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Permit CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit #: BUP2009 -00079 T1 G ARj? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009 Parcel: 2S1 12 DA00800 Jurisdiction: Tigard Site address: 15055 SW SEQUOIA PKWY 170 Subdivision: Lot: 0 Project: Spec Space Project Description: TI Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 05/13/2009 $282.85 #300 Tax - 12% State Surcharge 05/13/2009 $33.94 PHONE: Plan Review 05/13/2009 $183.85 Plan Review - Fire Life Safety 05/13/2009 $113.14 Contractor: MATTHEW OLSON CONSTRUCTION 5320 SW DOVER LN PORTLAND, OR 97225 PHONE: 503- 892 -0066 FAX: 503 - 892 -0067 • Specifics: Type of Use: COM Class of Work: ALT Dwelling Units: 0 Stories: 0 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: 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 . • = • - ith appr• _ • plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for mor the 18' •ays. ATTENTION: 0 - g. law requir:: ou to follow the rules adopted by the Oregon Utility Notification Center. Those . are set fo OAR 952-%01-0010 through OAR 95001 -01 • . ay obtain a copy of the rules or direct questions to OUNC by calling 503.2 - • • • = or 1.80 . 32.234 Iss.ted By: � fr • / Permittee Signature: ^ ^^ p Call 603.639.4175 by 7:00 a.m. for an Inspection that busi nes ay. 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 OFFICE USE ONLY F OR O RECEIVED , Pril City of Tigard �xt�B 5 I'e Permit No.: 1 � 0 ��? / ° 13125 SW Hall Blvd., Tigard, OR 97223 MAY 13 200 Plan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 DateB : — 5.52r TIGARD Inspection Line: 503.639.4175 Date Ready/By: ®See Attached Checklist for Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: 1011 Supplemental Information BUILDING DIVISION TYPE- OF WORK - I " 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 A 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 Number of bedrooms: ❑ ry g ❑ Multi- family ❑ Master builder ❑ Other: Number of bathrooms: - JOB SITE INFORMATION AND. LOCATION - . - . Total number of floors: Job site address: z�,r0 New dwelling area: square feet City/State /ZIP: �6,P-1:4,t.7C1 42 9 c9 !�/ Garage/carport area: square feet Suite/bldg. /apt. no.: Project name d ✓ � — f /' e' 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. 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. l�sooh3,1 „pee) v` GGs Valuation: $ i Q`) (2 /� 0-02_...----- rJ, t ,� / �7 �' Existing building area: s quare feet 0 / i/ ( � L /l New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: PacTrust Type of construction: l ' Address: 15350 S.W. Sequoia Pkwy., Suite 300 // � Occupancy groups: City /State/ZIP: Portland, OR 97224 Existing: .-7,271 / 92 E 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 S.W. Sequoia Pkwy., Suite 300 jurisdiction in which work is being performed. If the City/ State/ZIP: Portland, OR 97224 • applicant is exempt from licensing, the following reasons apply: Phone: (503) 624 -6300 Fax: : (503) 624 -7755 E -mail: dennisp @pactrust.com CONTRACTOR ''. . Business name: I''.". IT I C...." tU.�t.„ ,. BUILDING—PERMIT—FEES': - , 3t," Address: - (Pka``se iefer to la schedule) • ; -... • . City/ State/ZIP: Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: ( Ap 07 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: �C ei �� � T' y �� I Da l214,1, • Fee methodology set by Tri-County Building Industry Service Board. 1: \ BuildingWermits \BUP- PermitApp.doc 03/21 /06 440- 4613T(11 /02/COM/WEB) " Building Division Over - The - Counter (OTC) Building Permit TIGARD Check List Description of Project: GENERAL INFORMATION Class of Work:* 4 (, j Fl Areas (sq. ft.): Exterior Wall Construction: Type of Use:* ( , o n First floor: N: S: Type of Construction: /115 Second floor: E: W: Occupancy Group: Third floor: Openings Protected Y /N ?: Occupancy Load: ^J h Total sq ft.: N: S: Stories: _ Note: Combine total floor area for E: E: Height: all floors above third floor and Roof Construction: Floor Load: add to the third floor s . ft. Fire Retardant: Basement: Basement: Area Separation Rated: Mezzanine: Garage: Occu. Separation Rated: REQUIRED ITEMS Fire sprinkler: Handicap access: Smoke detector: Protected corridors: Fire alarm: Parking spaces ( #): Notes: Total Valuation: $ 35, 0 00 INSPECTIONS FEES DUE Footing/ foundation Firewall $ Permit Fee Post /beam structural Smoke detector $ State Surcharge Shear wall Misc. inspection $ Plan Review Fee Masonry Approach /sidewalk $ FLS Plan Review Fee • Framing $ Additional Permit Fee Insulation Sprinkler rough -in $ Additional Plan Review Fee Gyp board Fire alarm $ Metro Construction Excise Tax Suspended ceiling Sprinkler final $ School Construction Excise Tax Final inspection $ Misc. Fee $ Hourly Rate Fee $ Hourly Rate State Surcharge $ Other: $ 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.doc 08/19/08 r This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. 74 o BUILDING DIVISION e T I G A R D TRANSMITTAL LETTER a TO: DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED JUN 10 2009 FROM: 7 e 014 , 3 . 1 N / CITY Or TIGARD COMPANY: v BUILDING DIVISION PHONE: _c0 Oc7 -- _7d" 7 By: RE: 2 SAS � O/sa— T(-,,/ , k1/7 9 Site Address) / (Permit/Case Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: • Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: FOR O FIC USE ONLY . ., Routed to Permit hnician: Date: r o ( (C) •- ©, Initialg y Fees Due: es ❑ No Fee Description: Amount D e: (-- / $ 35( $ Special Instructions: Reprint Permit (per PE): ❑ Yes I ❑ No ❑ Done Applicant Notified: Date: Initials: • I: \Building\ Forms \TransmittalLetter- Revisions.doc 4/4/07