Permit CITY OF TIGARD BUILDING PERMIT
11 1. R COMMUNITY DEVELOPMENT Pe rmit #: BUP2012 00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/04/2012
Parcel: 1 S 136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Project: City County Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 4 -8 & 27
Project Description: TI. Move one wall.
Contractor: BNK CONSTRUCTION INC Owner: CITY COUNTY INSURANCE SERVICES
45 82ND DR, SUITE 53B 1212 COURT ST NE
GLADSTONE, OR 97027 SALEM, OR 97301
PHONE: 503 - 557 -0866 PHONE:
FAX: 503 - 557 -1085
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB DC Provision Review, COM TI - Ping 12/04/2012 $67.00
Occupancy Grp: B Occupancy Load: 21 DC Provision Review, COM TI - LRP 12/04/2012 $10.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 12/04/2012 $195.38
Demolition
Stories: 2 Height: 0 ft 12% State Surcharge - Building 12/04/2012 $23.45
Bedrooms: 0 Bathrooms: 0 Plan Review 12/04/2012 $127.00
Value: $8,000 Plan Review - Fire Life Safety 12/04/2012 $78.15
Info Process /Archiving - Lg $2.00 (over 12/04/2012 $6.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $506.98
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 don- - - ice 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: Or -:•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 '01 -0010 t rough OAR 9' -I: -0 9• You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss • d By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
Thls 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 R ECEIVED FOR OFFICE USE ONLY
City of Tigard
Date/By: eived ',�� Permit No P�i3r00 D
1111 q 13125 SW Hall Blvd., Tigard, OR 97223 D E C 0 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 � Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready /By: Jura' 0 See Page 2 for
Internet: www.tigard - or.gov BUILDING ON Notified /Method: 1�K 6 � c. Supplemental Information
17111IV �V+�`w'��� Sii_ C r_ UI
TYPE OF WORK vW 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.
dwelling Valuation: $
❑ 1- and 2-family g ® Commercial /industrial
❑ 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: 11675 66` Ave. New dwelling area: square feet
City/State /ZIP: Tigard Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: City County Insurance 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.
Tenant Improvement. Move one wall. Add one wall. Add a few outlets and data Valuation: $8,000
locations. Existing building area: 308 square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: City County Insurance Services Type of construction: T.I.
Address: 11675 66 Ave. Occupancy groups:
City/State /ZIP: Tigard, OR 97223 Existing: X
Phone: ( ) Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: BnK Construction, Inc. (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: Steve Close
FLS plan review fee (if applicable):
Address: 45 82 Drive, Suite 53B
Total fees due upon application:
City /State /ZIP: Gladstone, OR 97027
Amount received:
Phone: (503.5) Fax:: ( )
E -mail: close@bnkconstruction.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: BnK 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 8180.00
and administrative fees):
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): 821.60
CCB lic.: 0107555 Total fee due upon application: 8201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Steve Close Date: 12/04/12 * Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440 -4613T(l 1 /02 /COM /WEB)
° Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: M Pe ,) - DO4a
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: ALT. Occupancy Group: Type of Construction: S�
*Type of Use: CCOA Occupancy Load:
Q I Oregon Specialty Code:
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:
Total Project Valuation: $ FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ Plan Review, Structural
$5,000 - $74,999 4 6 le1/4 $67.00 $10.00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ 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: $ S $ 1 qg 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.docx 07/01/2012
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: Bu P aD I a - vUe:).4 -D ❑ Expedited Review
Plan Submittal Date: (a--( I / r
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 .r aL _ _ ,ice. , at 503 -718- 2q,3 or @tigard- or.gov)
Proposal:
c G z" elilivis
Zoning 77 L f E
Permitted Use Yes . No ❑
Land Use Required: Yes ❑ eisici ❑
Notes:
proved ❑ Not Approved Date: 1 / 2 -
REVISED 10/4/12