Permit (213) CITY OF TIGARD BUILDING PERMIT
I • COMMUNITY DEVELOPMENT Permit #: BUP2012 -00136
T I (A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/11/2012
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY X
Project: Marshalls Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Conversion of 778 sf of existing fixture storage to new DM office w /two offices & conference room. Accessibility
upgrades per BRIP form
Contractor: B DAVIS INC Owner: SN PROPERTIES PARTNERSHIP
1441 -A TERMINAL AVE 1121 SW SALMON ST
SAN JOSE, CA 95112 PORTLAND, OR 97205
PHONE: 408 - 436 -4800 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIIB DC Provision Review, COM TI - Ping 07/11/2012 $67.00
Occupancy Grp: M Occupancy Load: 863 DC Provision Review, COM TI - LRP 07/11/2012 $10.00
Dwelling Units: 0 Info Process /Archiving - Lg $2.00 (over 07/11/2012 $10.00
11x17)
Stories: 0 Height: 0 ft Info Process /Archiving - Sm $0.50 (up to 07/11/2012 $2.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $30,000 Permit Fee - Additions, Alterations, 07/11/2012 $509.05
Demolition
12% State Surcharge - Building 07/11/2012 $61.09
Floor Areas: Plan Review 07/11/2012 $330.88
Plan Review - Fire Life Safety 07/11/2012 $203.62
Total Area: 0
Accessory Struct: 0
Basement: 0
•
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,193.64
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes 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 Notif : ion 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 callints.232.1987 or 44120/ 1.800 32.2344.
/ LLLLiiCCC ..'
Issued By: I -- -[[JJW \\\ Permittee Signature: _
vvv "' IA
Call 503.839.4175 by 7:00 a.m. for the next available Inspection • te.
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
REC p'
Commercial FOR OFFICE ICE USE ONLY
City of Tigard JUL 1 D 2012 R Plan eceived Z I / I ! /2 sr Permit No.: �/ ) . c V /3 . 23' Review
• 13125 SW H Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 DgY Other Permit: See Page 2 for
- 1 C A R D Inspection Line: 503.639.4175 °CITY OF T Date Re ady B y: (o ®pmtal Information
Internet: www.tigard - or.gov BUILDING DIVISION Notified'Method: 1 1
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELL G
❑ New construction ❑ Demolition Permit fees* are based on the value of the work p onn •.
Indicate the value (rounded to the nearest doll: • of :
k r Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and • • pro for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2 -family dwelling KCommercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of fl, . :
Job site address: I i O r tftc. r 1 Z.2-4 ) New dwellin:. ea: square feet
City/State/ZIP: i c. / - (Z t� I O(t � Garage/ ..ort : ea square feet
Suite/bldg. /apt. no.:5,(k.G X I Project name:A G i- 5 Coy ch area: square feet
Cross street/directions to job site: Skik ,rDuitm (� . s • c ea: square feet
1, er structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map/parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
e4
Cafil 1. -510) c Q 77 4l Of S�NCI �1 n/i� s 1IVA `v Valuation: $ ?�! C V • b0
1A5 r -ed , w � 5 r1 ! W i- f . 6 O f 5 4 u � Existing building area: 731 square feet
4 . >45++�'u UPG Gam- S R -,,• g 11441 New building area: square feet
❑ PROPERTY OWNER I � 1 � 'A TENANT Number of stories: f
Name: - 73X <.o t st 5 1 4 V1 Type of construction: III g 4 45f rapaza
Address: 11 O W( l^1- w . Occupancy groups:
City/State/ZIP: f,OpNtujeltAfr / MA 10l 10 ( Existing: Al
Phone: Nis Rim 0(0(03 Fax: ( ) New: --
D / APPLICANT ''CONTACT PERSON BUILDING PERMIT FEES*
Business name! i)M H,l ..64- X5I( ,�I I OS AfaCHI C?IIJ2 ItINTE{1t0( G1,[ review (Please refer r deposit):
osit): schedule)
' � 1 I Structural plan review fee (or deposit):
Contact name: tk , O n) UM,}4g U&
Address: 53144 ft j f j FLS plan review fee (if applicable):
City / State/ZIP: W/i N I O� / 9 T '3 Total fees due upon application:
Phone: (5 . 3 1 „ - 0 3 563 I Fax: : ( 5 0 3 ) 9 2(0 — 93 31 Amount received:
E -mail: Nj�g a � • (��y� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: `� 1`7iN15 ( NC• Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: N Z f I —A- - ,U, . r4Vt. Solar Installation Specialty Code checklist.
City/ State/ZIP: f}fV ,..lLY / M(.1ED2Nl4- / 151 (Z Permit fee (includes plan review $180.00
and administrative fees):
Phone: ( pa) 1456 — ci gpp `?) I Fax: ( ) State surcharge (12% of permit fee): $21.60
,�CCB lic.: lt.1 (01 IVI 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: 4. , I Date: l/ 8lZ I • Fee methodology set by Tri -County Building Industry
6 Service Board.
1 1 11 1111 II
Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty -five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done, ��
excluding painting and wallpapering [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ I
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order.
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom f r each or a single unisex
restroom: 6 , ppi.,r- pVX $ • my
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When poss'ble, additional accessible elements such as storage C.l
agee �((et'1� and
alarms: k. 4t 1?-00-5 YtitiwaY 4 ff ae` $ ✓ �{ D .
TOTAL (shall equal line [2] of Valuation Computation): $
I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011
114 _ a Building Division
Over- The - Counter (OTC) Building Permit
T I G A R D Check List
Project Description: 8O 1 .2 - vol 36
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: A1-r Occupancy Group: /h Type of Construction: 3 ➢j
*Type of Use: CCtA Occupancy Load: ICA3 Oregon Specialty Code: po 10
SPECIFICS
Number of Stories: 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
Fire Sprinklers: Y Fire Alarms: Y Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ I FEES DUE
$ K DC Prov Rvw, COM TI — Ping
$ x DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ X Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ x 12% State Surcharge
Up to $4,999 0 $1 11 $ k Plan Review, Structural
$5,000 - $74,999 $67.00 10.01 $ op' x Plan Review, Fire Life Safety
$75,000 - $149,999 0 .00 $ 5 suf5 Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $268.00 $39.00 $ ' i61, Lfs Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: r "rt � '$ / 1 q 3. OTOTAL FEES DUE
*OPTIONS: '
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK: ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \Building \Forms \OTC - BUP.docx 07/01/2012