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Permit 1 pr i)T cD r s C On -- fcz CiOr 4,D CITY OF TIGARD 2 BUILDING PERMIT c COMMUNITY DEVELOPMENT Permit #: BUP2009 -00129 .TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2009 Parcel: 2S112DD00701 Jurisdiction: Site address: 15800 SW UPPER BOONES FERRY RD 120 Subdivision: Lot: Project: Jonathan Plant DVM Project Description: Interior TI. Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount ATTN• N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 07/14/2009 $629.38 #300 12% State Surcharge - Building 07/14/2009 $75.53 PHONE. Metro Const. Excise Tax - Commercial 07/14/2009 $128 40 Use Plan Review 07/14/2009 $409 10 Contractor: Plan Review - Fire Life Safety 07/14/2009 $251.75 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: 1 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $107,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch 0 Deck' 0 Garage: 0 Mezzanine: 0 Total $1,494.16 Required: Required Items and Reports (Conditions) Fire Sprinkler: No Parapet: Fire Alarm: Protected Corridors No 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 throu OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1 800.332 2344. Issued By: C n l rf� n < � Permittee Signature: R n oa f it i f V� ��JJ � Call 503.663 / n ( t 9. by 7:00 a.m. for an Inspection that business day. `x \ 111 n(�( 1 This permit card shall be kept In a conspicuous place on the job site until completion of the project IVI Approved plans are required on the job site at the time of each Inspection. CITY OF TIGARD BUILDING PERMIT • COMMUNITY DEVELOPMENT Permit #: BUP2009 -00129 T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 07/14/2009 Parcel: 2S112DD00701 Jurisdiction: Site address: 15800 SW UPPER BOONES FERRY RD 120 Subdivision: Lot: Project: Jonathan Plant DVM Project Description: Interior TI. Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 07/14/2009 $629.38 #300 12% State Surcharge - Building 07/14/2009 $75.53 PHONE: Metro Const. Excise Tax - Commercial 07/14/2009 $128.40 Use Plan Review 07/14/2009 $409.10 Contractor: Plan Review - Fire Life Safety 07/14/2009 $251.75 OWNER PHONE: FAX: Specifics: Type of Use: COM Class of Work: ALT Dwelling Units: 0 Stories: 1 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $107,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 • Covered Porch: 0 Deck: 0 • Garage 0 Mezzanine 0 Total $1,494.16 Required: Required Items and Reports (Conditions) Fire Sprinkler No Parapet: Fire Alarm: Protected Corridors: No 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 la 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 suspen or more th 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules : _ .e rth in OAR 952- 001 -0010 t -.ugh *AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. . • or 1.800.332 4 Issued By: ,4% �j l + ' I Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an Inspection tha usi • : • 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. • l y , Building Permit Applica I r \ l FOR OFFICE USE ONLY • City of Tigard Received I • i Date/13 : — I � f rj 13125 SW Hall Blvd., Tigard, O 'C' ti - '1049 A i Plan Review t�� Phone: 503 639.4171 Fax: 503. , 9:. 960 1 °'�� ' DateB : / AI"' (� O ther Pe` ur 1\3\'' 1\3\'' 1 l• Inspection Line: 503.639 4175 , Q �— �' � I ,, Date Ready : y" Suns El See Attached Checklist for Internet: www ci.tigard.or.us oF.�\G 0� \ Notified/Method. ( Supplemental Information REQUIRED. DATA :•.1 - AND 2= FAMIL 1)WELLING . ❑ N w construction El 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 i' :S, . . -, , �. -, ,, _ - 1 , - - •- - . -. ... ,....,,.... .. ., . . -. .� r.., , ., work indicated on this application. - ` -..! ` - ._ ,_ v � ,CtfiTEGURY. _ OF � STttUCT , . , 4.. � ;N'' ; •�, ; , -"` : ��• F,• ' Valuation: $ ❑ I - and 2- family dwelling ommercial/industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: ' -JOB SITE INFORMATION ANI); ` '' ; Total number of floors: • - Job site address: , 1 v y Ap square feet City/State/ZIP:"./ /<� Qs�� 6�- 9i Garage/carport area: square feet tfie Suitefbldg. /apt. no.: I Project na: /_ Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet . REQUIREDDATA: COMMERCIAL,USE GIIEcK ST 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 "''s =' `'t ''DESCRIPTION ,f - :DESCRIPT, ; WORK '' '; - -'�� : - J' work indicated on this application. ,''" / ...- .. r._�3•". =a :'r . - r• .: -a, -. . _s. :?r "µ" -ii ^•.;..rc -,,. , - / !7 gej�liT�uG ./�'..Q Air !l 7/24 T: -,ti Valuation: $ � �r� v �� _ / // /�� /� —, �� Existing building area: square feet ?trt �( j ar' /� / New building area: square feet ❑ PROPERTY OWNER" • ' f.� - t ' ® -.TENANT / _ . Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: 02,z g� Phone: ( ) Fax: ( ) New: ....10 0. APPLICANT•- - :- yj ` ® ; CONTACT PERSON• - . • ,, . , -.r • , - + - _ _ - 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 Parkway, 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 I Fax: : (503) 624 -7755 E -mail: dennisp@pactrust.com `' ' CONTRACTOR`. C '•+'( .-'Y; ; ' F., Business name: 7 0 0 ( 7— /7../ — c„,).... B U _ S' - ..__. =vf B$3DI1VG PERMIT EEE Address: Please refer to fee schedule City/ State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: Date received: Authorized signature: ` ♦ This permit exp ires if a per is e � — wit hin 180 days application after it exp ha s been accepted as not co mplete obtaind . Pnnt name: ` Date :' /.t /O f • Fee methodology set by Tri - County Building Industry Or �f 9 et i ' � / Service Board. � � � , `! 1 \Buddm mns \ g\PerBUP- PermitApp doc 12/03 440- 4613T(I I /02/COM/WEB) (�1