Permit = CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2012 -00206
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
TIGARD g Parcel: 2S 113AB00300
Jurisdiction: Tigard
• Site address: 16037 SW UPPER BOONES FERRY RD 110
Project: Professional Practices Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: TI
Contractor: PACIFIC CREST STRUCTURES INC Owner: OREGON STATE BAR, THE
17750 SW UPPER BOONES FERRY RD SUITE 16037 SW UPPER BOONES FERRY RD
190 TIGARD, OR 97224
DURHAM, OR 97224
PHONE: 503 - 968 -8949 PHONE: 503 - 431 -6313
FAX: 503 - 598 -6658
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review, COM TI - Ping 10/25/2012 $67.00
Occupancy Grp: B Occupancy Load: 10 DC Provision Review, COM TI - LRP 10/25/2012 $10.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 10/25/2012 $377.90
Demolition
Stories: 3 • Height: 0 ft 12% State Surcharge - Building 10/25/2012 $45.35
Bedrooms: 0 Bathrooms: 0 Plan Review 10/25/2012 $245.64
Value: $19,684 Plan Review - Fire Life Safety 10/25/2012 $151.16
Info Process /Archiving - Lg $2.00 (over 10/25/2012 $4.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
•
Garage: 0
Mezzanine: 0
.Total $901.05
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. ATTE■ • ■: • _•on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 %10 through OAR • •2 -001 -' • • 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: I X Permittee Signature: — 11.&a / •
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.
`wilding Permit Application
Commercial RECEIVED FOR OFFICE USE ONLY •
�l
City of Ti and R eceived
o
`, g DateBy: � , Ay /a h Permit No.: u ,j - ea �
• 13125 SW Hall Blvd., Tigard, OR 972 T 2 4 2012 Plan Review I /�� \ 0 8.41 '
Phone: 503.639.4171 Fax: 503.598. I 2 C L pat ( Tj �\1 +O •her Permit:
T I G A R D Inspection Line: € 03 CITY OF TIGARD Date /a Supplemental luris: See Page 2 for
Internet: �vw�v.li ardor. ov Notifieded /Methoetho d: /( / Information
BUILDING DIVISION ,`../2 -.4" ,P.,itA..) is 44-.a . G ,
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction 0 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 N umber of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 6 2 O 3 7 cSL'ZZ P 8a i-Le s R ✓ 1� pri New dwelling area: square feet
City /State/ZIP: 77 a/ O� 2 Z Garage/carport area: square feet
Suite/bldgiapt. no.: / / D Project name: ProiQ5-s7 &77 ,,..e 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: 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.
d'0 C! ize.ij/ i �- n t S A PvA' /s-/vi �/ SyO &-IL�� Valuation: $ / �/ /a 8 �/ vl�
/ , `J / Existing building area: /e) S- / square feet 1 0
New building area: /0 S / square feet C he nal
A PROPERTY OWNER I ❑ TENANT Number of stories: �1- � eodez _
Name: O e, 8 a - CO `
j O l f1 cS� Type of construction: /�, SUr / v ( I-- (4,0 d
Address: /6 3 7 Li`i j k xy 'oeei. / o 'J d Occupancy groups:
City /State /ZIP: 4 - 7 �� el �_ Existing: 8
Phone: (03) , r 3 / t,3 /3 Fax: ( ) New:
e APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: / AisJf 6i/„.v/� All contractors and subcontractors are required to be
Contact name: �� licensed with the Oregon Construction Contractors Board
l /� d y7' under ORS 701 and may be required to be licensed in the
Address: PP I? D X 0 jurisdiction in which work is being performed. If the
City /State/ZIP: _s / /1 / D/ � 7- O 7 5 applicant is exempt from licensing, the following reasons
1 /� apply:
Phone: ( ) 7,9 / ( / Y 7 I / I Far.. ( ) .5 7 0 d G v
E -mail: /S'//7 / 7 0 1 f/1 1• 7/ , p- L.40 /
CONTRA // CT
Business name: �G 61' �] e _ (. ht S u C /- BUILDING PERMIT FEES*
Address: 7 7 (Pleaserefrtofeeschedule)
�/ n� r "�'� S d Structural plan review fee (or deposit):
City /State /ZIP: D 1 ,, t , h a i, (2f/e. 77 ?1 ,-/ #
q FLS plan review fee (if applicable):
Phone: (9) 3) / a 0 , g i Cy g Fax: ( )
CCB lic.: /: 49 q/ Total fees due upon application:
(l Amount received:
Authorized signature: / .6� �/ ( ' This permit application expires if a permit is not obtained
Z.,„/ /7 n / / � /� / �} Date: / within 180 days after it has been accepted as complete.
Print name:
t_ /7-7 I `7 ' 2 • Fee methodology set by Tri- County Building Industry
Service Board.
IABuilding\Permits\BUP -COM PermitApp.doc 2/23 /07 440- 4613T(I I /02/COM/WEB)
„ .
Building Division
Development Code Provision Review
T t CARD Commercial Projects - No Associated Land Use Case
Building Permit No: - 314 P o90 /a -DDS / ❑ Expedited Review
Plan Submittal Date: /o /R // .'Z
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.
Planning Review (contact J1-1441. __ at 503 - 718- 2 SS or .) Ltd A @tigard- or.gov)
Proposal: In +'i vno4:P °it 41, cx 1$ 4 aft Le . VI; 14 Lo•v1 - in wA.
+b b e 071'I 145L .
Zoning 1/l CI tots t ri A l PQ rkc
Permitted Use Yes Er No ❑
Land Use Required: Yes ❑ No
Notes:
Approved ❑ Not Approved Date: / 0/2 y/12
REVISED 10/4/12
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: - it
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work:
A- LT Occupancy Group: Type of Construction:
*Type of Use: (' c,7 Occupancy Load: in Oregon Specialty Code: 7O(O
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: Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
A CO
Total Project Valuation: $ t l FEES DUE
$ 6`7, (5 DC Prov Rvw, COM TI — Ping
$ • DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ '? ?bQ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 5 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 2 • ( • Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ , . Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ , On 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: $ 90145-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 \O1'C - BUP.docx 07/01/2012