Permit (19) CITY OF TIGARD BUILDING PERMIT
a.. COMMUNITY DEVELOPMENT Permit#: BUP2013-00272
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2013
l
Parcel: 251018800401
Jurisdiction: Tigard
Site address: 11880 SW PACIFIC HWY
Project: Fidelity Fleet Subdivision: TIGARD ROAD GARDENS Lot: 5
Project Description: TI-remodel restrooms for ADA
Contractor: CLEAN COAT-CHUCK ZWEBER Owner: GULSONS PACIFIC LLC
13365 SW KINGSTON PLACE 307 LEWERS ST, STE 600
TIGARD,OR 97223 HONOLULU, HI 96815
PHONE: 503-858-4144 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB DC Provision Review,COM TI-Ping 11/12/2013 $70.00
Occupancy Grp: B Occupancy Load: DC Provision Review,COM TI-LRP 11/12/2013 $10.00
Dwelling Units: 0 Permit Fee-Additions,Alterations, 11/12/2013 $241.01
Demolition
Stories: 1 Height: 0 ft 12%State Surcharge-Building 11/12/2013 $28.92
Bedrooms: 0 Bathrooms: 0 Plan Review 11/12/2013 $156.66
Value: $10,166 Plan Review-Fire Life Safety 11/12/2013 $96.40
Info Process/Archiving-Lg$2.00(over 11/12/2013 $2.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $604.99
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 •r me rui- - •'ect questions to OUNC by calling or 1.800.332.2344.
Issued By. Ate— ermittee Signature: ��,'_ /L`/ -
Ca 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.
hlding Permit Application
Commercial FOR OFFICE USE ONLY •
City of Tigard RECEI V Received �/A g 1 pm Permit No.: : Q o?p 3-60,,,,,q 7
■ 13125 SW Hall v Tigard,OR 97
all BI d, gar ,O 97223 Plan Review 7-1/11k
2 Phone: 503.639.4171 Fax: 503.598.I�V 5 2013 Date/By: 1 , Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: 171 See Page 2 for ,
Noti ethod: M �A Supplemental Information
Internet: www.tigard-or.gov
CITYOFTIGARD
TYPE 'Ow t et t N 1 i 1 . I 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 ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: // 0 $ ® 5 W Pd e/I New w dwelling area: square feet
City/State/ZIP: 2 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ,. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
4a II 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
�,/_ D/E'SCRIPTION OF WORK ,�® work indicated on this application.
re,rn 0 CLG-C.- -� 1...5 h - z 'Cl� �,7✓ Valuation: $ /0 �O
Existing building area: 5-130z square feet
New building area: /to `A qu et
❑ PROPERTY OWNER i TENANT Number of stories:
Name: Fi cie,/„ 72 Type of construction: p.
Address: % % 1 / L 'i .d III 1 Occupancy groups:
City/State/ZIP: ` J
l,(/l 4 Existing:
Phone:(5O3) 7 0`s— Li I g Fax:( ) New:
/] APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 77 ...4..s.c La
" / /7 6 fp Gr All contractors and subcontractors are required to be
�I h �Iir sue., licensed with the Oregon Construction Contractors Board
Contact name:
under ORS 701 and may be required to be licensed in the
Address: PO SIB OA Go
/' g 7 jurisdiction in which work is being performed.If the
City/State/ZIP: �� U�' i / 075 applicant is exempt from licensing,the following reasons
apply:
( ) 7 z5! j,7 1 / I Fax:: PP Y
Phone: ( )
E-mail: lr Sh,,721, e -7`-tc/t ftl..) g r'z',//A. GDrn
CONTRACTOR __
Business name: ` -,7 - _ -- BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP:
Phone:( ) lJSP �/ ! (-,� Fax:( ) - FLS plan review fee(if applicable):
CCB lic.:
/� D ` JJ Total fees due upon application:
Amount received:
Authorized signature: % This permit application expires if a permit is not obtained
!� within 180 days after it has been accepted as complete.
Print name: `i,,, (L ow!/, Date: //. /3 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 2/23/07 • 440-4613T(I l/02/COM/WEB)
Building Division •
Over-The-Counter (OTC) Building Permit
T I G A R D Check List
Project Description: T
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: ikur Occupancy Group: iM Type of Construction:
Type of Use**: COIAA Occupancy Load: _ Oregon Specialty Code: 20(�
SPECIFICS
Number of Stories: I 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 � p,.�
Fire Sprinklers: k ) Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 10)1 (:%6 .CO FEES DUE
$ 70,c0 DC Prov Rvw,COM TI—Ping
$ (Q,cO DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI (effective 7/1/2013) $ Permit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ 7P.3,`l� 12%State Surcharge
Up to$4,999 $0.00 $0.00 $ 6'o.(pCo Plan Review,Structural
$5,000-$74,999 $70.00 $10.00 $ 1%40 Plan Review,Fire Life Safety
$75,000-$149,999 $174.00 $26.00 $ Z,QO 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
$ i Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc.Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: $ Other:
Date/Time: $ TOTAL 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 Division
°- Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: Pa u P s-oC?7 9- Expedited Review
Project Name: / D tc.-i —y
Site Address: ii gee) iD k A C F t e_ , Suitc/Bldg #:
Plans Routed:
Original Plan Submittal Date: II /4 Routed :
1" Revision Submittal Date: Routed By:
2nd Revision Submittal Date: Routed By:
To the Applicant:
➢ If the proposed use is not permitted within the zone,please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718-2439.
➢ If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved.
Planning Review (contact _)O1,,/1 at (503) 718-02142, or @tigard-or.gov)
Proposal: C,4.4 e G4tJ VICE /rte 5°,k' Ai /mooICI' LSt c
Zoning //1v-Ck50
Permitted Use Yes 0No ❑
Land Use Required: Yes ❑ No l!�'
Notes:
Approved ❑ Not Approved ❑ DCPR Not Required-No DCPR Fees Due
Date Routed to Building:
__1:\CURPLN\Masters\Development Code.Provision Reviev ADCPR_COM=NoLandUse.doc_Rev..01/16/13_