Permit CITY OF TIGARD BUILDING PERMIT
1114 I -• COMMUNITY DEVELOPMENT Permit#: BUP2013 00018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2013
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15800 SW UPPER BOONES FERRY RD 400
Project: The Upper Cervical Clinic Subdivision: 1994-006 PARTITION PLAT Lot: 2
Project Description: Interior TI
Contractor: DURUS CONSTRUCTION LLC Owner: PACIFIC REALTY TRUST
15806 UPPER BOONES FERRY RD ATTN• N PIVEN
LAKE OSWEGO,OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE 503-320-8601 PHONE:
FAX 503-244-4318
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB DC Provision Review,COM TI-Ping 01/22/2013 $67.00
Occupancy Grp: B Occupancy Load: 12 DC Provision Review,COM TI-LRP 01/22/2013 $10.00
Permit Fee-Additions,Alterations, 01/22/2013 $286.64
Dwelling Units: 0 Demolition
Stories: 1 Height: 0 It 12%State Surcharge-Building 01/22/2013 $34.40
Bedrooms: 0 Bathrooms: 0 Plan Review 01/22/2013 $186 32
Value: $13,200 Plan Review-Fire Life Safety 01/22/2013 $114 66
Info Process/Archiving-Sm$0 50(up to 01/22/2013 $1 50
11x17)
Floor Areas:
Total Area: 0
Accessory Struct. 0
Basement: 0
Carport: 0
Covered Porch 0
Deck: 0
Garage: 0
Mezzanine' 0
Total $700.52
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 Special --- -•• 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 d- - of issuance, or if w• is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Not on =-ter Those ules are set forth in OAR
952-001-0010 through OAR 952-001-0090 You may obtain a copy of of the rules or direct questions to OUNC b ing 503.232 1•:7 or 1 800 332 : 44
��J„(/////(lll4// p
Issued By: / �C J Permittee Signature:
c aaa
Call 503.639.4175 by 7:00 a.m.for the next available in •ectlon
This permit card shall be kept in a conspicuous place on the job site unb •mpletio• •
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
RECEIVED
Commercial FOR OFFICE USE oNLI
City of Tigard JAN 2 2 2013 di — Permit No.: P�013_ �g
1 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OFTIGARD DateBy: ' 22 I l a Other Permit:
T I G A R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready �7 j 0 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.
Indicate the value(rounded to the nearest dollar)of all
IdAddition/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 Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ‘,SS 00 Sli,- v,QVP_ - F K-CA New dwelling area: square feet
City/State/ZIP: 1-1.c J a ck NZ-, 103 S" u Garage/carport area: square feet
Suite/bldg./apt.no.: �� Project name: " L o,C r/l,l}W 64„,.4 1W C1iilt(, 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(rotnded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
`Y\iN;�_ �k Valuation: $ 3 �
Existing building area square feet
New building area: square feet
1:5.PROPERTY OWNER ❑ TENANT Number of stories:
Name: ?aCr■l-uS%-- Type of constructionV IN—
Address: I S0 St.. 5110(G.,
16...)y 3 Ua Occupancy groups: Q
City/State/ZIP: 1DC>t/�Q'�!� _ 'I )Z2_'�- l (-C� Existing: 1�
Phone:(5 ) (t,Z'4 - woo Fax:(5 ) L.2Z+ -7 7'S New: SpwA.,L—
ig APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
S (Please refer to fee schedule)
Business name: ate. Structural plan review fee(or deposit):
Contact name: `[C/H/l Pk" V, �
U 1� FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application:
Phone:('S-p& 707-18`F4 Fax::( ) Amount received:
E-mail: ry gun 1,4,,,e pac,trVS+rQ.NV„ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
(� CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: OUYruS 645 hS frUCI1r� 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:( )
State surcharge(12%of permit fee): $21.60
CCB lic.: 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: / r * Fee methodology set by Tri-County Building Industry
Date: / ZZ /f Y tY g5
(` ` Service Board
1 1:1Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
• Building Division
= Development Code Provision Review
T I c A li D Commercial Projects - No Associated Land Use Case
Building Permit No: i JU P apU!3-aDO rl e ❑ Expedited Review
Project Name: the tArem- wry)(471 t I h I L
Site Address: I Sea? Sw up r r tvDne- . , Suite/Bldg #:
Plan Submittal Date: I I c2-4--I f3
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 •A it 1+ • at 503-718421 or @tigard-or.gov)
Proposal: &i .'\0 _ 1111' CA'1e1 .C)
Zoning 1 –
Permitted Use Yes ISKI No ❑ —/
Land Use Required: Yes 0 N E
Notes: (lin l C, "D C{I n l C. - h Q C ArtiL��,i t .
ET/Approved ❑ Not Approved Date: CI J 2Z 1 127
I:\CURPLN\Masters\Development Code Provision Review\No Land Use Comm.doc REVISED 10/4/12
_ " Building Division
Over-The-Counter (OTC) Building Permit
T I G n R D Check List
Project Description: ( 35 u.P off/ 3 " OtAX8'
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: 04r1--- Occupancy Group: T Type of Construction:
*Type of Use: CCM Occupancy Load: (Z Oregon Specialty Code: 20 tai
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: /Q Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ (3 2-CCD FEES DUE
$ • .60 DC Prov Rvw,COM TI—Ping
$ , DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI ilint Permit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ 'jam 0 12%State Surcharge
Up to$4,999 $0.00 $0.00 $ : Plan Review,Structural
$5,000-$74,999 $67.00 $10.00 $ ( ' , (u., 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 $ I ,�j(:)' 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: $ (Q1 /57-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