Permit ' CITY OF TIGARD BUILDING PERMIT
'`1` = COMMUNITY DEVELOPMENT Permit #: BUP2012 00209
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/31/2012
Parcel: 1 S135DC00200 -,
Jurisdiction: Tigard
Site address: 11825 SW GREENBURG RD 112
Project: Spec Space Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: TI
Contractor: GENERAL CONSTRUCTION SERVICES Owner: TWO G'S REAL ESTATE LLC
18395 WOOD THRUSH ST 18395 WOOD THRUSH ST
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 ,
PHONE: 503 - 684 -0550 PHONE: 503 - 684 -0550
FAX:
- Specifics: FEES
" Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee - Additions, Alterations, 10/31/2012 $119.33
Demolition
Occupancy Grp: B Occupancy Load: 2 12% State Surcharge - Building 10/31/2012 $14.32
Dwelling Units: 0 Plan Review 10/25/2012 $77.56
Stories: 2 Height: 0 ft Plan Review - Fire Life Safety 10/25/2012 $47.73
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Lg $2.00 (over 10/31/2012 $2.00
Value: $3,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $260.94
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No 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 Ce Those r = - et 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 503.2 •r 1.800
y
Issued By: /Uj .( 11 by Permittee Signature: . -
�ovl
Call 503.639.4175 by 7:00 a.m. for the next available inspec ,
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.
Auilding Permit Application
Commercial FOR OFFICE USE ONLY
IVED Received �^ —D�
III City of Tigard Date/By: lt7 „4 r Permit No.: / tvv�� ?
° 13125 SW Hall Blvd., Tigard, OR 9 Plan Revre fr y
Z . Phone: 503.718.2439 Fax: 503.598.1007 . C 2012 Date/By: � �� 1' � l 6 1 1 . 4 0 er Permit:
TI G A RD Inspection Line: 503.639.4175 v J Date Ready/By: `` s WI See Page 2 for
Internet: www.tigard- or.gov Notitied/Method: I 13 �a- 1 Supplemental Information
(1 OF fiGARO c.,M / pa,r"./
TYPE kIIMING DIVISION 1SION 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 4Commercial/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: 1 % 2 Is s IJ c Asirxirs V to ' at, New dwelling area: square feet
City /State /ZIP: -n 4 A M? 9 tti 9 — 1 . Garage /carport area: square feet
C RIB Idglapt. no.: 1 I 2... Project name: S J 1 7 G: 1. 1 'Z 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.
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.
P Valuation: $
ftrJT �{ I� wa
TVA on.- PA A.1 ■ 7 lD,./S S�/ Otldild0 e 000
C ILt.J a, s,( s 7G� Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 2.
Name: Type of construction: v 3
Address: Occupancy groups:
City/State /ZIP: Existing: 13
Phone: ( ) Fax: ( )
New: pp G,HAtJ6
(APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: �.t'Li 1- 30 V S IC review fe e ( deposit):
Contact le)
Structural plan review fee (or deposit):
Contact name:
f� FLS plan review fee (if applicable):
Address: 2 (0O S S t..,) 1� 104 11110A.. ]' C 7
City/State/ZIP: Total fees due upon application: c�
f�G s o p lL 9 14o Amount received: � j /
Phone: 6, 3) 6 TO _ ce ,44 Fax:: ( )
E - mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: ( C. S Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 194 �! 7 p 5 w V OQ> �{.M JS 0 5 ` Solar Installation Specialty Code checklist.
Permit fee (includes plan review
City /State /ZIP: LdKK fD5via(O O A.-- 1Z0 3 and administrative fees): $180.00
Phone: ( ) L V 4 _ Os $ C Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: ($ ( 0 o , Total fee due upon appLcation: $201.60
Authorized signature '' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print nam ���' Date: ) p — 2.,,<,...-) * Fee methodology set by Tri -County Building Industry
_ Service Board
l:\Building\Permits\BUP -COM PermitApp.doc 02/2 ' 440- 4613T(11 /02 /COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY
III : ; _ 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD.
BUP2012 -00209 - 11825 SW GREENBURG RD 112, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee - Additions, Alterations, 230 - 0000 -43104 $119.33 $119.33 $119.33
Demolition
12% State Surcharge - Building 100 - 0000 -24001 $14.32 $14.32 $14.32
Plan Review 230 -0000 -43106 $77.56 $77.56 $77.56 10/25/12 Credit Card 188913 $0.00
Plan Review - Fire Life Safety 230 - 0000 -43108 $47.73 $47.73 $47.73 10/25/12 Credit Card 188913 $0.00
Info Process /Archiving - Lg $2.00 (over 230 - 0000 -43135 , $2.00 $2.00 $2.00
11x17)
Totals for Fees $260.94 $260.94 $125.29 $135.65
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
188913 Credit Card Russell G Goddard - 10/25/2012 $125.29
GCS
Total Payments: $125.29
Balance Due: $135.65
71 Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: ( Ov (> - X e2C9 ❑ Expedited Review
Plan Submittal Date: i cI P S//9
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 /44) at 503 -7182 t / 1 4 or @tigard - or.gov)
Proposal: r ,-v 1/'.&t, Gl-46
Zoning C /
Permitted Use Yes G No ❑ /
Land Use Required: Yes ❑ No Br
Notes:
r --,
le 1 /' i / n /
/!/
L'7 Approved ❑ Not Approved Date: l L l/ a- g I DS
REVISED 10/4/12