Permit CITY OF TIGARD BUILDING PERMIT
II = COMMUNITY DEVELOPMENT Permit#: BUP2014-00065
Date Issued: 05/07/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S136CD00102
Jurisdiction: Tigard
Site address: 11681 SW PACIFIC HWY
Project: Jimmy John's Subdivision: 2006-016 PARTITION PLAT Lot: 3
Project Description: TI for new tenant.
Contractor: MADISON HOMES LLC Owner: WILSAL LLC
2705 BUNKER LAKE BLVD, STE 105 834 SW ST CLAIR ST
ANDOVER, MN 55304 PORTLAND, OR 97205
PHONE: 612-290-6266 PHONE.
FAX: 651-389-9273
FEES
Specifics:
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 05/07/2014 $1,166.35
Demolition
Occupancy Grp: B Occupancy Load: 31 12%State Surcharge-Building 05/07/2014 $139.96
Dwelling Units: 0 Plan Review 03/25/2014 $758.13
Stories: 1 Height: 0 ft Plan Review-Fire Life Safety 03/25/2014 $466.54
Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 05/07/2014 $174.00
Value: $110,000 DC Provision Review,COM TI-LRP 05/07/2014 $26.00
Info Process/Archiving-Lg$2.00(over 05/07/2014 $60.00
11x17)
Floor Areas: Info Process/Archiving-Sm$0.50(up to 05/07/2014 $2.50
11x17)
Total Area: 0 Metro Const. Excise Tax-Commercial 05/07/2014 $132.00
Accessory Struct: 0 Use
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,925.48
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. 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 X0.332.2344.
Issued By: a - 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.
N'uihcli'ng Permit Application
Commercial `,FOR OFFICE USE O\I.1
City of Tigard Date/B P(5 /`t :rm. it No �� jl(1���j
Mil
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review o�
Phone: 503.718.2439 Fax: 503.598.1960 DateB : aLy I I I∎ r Permi[:
TIGARD Inspection Line: 503.639.4175 t::; Daze ReadyB �/� ` tug ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: "/ �!(Kfr 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 CONS RUCTION
work indicated on this application.
El I-and 2-family dwelling Commercial/industrial
Valuation: $
El Accessory building El Multi-family
Number of bedrooms: S.
❑Master builder ❑Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: //6 8/ 6 to -461 F 1G /Q NGeJP1 y New dwelling area: square feet
City/State/ZIP: -rI CI 412D , Oft /722.3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: dofr o'5 Covered porch area: square feet
_ JIM MY ri"
Cross street/directions to job site: S'& PAC/plc Alto y 3 5(,r.) -79—"A li Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST f..
Subdivision: Lot no.: Permit fees*are based on the value of the work performed. ('
5 3�CD�� y .2- Indicate the value(rounded to the nearest dollar)of all r•A
Tax map/parcel no.: .tO equipment,materials,labor,overhead,and the profit for the cI
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
TENAurT /�i4PadvElt(E , e A NEtu �E5Tf1-u,t41477 DJ ®�� y�
A/6741 ,VON sneUC fGt.2/4L, PAIQ rrn digs, F/N 15 NE51 Fut2 N 17 E Existing building area: /t /,Z� square feet l�J
.ESZ et l eit.I ENT /14 K IT-CHEW, REST-AMA-41, 416,1T/N4 New building area: ft /26 square feet
❑ PROPERTY OWNER 9'TENANT Number of stories: D N E
Name: Pjt}uOR (/tEN7.42.65, /NC'. — 5-coTT lPA4JOr2 Type of construction:
_ V d - NON R,4Tt'J� 'v
Address: /8033 /�(,O EVEat/gEN 'PARKWAY', Su1TE J Occupancy groups: 1`
City/State/ZIP: Ze14Vs-12•fd N 02 ,700 Existing: .8 3
Phone:( ) Fax:( ) New: a N.,
❑ APPLICANT W.-CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: ,STIt}NTE'C /GH/7$'GTi.tttZE Structural plan review fee(or deposit):
Contact name: 2o36-72.1— -..Z.4 b i.4 t 5 ey FLS plan review fee(if applicable):
Address: /477 3 2 / ..r Av E 5u 11 30 7 Total fees due upon application:
City/State/ZIP: 3'•op -e_E- 1.43,1' 98 /0/
Amount received:
Phone:(2O ) 770 — 38 e,l9 Fax::( )
E-mail: /2013€12-r_Rua N i S le y @ STi4NTEc.CO A4 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: d 1 pad_136 A 14 0,A(,4,S 1_ Submit two(2)sets of roof plan with connection details
Address: ,fi r ;7 �,tJ �u I I _ , and fire department access,along with the. Oregon
a p `1 C Solar Installation Specialty Code checklist.
City/State/ZIP: (� t, Permit fee(includes plan review
�� OV{ Apt r and administrative fees): $180.00
Phone:( p�?J alp �'pa� Fax:(651) 315.1 qa 7-5 State surcharge(12%of permit fee): $21.60
CCB lie.: )qa 2,92 h 'i/" ' Sd 54•�- Total fee due upon application: $201.60
I _
Authorized signature: /� -Li/!/ This permit application expires if a permit is not obtained
,1( Q within 180 days after it has been accepted as complete.
Print name: l r irl- gG r� Date: .3/2 5/p./ * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
. - .
Building Permit Number: u e pub /4 - ,65-
114 Building Permit Review
Commercial Project —No Associated Land Use Case
FIGARD
Site Address: I I tq I (-0 PAC I F I c 14 w y
Verify site address is valid.
Project Name : �r...t M h ,\j S
Planning Review
Proposal: 1..!Oa QOM • • • -ho accorrnx-fcci i Y-e .i • rev al.
ug, cagD r-es-tura
'oning: G—Of
[ 1�' rmitted Use 0 Yes ❑ No ❑ Spec Space
al-and Use Required ❑ Yes 'K. No
Notes: II(7 ekle kiDtz ( ArT pro
Approved by: V Date: *4)14
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Building Permit Submittal /
Original Plan Submittal: Date: �/a62 l it By:Ci�a-k)
Site Plans: # 3
Building Plans: # S
Create Casc Record#: ravEnter case#above for Building Permit Number.
Workflow Routing: 'lanning engineering Permit Coordinator [ -i$uilding
Workflow Sign-off: Sign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: "Building: original permit application,site plans,building plans,engineer and
/� beam calculations and trust details,if applicable,etc.
Reviewed By: CL, C-Cc.G 4 Date: 1 or/6/
Notes:
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_123013.docx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11681 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - C of O
August 4, 2014 at 12:40:32
PM
BUP2014-00065
Jeff Grove
Violation Summary:
Inspector Contractor