Permit CITY OF TIGARD BUILDING PERMIT
IS • COMMUNITY DEVELOPMENT Permit #: BUP2012 -00231
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 1 S 136AD06505
• Jurisdiction: Tigard
Site address: 10998 SW 68TH PKWY
Project: Bailey - Golsan Building Subdivision: WAY LEE Lot: B
Project Description: Add partition office walls and alter partition office walls
Contractor: MCINNIS INDUSTRIES LLC Owner: KEN GOLSAN
PO BOX 920 BAILEY GOLSAN LLC
BEAVERTON, OR 97075 10998 SW 68TH PARKWAY
TIGARD, OR 97223
PHONE: 503 -643 -6343 PHONE: 503 - 244 -0297
FAX: 503 -643 -6343
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Vg DC Provision Review, COM TI - Ping 11/20/2012 $67.00
Occupancy Grp: B Occupancy Load: 34 DC Provision Review, COM TI - LRP 11/20/2012 $10.00
Dwelling Units: 0 Permit Fee.- Additions, Alterations, 11/20/2012 $453.95
Demolition •
Stories: 2 Height: 0 ft 12% State Surcharge - Building 11/20/2012 $54.47
Bedrooms: 0 Bathrooms: 0 Plan Review 11/20/2012 $295.07
Value: $25,000 Plan Review- Fire Life Safety 11/20/2012 $181.58
Info Process /Archiving- Lg $2.00 (over 11/20/2012 $18.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0 •
Carport: 0 •
Covered Porch: 0 •
Deck: 0
Garage: 0 •
Mezzanine: 0
Total $1,080.07
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 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 0.332.2344.
Issued By: r) Permittee Signature:
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 FoR orrlcf: us,: ()Nix �je�
Received
Date/B Y )' "V /
q City of Tiga Date/B �( >p Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie I
11111
C , Phone: 503.718.2439 Fax: 503.598.1960 Date/B : � ' / Other Permit:
I' I G n Ii D Inspection Line: 503.639 Date Ready :y: . 1u ' .. ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: l Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
ddition/alteration / replacement ❑ Other: equipment, the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ t- and 2- family dwelling "Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms: -4:r-
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 7---"
Job site address: / 047 g Ski) /013 r,„,/!' ! / /`2_ New dwelling area: A) square feet
City /State /ZIP: T _ l Q Q___..-- . Garage/carport area: square feet
Suite/bldg. /apt. no.: J Project name: '3 ( g 1 _ ( 31/ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
I D (Ft___ Soc,7i //A.) Other structure area: N. 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.
— 4 11 Valuation: $ C)
j / ,�� [ ' ' i i Existing building area: ? -ACC square feet
l T � New building area: square feet
,PROPERTY OWNER I ❑ TENANT Number of stories: -2-
Name: K ( 114 — B G a (11 & L5 t L. Type of construction:
Address: / p 7' 8 5'1 (;, d.11 1 — Pt ;//-4-w4 Occupancy groups:
City /State/ZIP: 5 e..,� ... Existing:
Phone: ( c 3 - ( 4 —0 ) L 7'7 Fax: ( ) New:
[ APPLICANT T Er CONTACT BUILDING PERMIT FEES*
PERSON /
Business name: M CI et .S -}� h/� S� V ` L S u review fee (or fee sit): schedule)
e L Structural plan review fee (or deposit):
Contact name:
Gv,2, � n vti S
Address: ),,1 FLS plan review fee (if applicable):
City/State/ZIP: " a/� n 0.---- Total fees due upon application:
Phone: (S—'03) B b z> – (, t{5 / Fax:: ( ) an- Amount received:
E -mail: mil✓ /'11 C--: ki ni $ C PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"
CONTRACTO 4 u y Comme and residential prescriptive installation of
roof -top mounted PhotoVoltaic Solar Panel System.
Business name: S' Giti_Q____ 4_ s ,-- 6, Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City /State /ZIP: Permit fee (includes plan review $180.00
and administrative fees):
Phone: ( ) Fax: ( ) a
G State surcharge (12% of permit fee): $21.60
CCB lic.: /O� ' Z 3 3
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 6-6 {4 al—. k CT tii ;$ Date: i / /Z0 /` Z� • Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11/02/COM/WEB)
•
114 E a Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List a
Project Description: T( /iJ� . P. l a`-- OZ - 3/
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: rI Type of Construction:
*Type of Use: Occupancy Load: Oregon Specialty Code: -Ztl )
SPECIFICS
Number of Stories: . 2. , - - 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: M Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ -2 -5 - ) OL FEES DUE
$ FS , OA DC Prov Rvw, COM TI — Ping
$ la DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ ' — Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ •a 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 7... . 1:) Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ o r ,65 Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ 1,0Q 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: if 1080.07 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. s
I: \Building \Forms \OTC- BUP.docx 07/01/2012
o ° Building Division
Development Code Provision Review
T I G A R D Commercial Projects - No Associated Land Use Case
Building Permit No: ❑ 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.
Planning Review (contact ti l 5uya..„.. -k at 503 -718- 2,0y or @tigard- or.gov)
J 11
Proposal: • /7 p /?2
Zoning .-- &-
Permitted Use Yes ' No ❑
Land Use Required: Yes ❑ No
Notes:
•
Approved ❑ Not Approved Date: /1 0
REVISED 10/4/12