Permit 1 CITY OF TIGAR® BUILDING PERMIT
1,
` ,_. COMMUNITY DEVELOPMENT Permit #: BUP201000069
•TiGhAL� 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/07/2010
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Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 140
Subdivision: Lot: 0
Project: Winzler Kelly
Project Description: Interior TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 04/07/2010 $509.05
PORTLAND, OR 97224 Demolition
PHONE: 503- 624 -6300 12% State Surcharge - Building 04/07/2010 $105.97
Plan Review 04/07/2010 $574.01
Plan Review - Fire Life Safety 04/07/2010 $203.62
Contractor:
PACIFIC REALTY ASSOCIATES LP
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300
FAX: 503 - 624 -7755
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $30,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,392.65
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 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. _ - mit 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- requires . •u to folio the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0 . • • •2 -001 -• 00. You m- obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 •r 1.800.332.2344.
Issued By: � Permittee Signature: � . - a ( A
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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 FOR OFFICE USE ONLY
City of Tigard Received + , ;, , ' I •
Date/
M I
B q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �►�1
Phone: 503.639.4171 Fax: 503.598.1960 DatefB : Permit No.: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Read - . Juris: ® See Attached Checklist for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
. ., i ,. : Indicate the value (rounded to the nearest dollar) of all
*Addition /alteration/replacement ❑ Other: �' ilk ,� • / J tN� Re i' � e nt, materials, labor, ov erhead, and the profit for the
�3l`�
CATEGORY OF CONSTRUCTION work indicated on this application.
r r ;Valuation: $
❑ 1- and 2- family dwelling ® Commercial /industrial
❑ Accessory building ❑ Multi- family CM! „,, . Number of bedrooms:
❑ Master builder ❑ Other: Etw DT T Number of bathrooms:
JOB SITE INFORMATION AND LOCATION. Total number of floors:
Job site address: / % ew dwelling area: square feet
City/State /ZIP: i .,� ti , ., �J C Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Uv Li i
l w j,, --c /' / ye / J Covered porch area: square feet
Cross street/directions to job site: 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.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
/! //l ' 7.--4' DESCRIPTION OF WORK work indicated on this application.
Gi `` i .21 „0/2... �' / Valuation: $ j
/✓ 7 � 4A _ i r7 / C/C/
/ 1 ri N C Existing building area: square feet
64 j7 New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: /
Name: PacTrust Type of construction: / .1 -,
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups:
City /State /ZIP: Portland, OR 97224 Existing: 9
Phone: (503)624 -6300 Fax: (503)624 -7755 New: -
® APPLICANT ® CONTACT PERSON
NOTICE
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: Dennis Pagni licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15350 S.W. Sequoia Pkwy., Suite 300 jurisdiction in which work is being performed. if the
City /State/ZIP: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 624 -6300 Fax: : (503) 624 -7755
E -mail: dennisp @pactrust.com
. ' CONTRACTOR •
Business name: /- ) �� v6, :: BUILDING PERMIT FEES* ..
Address: - - (Please refer to fee schedule)
City/State/ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: Total fees due upon application:
Authorized signature: Amount received: C 1.01 r �'1
This permit application expires if a permit is not obtained
/ z.;.." 1_ within 180 days after it has been accepted as complete.
Print name: / >� N ,/ s �� /� it - Date: / // /-,/ * Fee methodology set by Tri-County Building Industry
Y / Service Board.
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