Permit II CITY OF TIGARD MASTER PERMIT
_ COMMUNITY DEVELOPMENT
Permit#: MST2014-00112
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2014
Parcel: 25101 BA00400
Jurisdiction: Tigard
Site address: 12215 SW 72ND AVE
Subdivision: PALMER ACRES Lot: 4-8, PLUS PT VAC
Project: Clackamas County Bank
Project Description: Removal of 525 sq ft of garage due to road widening.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First 0 sf Basement 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $4,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF 0
Owner: Contractor:
CLACKAMAS COUNTY BANK KERR CONTRACTORS OREGON INC Required Items and Reports(Conditions)
38975 PROCTOR BLVD PO BOX 1060
SANDY,OR 97055 WOODBURN,OR 97071
PHONE: PHONE: 971-216-0050
FAX:
Total Fees: $238.63
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 - -• •- «- i 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. TENTION: Oregon .w r-• 'res you to follow the rules adopted by the Oregon Utility Notification Center. Tho rules are set forth in OAR
9 -001-0010 through OAR 952-0• -0090. Y41.• may obtain a copy of the rules or direct questions to OUNC by calling 503.23 .1987 or 1.80' 2.2344.
I �
ssued By: i t iI Permittee Signature: itIk
Call 503.639.4175 by 7:00 a.m.for the next available inspectio •ate.
This permit card shall be kept in a conspicuous place on the job site until completion of the • •l, t.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System ._ FOR OFFICE USE ONLY
City of Tigard 4°` "0 .e se i Received / //I 4 y�
- `J g j 1 't K Date/By: /r/e//c(\ `�}r/, Permit No./\I I ` -C.0///y
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 • DateBy: Other Permit:
I'I G ARD Inspection Line: 503.639.4175 ' Date Ready/By: Juris: H See Page 2 for
Internet: www"tigard-or.gov Notified/Method: Supplemental Information
':.i:t i ',' .•,;« i. .,.
T W Olt) - REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rowded to the nearest dollar)of all
Q lition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ 14 I ( )o❑ 1-and 2-family dwellin g El
El Accessory building El Multi-family Number of bedrooms:
❑Master builder Other: C 1 V 1 L Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: \Z Z i 5 54___s 7 Z„,j AvE IQ v E New dwelling area: square feet
City/State/ZIP: T i c,ar U Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 7z ts3D t& r rvo tit-J-( t m P v. 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.: �'(� IA 2 5 , L1 Indicate the value(rouided to the nearest dollar)of all P. equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1)17.- 01-\T t est../ O f IAA G t_ A 7-'T A.C I-1 IJ Valuation: $
,76 4-( (.3 y S 6 F Qa- O D D W I c)6 t N Existing building area square feet
.5aC ' New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: C\qc_‘,6_A T-\n S C v"n; Y 43 P N.; K Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
L7 XPPLICANT ❑ CONTACT PERSON NOTICE
Business name: L L-it 2 a c,. i 12 A C Tc5 a S OIL.E G v 1..2 All contractors and subcontractors are required to be
Contact name: T t�S O� C 2 t 0(Zq licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: ?to lo(,, 0 jurisdiction in which work is being performed.If the
City/State/ZIP: yt� applicant is exempt from licensing,the following reasons
W CEO l�c3‘.1 0 '4 O�-� apply:
Phone:(17i) Z IC, — (s U
SO Fax::(s--63) ?&I— i (o I
E-mail: ( O -c e c-0.,,, -
kQA-,r C 0,..}-,c,c„.c'i-,3 4-S•C o,N1
CONTRACTOR BUILDING PERMIT FEES*
Business name: it A 5 A pp Lk c A2\...); (Please refer to fee schedule)
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%ofpermit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.: \ 9 t( % Total permit fees:
Authorized signature: P.,,,A---------- Amount received:
This permit application expires if a permit is not obtained
(4 within 180 days after it has been accepted as complete.
Print name: / Se�� Co C of( Date: �l f(l .Z C7 * Fee methodology set by Tri-County Building Industry
Service Board
1:\Building\Pennits\FPS-PermitApp.doe Rev 01/05/2012 440-46131(11/O2ICOM/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 ❑ Ivry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El 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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I:\Building\Pemrits\FPS_PermitApp.doc Rev 01/05/2012 2
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