Permit � CITY OF TIGARD
BUILDING PERMIT
f le
N ✓: COMMUNITY DEVELOPMENT Permit #: BUP2009 00206
13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2009
aTr1 9 Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY 100
Subdivision: Lot: 0
Project: Bridgeport MRI
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 11/04/2009 $917.70
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 11/04/2009 $110.12
Plan Review 11/04/2009 $596.51
Plan Review - Fire Life Safety 11/04/2009 $367.08
Contractor:
FORTIS CONSTRUCTION INC
1705 SW TAYLOR ST #200
PORTLAND, OR 97205
PHONE: 503 - 459 -4477
FAX: 503 - 459 -4478
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $75,000
Floor Areas:
Total Area: 0
Accessory Strict 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck. 0
Garage: 0
Mezzanine: 0
Total $1,991.41
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: No
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This rmit is issued s •.- t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
done in accordance with a• •ro • ans. 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 I. • r.. uires ' . • ollow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0018 through 0A• 952 -00 -01$1 You may obtain a copy of the rules or direct questions to OUNC by calling 50 .246.6699 or 1.800.332.2344
Issued By: 1 /. / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business d y.
This permit card shall be kept in a conspicuous place on the job site until comple of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial ��j FOR OFFICE USE ONLY
City of Tigard � . C.CJ
CEIVED Received D '��� �� Permit No.: f� M �
Date/ r f .
13125 SW Hall Blvd,. Tigard, O RE 97223 n
' - . Phone: 503.639.4171 Fax: 503.59 p 0 4 2009 9 Dat R ev .. i �� U O J Other Permit:
TIGARD Inspection Line: 503.639.4175 L Date Ready y: 1 to ' • El See Page 2 for
Internet: www.tigard-or.gov Notified /Method: /�jt Supplemental Information
CITY OF TIGARD ``ff��
Typ plaLRIN DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work perlbrnlcd.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration /replacement ® Other: Tenant Impro equipment, materials, labor. overhead. and the profit tbr the
CATEGORY' OF CONSTRUCTION
work indicated on this application.
Valuation: S
❑ 1- and 2- family dwelling ®Co mmercial /industrial
111 Accessory building Ill Multi-family Number of bedrooms:
1=1 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15755 SW Sequoia Parkway, Suite 100 New dwelling area: square feet
City /State /ZIP: 97224 Garage /carport area: square feet
Suite /bldg. /apt. no.: 100 Project name: Bridgeport hflu N.... Covered porch area: square feet
Cross street /directions to job site: Carmen drive and SW Sequoa Parkway Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
New walls and doors to create space for new medical equipment Valuation: SS75,000.00
Existing building area: NC square l
New building area: NC square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name: Bridgeport Imaging Type of construction: ,5
Address: 15755 SW Sequoia Parkway, Suite 100 Occupancy groups:
City /State /ZIP: Tigard, Oregon 97224 Existing: 13
Phone: (503)774 -7700 Fax: (503)774 -7701 New: 13
® APPLICANT ® CONTACT PERSON NOTICE
• Business name: Jon R..lurgens & Associates, Inc. All contractors and subcontractors are required to he
Contact name: David Johnson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to he licensed in the
Address: 15455 NW Greenbriar Parkway jurisdiction in which work is being performed. lithe
City/State/ZIP: 97006 applicant is exempt from licensing. the following reasons
apply:
Phone: (503) 690 -1779 Fax: : (503) 690-0913
E -mail: djohnson @jrjarch.com
CONTRACTOR
Business name: Fortis Construction , Inc BUILDING PERMIT FEES*
Address: 17(15 SW Taylor Street (Please refer m fee schedule)
Structural plan review lee (or deposit):
City /State /ZIP: Portland, Oregon, 97205
FLS plan review fee (if applicable):
Phone: (503) 459 -4477 Fax: (503) 459 -4.478
"total fees due upon application:
CCB lie.: 155766 \
1 I
(
Authorized signatsignature' A Amount received:
t � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: David Joh sol , d' 1 Date: 4 Nov, 2009 * Fee methodology set by "1ri- County Building Industry
J Service Board.
l:ABuilding \Permits \BUP -COM PermitApp.doc 10 /01 /09 440 - 4613 "1(1 l /02 /COM /WEl3)