):
City/State/ZIP: Sherwood OR 97140
Total fees due upon application:
Phone: (503) 680 -6444 I Fax: : ( ) Amount received:
E -mail: Darin@NW- Precision.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: Mike Smith Construction & Plumbing, Inc. Submit two (2) sets of roof plan with connection details
m and fire department access, along with the 2010 Oregon
Address: 455 N 10 Street Solar Installation Specialty Code checklist.
City/State/ZIP: St. Helens OR 97051 Permit fee (includes plan review $180.00
and administrative fees):
Phone: (503) 397 -7749 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: 174608
Total fee due upon application: $201.60
Authorized si This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
I Print name: — DA tZ1 3 0 v S co/ I Date. 7 /to i L I • Fee methodology set by Tri-County Building Industry
Service Board.
o ° Building Division
Over - The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: T 1 &. �" 01 ( 3
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: Type of Construction:
*Type of Use: (CAN Occupancy Load: Oregon Specialty Code: 2.01(')
SPECIFICS
Number of Stories: 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: (?f 7 Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ ic2W I FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ , I'• Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ • .2' 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ , - Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ ?C.,0 Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $268.00 $39.00 $ 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:
$ Other:
Building Staff: $ Other:
Date /Time: $ 1 Off 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; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \ Building \Forms \OTC - BUP.docx 07/01/2012