Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2014-00032
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/13/2014
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 212
Project: Miadonna Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: TI for new tenant:Minor demolition and new walls.
Contractor: RUSSELL CONSTRUCTION INC Owner: LINCOLN CENTER LLC
20915 SW 105TH AVE BY SHORENSTEIN PROPERTIES LLC
TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-692-9002 PHONE:
FAX: 503-692-9008
Specifics: __ - FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review,COM TI-Ping 02/13/2014 $70.00
Occupancy Grp: B Occupancy Load: 19 DC Provision Review,COM TI-LRP 02/13/2014 $10.00
Dwelling Units: 0 Permit Fee-Additions,Alterations, 02/13/2014 $423.53
Demolition
Stories: 3 Height: 0 ft 12%State Surcharge-Building 02/13/2014 $50.82
Bedrooms: 0 Bathrooms: 0 Plan Review 02/13/2014 $275.29
Value: $22,500 Plan Review-Fire Life Safety 02/13/2014 $169.41
Info Process/Archiving-Lg$2.00(over 02/13/2014 $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 $1,003.05
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes 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 C=nter. 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 54 .232 987 or .800.332.2344.
iiiIst
Si
ermittee By:
sued •ermee gnaure: /�
r� r r -
�j�i•?.39.4175 by 7:00 a.m.for the next available in •ectio• •ate.
This permit card shall be kept in a conspicuous place on the job site u • ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
P s ' Building Division
Over-The-Counter (OTC) Building Permit
T l c'n K Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: (`T Occupancy Group: .. Type of Construction: Le,
Type of Use**: CCM Occupancy Load: , _ Oregon Specialty Code: 2 r)
SPECIFICS
Number of Stories: '3 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: [i&: Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ i2- 6■0 FEES DUE
$$ i Q , _ DC Prov Rvw,COM TI—Ping
DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI(effective 7/1/2013) $ Liz , Permit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ 05-0 2 12%State Surcharge
Up to$4,999 $0.00 $0.00 $ ' 7 , r Plan Review,Structural
$5,000-$74,999 $70.00 $10.00 $ am Plan Review,Fire Life Safety
$75,000-$149,999 $174.00 $26.00 $ £ Info Proc/Arch,Lg(over 11x17$2.00)
$150,000 and over $278.00 $41.00 $ 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: $ �(` . OTAL FEES DUE
*TYPE OF USE: COM=commercial;CMS=commercial manufactured structure.
**CLASS OF WORK ACS=accessory;ADD=addition;ADU=accessory dwelling unit;ALT=alteration;DEM=demo;NEW=new;
OTR=other(use for fences,decks,retaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC-BUP.docx 07/01/2013
Building Permit Number: A/Pti/Y-c
Building Permit Review
Commercial Project —No Associated Land Use Case
TIGARDD
Site Address: 10250 S W 6retnbtAfs Rd . -#I1 -
INiVerify site address is valid. J
Project Name : k4Iabonn6L-
Planning Review
Proposal: I rife rio✓ ken ant imprc✓elm-n-1- -Co( new -fe,nant, X11iaDonna. Online_
so,Its wi}h showroom. Mino,K demoli-ion anA neu/ wads.
IV/Zoning: My E-1
LN Permitted Use 0 Yes D,/No ❑ Spec Space
Land Use Required ❑ Yes C� No
Notes:
Approved by: 7---, m 1�%Yl(K a ci l Date: 2((3 ji Li
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Building Permit Submittal
Original Plan Submittal: Date: a/j 3//y+ By: glevreeyd
Site Plans: # A//A}
Building Plans: #
Create Case Record#: g-"Ei_3,ter case# above for Building Permit Number.
Workflow Routing: lan . g ❑ Engineering ❑ Permit Coordinator ding
Workflow Sign-off: ign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: /L CO Date:Notes:
I:\Buil ding,Forms\BldgPennitRvw_COM_NoLandUse_123013.docx
Building Permit Application
Commercial ENE. FOR OFFICE USE ONLY
City of Tigard 6\4 oate;s� Permit No.: • , , /
• 13125 SW Hall Blvd.,Tigard,OR 97223 cE8 15. Plan Review 1'_ 1
Phone: 503.718.2439 Fax: 503.598.1960 �'1' aD Date/B : !A'S; 4M - 'rPermit:
•T I c n R[� Inspection Line: 503.639.4175 O�S�� R1 CI to Ready/up Hi See Page 2 for
Internet: www.tigard-or.gov GV NG�Ekol4r.E Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:I-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 ®Commercial/industrial
Valuation: $
❑Accessory building El Multi-family Number of bedrooms:
❑ Master builder El Other. Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:4 Lincoln-10250 SW Greenburg Road New dwelling area: square feet
City/State/ZIP:Portland,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:212 Project name:MIADONNA Covered porch area: square feet
Cross street/directions to job site:Project located north of SW oak street, Deck area: square feet
south of SW Locust Street and east of Greenburg Road 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.
Creating a tenant improvements for a Class A office. The previous tenant Valuation: $22,500
was also a Class A office/business.Work to include minor demoltion,new walls, Existing building area: 1,869 square feet
doors,cabinetry and plumbing. New building area: 1,869 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 3
Name:Shorenstein Type of construction: I-B
Address:One SW Columbia Street Suite 500 Occupancy groups:
City/State/ZIP:Portland,OR 97258 Existing: B
Phone:(503)412-4902 Fax:(503)412-4903 New: B
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:Mackenzie (Please refer to fire schedule)
Structural plan review fee(or deposit):
Contact name:Kim Ford
FLS plan review fee(if applicable):
Address:1515 SE Water Ave Suite 100
City/State/ZIP:Portland,OR 97214 Total fees due upon application:
Phone:(503)224-9560 Fax::(503)228-1285 Amount received:
E-mail:kford @mcknze.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Russell Construction Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:20915 SW 105th Ave Solar Installation Specialty Code checklist.
City/State/ZIP:Tualatin,OR 97062 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)692-9002 Fax:(503)692-9008
State surcharge(12%of permit fee): $21.60
CCB lic.:58918
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:Kim Ford Date:02/13/2014 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Petmits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB)