Permit I CITY OF TIGARD BUILDING PERMIT
II
COMMUNITY DEVELOPMENT Permit#: BUP2014-00067
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/09/2014
Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Project: Summerfield Estates Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Replacing existing freestanding monument sign on existing concrete pad. The sign is proposed on the south
portion of the property within landscaped area.
Contractor: MEYER SIGN CO OF OREGON Owner: TIGARD RETIREMENT RESIDENCE LLC
15205 SW 74TH AVE PO BOX 847
TIGARD,OR 97224 CARLSBAD, CA 92018
PHONE: 503-620-8200 PHONE:
FAX: 503-620-7074
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-COM-New Construction 04/09/2014 $112.96
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 04/09/2014 $13.56
Plan Review 04/09/2014 $73.42
Dwelling Units: 0 Info Process/Archiving-Sm$0.50(up to 04/09/2014 $2.00
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $3,600
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $201.94
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 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. . . • : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C ter. Those rules are set forth in OAR
9 •-001-0010 through•..R • -0' 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 . 987••1.800.332.2344.
ssued By: , 4 (d 0,7i /q / 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 -project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
6b ef-c-/`q/ ���� FOR OFFICE. USE ONLY
s� Received
Ci}�, of Tigard �C Permit No.:
City g DateB /./ rYi Q. 7 ��1a .
13125 SW Hall Blvd.,Tigard,OR 9722 Plan Re e t
Phone: 503.718.2439 Fax: 503.598.1960 c�01� DateB : :1/��rl�MS3I= Other Permit: _ AV 2
I'I e i n li l Inspection Line: 503.639.4175 `, U Dale Ready :y: J°ds: ® See Page 2 or >
Internet: www.tigard-or.gov �V`� r_� ,Notified Shod:/ /l� Supplemental Information
TYPE OF WORi4 #"C,� t QUIRED DATA:1-AND 2-FAMILY DWELLING
tNew construction ❑D nn Permit fees*are based on the value of the work performed.
Indicate the value(rotnded 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.
El 1-and 2-family dwelling C1 Commercial/industrial Valuation: $
❑Accessory building 12 Multi-family Number of bedrooms:
❑Master builder 12 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION ;� Total number of floors:
Job site address: //Z,6 5 kJ. J J Mt .t.E-/�L 6-U, 1 . New dwelling area: square feet
City/State/ZIP: / `6A-,A? , ax_ 77/.2-14 Garage/carport area: square feet
Suite/bldg./apt.no.: ' Project name: J U i.L p.,ALA.„ t-17.17-C.15 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: I Lot no.: Permit fees'are based on the value of the work performed.
Indicate the value(romded 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.
/(n,U✓E. I /AYSTA-t-e-- 0.)6 /t/4/ti —//4tiGiv,41--/FY7 Valuation: $ (€00 .00
/1,t D,J-1itCk- )r s!6 i,} If d 1 zjs/-/,J 6 /j,.J Existing building area square feet
/>A-6 New building area: square feet
(PROPERTY OWNER I 0 TENANT Number of stories:
Name: --!`G,¢/Lo /2671 /vc bt,1'Jr- jeES1 4 ' (i.e___ Type of construction:
Address: 0 6 7 Ai. 3 A J'Q a517L./A-L jA)A-'-J Occupancy groups:
City/State/ZIP: P )2 Q/&. 9 7 7 0 / Existing:
Phone:(54/J)- 3?-3 ._ 41X `---1 Fax:( )
New:
El/APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Al, E2 j j 6 A Oft , e Q , I 0/J All contractors and subcontractors are required to be
Contact name: �A) Al C-Cv/ /4 1 u( licensed with the Oregon Construction Contractors Board
`L under ORS 701 and may be required to be licensed in the
Address: 15;16c ,S.jJ. 7( /'" /41) -- jurisdiction in which work is being performed.If the
City/State/ZIP: -no apt..} e 2 97..)- applicant is exempt from licensing,the following reasons
apply:
Phone:(a3) .2 4) _ (3 1-6 b Fax::03 ) Z.° . 7 6/4 —
E-mail: -/Z.ytiT'.S e /L(.Ly bL s/6,) Cp. 0-0 A.&
CONTRACTOR BUILDING PERMIT FEES*
Business name: /i/1 � J/G,0 e4. dl D/L560 0 (Please refer to fee schedule)
Permit fee:
Address: /62-0 5 g,(,t) 74 /1-1) .
City/State/ZIP: 17D Alt.I Pk. g'/ajl-f State surcharge(12%of permit fee):
FLS plan review(40%ofpermit fee):
Phone:(So0 ) ((LD - e�V Fax:(503 ) t w - 76 7 4-1. (Due upon application.)
CCB lie.: W j t-i Total permit fees:
Authorized signature: ( C Amount received:
,(,, � / This permit application expires if a permit is not obtained
Print name: r 4- d cJy 6 G e4)11Z(4 Date: y/a(� /1 f within 180 days after it has been accepted as complete.
/ /// * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permite\FPS-PermitApp.doe Rev 01/05/2012 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ IDry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinlder Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
_ 0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal(see A,B&C above): $
Permit fee based on project valuation(see fee schedule): $
Permit fee based on square footage(see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
Plan review requires a completed application and her g(3) sets of plans at submittal.
Plan review fees are required at submittal.
I:\Building\Permits\FPS-PemutApp.doc Rev 01/05/2012 2