Permit CITY OF TIGARD BUILDING PERMIT
' COMMUNITY DEVELOPMENT Permit#: BUP2015-00309
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 11/16/2015
Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12266 SW SCHOLLS FERRY RD
Project: Tigard Modern Dentistry and Orthodontics Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: New internally illuminated wall sign on East side of building.
Contractor: SECURITY SIGNS INC Owner: FW OR-GREENWAY TOWN CENTER LLC
2424 SE HOLGATE BLVD PO BOX 790830
PORTLAND, OR 97202 SAN ANTONIO, TX 78279
PHONE: 503-546-7114 PHONE.
FAX: 503-230-1861
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: VB Permit Fee-Additions.Alterations. 11/04/2015 $83.78
Demolition
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Building 11/04/2015 $10.05
Dwelling Units: 0 Plan Review 11/04/2015 $54.46
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 11/04/2015 $2.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $1,365
Floor Areas:
Total Area 0
Accessory Struct 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $150.29
Required: Required Items and Reports(Conditions)
Fire Sprinkler. Parapet.
Fire Alarm: Protected Corridors:
Smoke Detectors. Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00,1D4troagh...AR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23211987 or 11..800.332.2344
Iss ed By: . , - , Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FOR OFFICE USE ONLY
Received �r
City of Tigard R Date/By: / 5 Permit No.: z. �`?,, IS(y)'_`i
• 13125 SW Hall Blvd.,Tigard,OR 97223 1�Ev Plan Revi-• C� I �J
Phone: 503.7(8.2439 Fax: 503.598.196��G� Date/By: , 1 ' r 1 �'( (• Other Permit:J o v Z IS--004,111"
TIGARD Inspection Line: 503.639.4175 v O�� Date Ready : •�� !uric: See Page 2 for
Internet: www.tigard-or.gov A1av 4 Z Notified/Method. / /Z /$ .0—, Supplemental Information
1 t p 1/1t /cy is i
TYPE OF WORK coy y fr. 814 REQUIRED DATA:1-AND 2-FAMILY DWELLING
lErNI-ew construction ❑D la's '';'' 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.
El Co
1-and 2-family dwelling mmercial/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: /2.041 �4))�,5� DG� ���7���/ New dwelling area: square feet
City/State/ZIP: `,�G/1/26.-��f[/N CA., 97006 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:r�Ith,,249 erz,v z1Tjs re overed 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(rounded 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.
6IA 1 /�,i .� )/1.GG. 614 Al Ong � � Valuation: $ l 1 3417S-..=�
IV t/W LOG-0 ' `i• wm`'/W � Existing building area: square feet
Ci Li `% i71 " 14'J "0" G New building area: square feet Too
❑ PROPERTY OWNER ,! r ["TENANT Number of stories:
Name: -Ty A 2 rnzog2A1 O( -risnQ( Type of construction:
Address: / 24 6, Sid) t eltfOl .S fg;t2gY Rot9 Occupancy groups:
City/State/ZIP: 8r}jb11_Jv � d� Existing:
Phone:( ) ``'`' '"'�� Fax:( ) New
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:SECURITY SIGNS,INC
Structural plan review fee(or deposit):
Contact name:CYNDI KRACKE
FLS plan review fee(if applicable):
Address:2424 SE HOLGATE BLVD
Total fees due upon application:
City/State/ZIP:PORTLAND,OR 97202
Phone:(503)546-7102 Fax: :(503)230-1861
Amount received:
E-mail:permits @securitysigns.cum PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR . v roof-top mounted PhotoVoltaic Solar Panel System.
Business name:SECURITY SIGNS,INC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:2424 SE HOLGATE BLVD Solar Installation Specialty Code checklist.
City/State/ZIP:PORTLAND,OR 97202 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)546-7102 Fax:(503)230-1861 State surcharge(12% of permit fee): $21.60
CCB lie.: 122809 -
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:CYNDI KRA E Date: !D//L7``S * Fee methodology set by Tri-County Building Industry
(` Service Board.
L\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY
•I
N_ C _ 13125 SW Hall Blvd.,Tigard OR 97223
' 503.639.4171
TIIGARD
BUP2015-00309 - 12266 SW SCHOLLS FERRY RD, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-Additions,Alterations, 230-0000-43104 $83.78 $83.78 $83.78 11/4/15 Credit Card 400445 $0.00
Demolition
12%State Surcharge-Building 100-0000-24001 $10.05 $10.05 $10.05 11/4/15 Credit Card 400445 $0.00
Plan Review 230-0000-43106 $54.46 $54.46 $54.46 11/4/15 Credit Card 400444 $0.00
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $2.00 $2.00 $2.00 11/4/15 Credit Card 400445 $0.00
11x17)
Totals for Fees $150.29 $150.29 $150.29 $0.00
Receipt# Payment Method Check# Pavor: Receipt Date Receipt Amount
400444 Credit Card Cynthia Kracke/ 11/04/2015 $54.46
Security Signs, Inc.
400445 Credit Card Cynthia Kracke/ 11/04/2015 $95.83
Security Signs, Inc.
Total Payments: _____$$150`
( BceDue: $0.00
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
12266 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2015-00309
Jeff Grove
Violation Summary:
Inspector Contractor