Permit
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2010-00013
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/28/2010
Parcel: 2S 113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 9
Project: VERIS N2
Project Description: Installation and anchorage of 3000 gallon bulk nitrogren tank.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 01/28/2010 $509.05
PORTLAND, OR 97224 Demolition
PHONE: 503-624-6300 12% State Surcharge - Building 01128/2010 $61.09
Plan Review 01/22/2010 $330.88
Plan Review- Fire Life Safety 01/22/2010 $203.62
Contractor:
AIRGAS NOR PAC INC
11900 NE 95TH ST STE 400
VANCOUVER, WA 98685
PHONE: 360-944-4000
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units:
Stories: Height: ft
Bedrooms: Bathrooms:
Value: $30,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $1,104.64
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No Manual Pull Stations:
Accessible Parking:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an II other a cable law. All ill
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, o rf work is s pe 0
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. T se les t f in O
952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by c in 03. 9 r 1 00 3 . 34
Issued By: Permittee Signat
Call 503.639.4175 by 7:00 a.m. for an inspection that busine day.
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
REop FOR OFFICE USE ONLY
City of Tigard Date/BReceived Permit No.: ~jt taDOr
`J
13125 SW Hall Blvd., Tigard, OR 972244" 2 'Z01Q Plan Revre
Phone: 503.639.4171 Fax: 503.598. N Date/B : . c3 Other Permit: UP'g010-0001 A
Inspection Line: 503.639.4175 T h Date Read y: luris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF i I Notified/Method: Supplemental Information
1' 1 , IVY`
"I III , TYPE, O ORh REQl1IRI:D DATA: I-.kND 2-FAM1IH;I' DNN:EE I_l\(.
® 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
C:1lta;ORY 01 (tlNyTRUCTIp\' work indicated on this application.
Valuation: $
❑ I -and 2-family dwelling ® Commercial/industrial
❑ Accessory building ❑ Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB 1,111: INFORMATION ~NIt LOCATION Total number of floors:
Job site address: 1~6 W 72/J D New dwelling area: square feet
City/State/ZIP: I. CIA-PLO 0 q 7 y~ Garage/carport area: square feet
Suite/bldg./apt. no.: Project name: v`CF-T`j AJ Z L Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRFD DATA: CONIMERCIAL-USE CHECKLI, I
Subdivision: 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
DLSCRIPTION OF WORK work indicated on this application.
~Nr7 T7~'~ ODO ~j w[.LL /v t{,rt(, Valuation: 0 0 p
1 ' ~~'l.l $ _~t3J ~l~tS~Z 13 Existing building area: square feet
New building area: square feet
❑ PROPERTY, OWNER ~ TENANT Number of stories:
Name: 11-e VLt S SW iDUt; ( Type of construction:
Address: 2w„0 67 Occupancy groups:
City/State/ZIP: &47, 1," 1 fZ~ Existing:
Phone: (5-j) 6?0 ( ZD l _ Fax: ( ) New:
❑ APPLICANT - ❑ ( u\ I_I( I I'EI:SON' NO"flCh
-
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) ~0 Q Fax::( )
E-mail:
COtiTR4CTOR
Business name: *1~ 0"L f3T'TLDINGPERMITFFFS*'
Address: /l q d c> /V C S tr> Meuse re er to- eescliedule
City/State/ZIP: L)&%Icoll ✓Lr?L W Pr cL 4,0,6 Structural plan review fee (or deposit):
S
Phone: J&t) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: D 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: r ;;-k 7 S Date: Fee methodology set by Tri-County Building Industry
Service Board.
l:\Building\Permits\BUP-COM PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
CITY OF TIGAR® BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2010-00013
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/28/2010
Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 9
Project: VERIS N2
Project Description: Installation and anchorage of 3000 gallon bulk nitrogren tank.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 01/28/2010 $509.05
PORTLAND, OR 97224 Demolition
PHONE: 503-624-6300 12% State Surcharge - Building 01/28/2010 $61.09
Plan Review 01/22/2010 $330.88
Contractor: Plan Review - Fire Life Safety 01/22/2010 $203.62
.
AIRGAS NOR PAC INC
11900 NE 95TH ST STE 400
VANCOUVER, WA 98685
PHONE: 360-944-4000
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units:
Stories:' Height: ft
Bedrooms: Bathrooms:
Value: $30,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $1,104.64
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No Manual Pull Stations:
Accessible Parking:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an II other a cable law. All r ill
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, o if work is s pe 0
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. T se les t f in O
952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by c in 03. 9 r 1 00 3 .234
Issued By: Permittee Signat
,A-~a-wo\ZOLL - 0-1 kl-~ - -
Call 503.639.4175 by 7:00 a.m. for an inspection that busine day.
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.