Permit II CITY OF TIGARD BUILDING PERMIT
a COMMUNITY DEVELOPMENT Permit #: BUP2012 -00155
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD •
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: Interior Partition Walls
Contractor: MIKE SMITH CONSTRUCTION & PLUMBING INC Owner: FVV 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 DC Provision Review, COM TI - Ping 08/02/2012 $67.00
Occupancy Grp: A -2 Occupancy Load: DC Provision Review, COM TI - LRP 08/02/2012 $10.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 08/02/2012 $674.35
Demolition
Stories: 1 Height: 0 ft 12% State Surcharge - Building 08/02/2012 $80.92
Bedrooms: 0 Bathrooms: 0 Plan Review 08/02/2012 $438.33
Value: $45,000 Plan Review - Fire Life Safety 08/02/2012 $269.74
Info Process /Archiving - Lg $2.00 (over 08/02/2012 $10.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0 .
Total $1,550.34
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 Notification Center. Those rules are 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 calling 503.232.1987 or 1.800.332.2344.
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Issued By: Permittee Signature: kAt
___ Ait
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 RECEIVED FOR OFFICE USE ONLY
City of Tigard AUG 0 2 2012 DatelB $/a 1 Y Permit No. DI - — DD! SSA
�' = 4 1 13125 SW Hall Blvd-, Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19fi0r Date/B . O ther Permit: -00
I i.3 Aut.) Inspection Line: 503.639.4175 hr�111A IE llJJttiillWW Date ReadyBy. ®See Page 2 for
Internet www.tigard- or.gov BUILDINODIVISION Notified/Method: - Suppl em ental lnf o rm aeon
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.
❑ 1- and 2- family dwelling ® 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: 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: Little Caesar's Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Greenway Town Center 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.
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Interior Partition Walls Valuation: $$45,000.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I 0 TENANT Number of stories: 1
Name: Regency Centers Type of construction: VB
Address: 5335 Meadows Rd # 295 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 reterro fee schedule)
Structural plan review fee (or deposit):
Contact name: Darin Bouska
FLS plan review fee (if applicable):
Address: 22605 SW Pinehurst Ct.
City / State/ZIP: Sherwood, OR 97140 Total fees due upon application:
Amount received:
Phone: (503) 680 -6444 Fax:: ( )
E -mail: Darin @NW- Predsioncom PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: Mike Smith Construction, Inc Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 455 North 10th Street Solar Installation Specialty Code checklist.
City /State/ZIP: St. Helens, OR 97051 Permit fee (includes p lan review $180.00
and administrative fees):
Phone: (503) 397 -7749 Fax: ( ) State surcharge (12% of permit fee): $21.60
0............
CCB lic.: 174608
Total fee due upon application: $201.60
Authorized signature: 1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Darin Bouska I Date: 8/1/2012 * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Bullding\Permits\BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11/02 /COM/WEB)
4.
IIIIII o ° Building Division
Over- The - Counter (OTC) Building Permit
T I G i\ K D Check List
Project Description: ( ( 6a to/ a - 0015"5"
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: = Occupancy Group: Z Type of Construction: �
*Type of Use: Occupancy Load: Oregon Specialty Code: ZCLD
SPECIFICS
Number of Stories: i 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: e-e6 j Fire Alarms: Smoke Detectors:
Parapet: ' Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ FEES DUE
$ 7, Co DC Prov Rvw, COM TI — Ping .
$ 0� DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ �fD Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ oz. 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ .. Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ c-(•7 Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ j U. 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: $ , OTAL 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
IN
• ° Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: et t-P ?V I a - 0 01 S.- r ' ❑ Expedited 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.
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Planning Review (contact \To A N F/ at 503 -718- 'f or \ '4 b4'" @ tigard- or.gov)
❑ Zoning G_6- Permitted Use Yes 1S1 ,'No ❑
❑ Land Use Required: Yes ❑ n No (explain below) ��
Notes: �1nf Z,( /&S i� ).C/ G of (/SL' — MAO d0/) -- Uoc /S
'Approved ❑ Not Approved Date: 2 C•/
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date:
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I: \CURPLN