Permit CITY OF TIGARD BUILDING PERMIT
III COMMUNITY DEVELOPMENT Permit#: BUP2019-00111
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
T t C A I=.1-) g Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: Kimberly Bergis Rebel Fitness Club Subdivision: Lot: 4
Project Description: Installing(1)illuminated wall sign 65 sf on northwest elevation.
Contractor: SECURITY SIGNS INC Owner: BSM REALTY LLC
2424 SE HOLGATE BLVD BY RITE AID
PORTLAND, OR 97202 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503-546-7114 PHONE: 503-407-1334
FAX: 503-230-1861
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VBPermit Fee-Additions,Alterations, 05/02/2019 $164.96
Demolition
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Building 05/02/2019 $19.80
Dwelling Units: 0 Plan Review 04/29/2019 $107.22
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 05/02/2019 $2.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $5,295
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $293.98
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 1.800.332.2344.
Issued By: � - •.'tee Signature:
Call 5. 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
City of Tigard R EC E I VE D Received /1 / 9 /y �/� /C, /' / /
Date/By: —/ `, • i [ Pe y��•�+�L /�C/ l !/
,111 a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /��
_' Phone: 503-718-2439 Fax: 503-598- 29 Date/By: ,' �" (� Related Permit:
TI G A RD Inspection Line: 503-639-4175 2019 Date Ready/By: / Jaris: ® See Page 2 for
-Notified/Meta.d: 7/ j Supplemental Information
Internet: www.tigard-or.gov
DIY OF TIGARD � of � .4,411 a
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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 0 Other: equipment,materials,labor,overhead,and the profit for the
SI
u ,i) %:.. f i 1,# yy e a i, �' work indicated on this application.
0 1-and 2-family dwelling XI Commercial/industrial Valuation: $
0 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ElOther: Number of bathrooms:
n(� WE ya r[a l,' f aJ i—il tL��� 'kiwi r
�iiTotal number of floors:
Job site address: „`_ =! 54.) /27�JAt ST New dwelling area: square feet
..
City/State/ZIP: !
6j�' / � -'•��
223 Garage/carport area: square feet
Suite/bldg./apt.#: Project nameK(4l tI uee j3 y24 is Covered porch area: square feet
Cross street/directions to job
� site:: 'a' 2 F7��5 e�i5 Deck area: square feet
f AKS 9r Other structure area: square feet
i R -ui eitiiar d `
ria ,a ��
Subdivision: Lot#: based• of the work performed.
Tax map/parcel#: 251 a2 • 00 910 Indicate (rounded ' the nearest dollar) '
quipment,materials,labor,overhead,and the profit for the
/tSThLL / IL1.-r//11A/R-r-00 1)A I,
.-
5[4A 65 Sal Fr akr N OiCT1fG3C57- Existing buildingsquare
froom New building area: square feet
z e y ,15 iB 1i e ii �d� -= ,� ; 'I
u ilt - til, - illi �ii� .; 6 ;y _ GSE _� 11 �yi Number
Jr; of construction:
I t L
Address: 1 .0e0 S ) ///ei-/Ai 57-- Occupancy groups:
City/State/ZIP: 7 GA•zo t /4.72
Phone:(5!).3 0-7i-3- 4../ > G) / ' dr,•/'... . , :4;4 • 4,4 �+Existing:
( ,i 1:11 � �9 Ili
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eGw 7�1 516NS, /A .
Business name: _
Structural plan review fee(or deposit):
Contact name: e YAwl 5-nps
FLS 2y2� 5E H-01-6A-TE 31_. , . ..
Address:
City/State/ZIP:
10(A-Ft.,l ll� o2 .92202 • . .• •
Amount received:
Phone:( . iZy2. Fax::( - 2 • i 1
Email: i rill 1 € Shu' -�-V[ $/l n S i, .. !r o °i l .
wH = . 7Plii, r urCommercial and residential prescriptive installation of
r -;'1:1-:,--::",7, -).; << -7,1%,'1,;".J.''.74,-,;_,,,,,,;.,,,,0 roof-top mounted Photo Voltaic Solar Panel System.
Business name: 5g�� y S/lT 4 t s 1A0 Gr Submit two(2)sets of roof plan with connection details
/ and fire department access,along with the 2010 Oregon
Address: 2L/2'1 ge J��f�J laga7 �fJ Solar Installation Special Code checklist.
City/State/ZIP: �kitil-t/0 tl��C • $180.00and administrative fees :
Phone:( 501 6. 7102 Fax:( �� /06,( State surcharge(12%of permit fee): $21.60
CCB Lic.: /2-?-00,
/' Total fee due upon application: $201.60
Authorized signature: �/ JThis permit application expires if a permit is not obtained
���"""' within 180 days after it has been accepted as complete.
Print name: CYru (
&31
Date: 64//2,,,c/ * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12084 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Building BUP2019-00111
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor