Permit ;` CITY OF TIGARD
BUILDING PERMIT
a
, ,�: COMMUNITY DEVELOPMENT
Permit #: BUP2010 -00067
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/06/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 04/06/2010 $1,800.55
PORTLAND, OR 97224 Demolition
PHONE: 503- 624 -6300 12% State Surcharge - Building 04/06/2010 $216.07
Metro Const. Excise Tax - Commercial 04/06/2010 $258.00
Use
Contractor: Plan Review 04/06/2010 $1,170.36
MATTHEW OLSON CONSTRUCTION Plan Review - Fire Life Safety 04/06/2010 $720.22
5320 SW DOVER LN
PORTLAND, OR 97225
PHONE: 503 - 892 -0066
FAX: 503 - 892 -0067
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $215,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $4,165.20
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: Yes
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issu- • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i cordance wit : • • roved 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. • TENTION: Oregon la - you to follow the rules adopted by the Oregon Utility Notification Cente ose es are set forth in OAR
952 -' •01 -0010 through OA 952 -01 • e s ou may obtain a c• of the rules or direct questions to I • • • - • • 503.246.6699 or 1.800.332.2344
Is- ed By: � jl ( 1 Permittee S' nature:
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 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
Cit y Tigard
Ti and G � D
I
DateB : 7 Permit No.:
rt
r 13125 SW Hall Blvd., Tigard, OR 97223 Rev Received Review ia ,
Phone: 503.639.4171 Fax: 503.598.1960 ,� 1�� � � ' � � � j � / f • Other Perrttit
I �( b ..
TIGARD
Inspection Line: 503.639.4175 �-' a.te - eady't e: kris. ® See Attached Checklist for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
APR „ .
f -" TYPE OF WORK , REQUIRED DATA: I= AND 2- FAMILY DWELLING
I �� " `�., �' ` °'� Permit fees* are based on the value of the work
New construction 0 ���� D r; � � /- _. �� performed.
' ° °� erformed. Indicate the value (rounded to the nearest dollar) of all
A Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION - work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
ID Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION. Total number of floors:
Job site address: /�/�OG� /_ / / /� jAVj / � �/�v New dwelling area: square feet
City/State /ZIP: / j & "-- �� Q 9:71,9,1 J( Garage /carport area: square feet
/
Suite/bldg. /apt. no.: Project name:9e 4� ..00` , N 44 p8red porch area: square feet
Cross street/directions to job site: ' 7 ,e1�`� Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST •
Subdivision: 1 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.
-I. fir ' • � Valuation: $ ,J,-��(�
!f Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 7
Name: PacTrust Type of construction: ,ly
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy' groups: Sie
City/State /ZIP: Portland, OR 97224
Existing:
Phone: (503)624 -6300 Fax: (503)624 -7755 New: �2
® 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: /y� �1��1 J �O BUILDING PERMIT FEES*
Address: / // /`'` (Please refer to fee schedule,- "
City/State/ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature: agob.s, J This permit application expires if a permit is not obtained
r within 180 days after it has been accepted as complete.
Print name: ����45_, ��. Date: L � , * Fee methodology set by Tri-County Building Industry
Service Board.
1:\ Building \Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB)
Building Division
Over -The- Counter (OTC) Building Permit
TIGARD Check List
Description of Project:
GENERAL INFORMATION
Class of Work:* k4--T Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:` First floor: N: S:
Type of Construction: 3 .3 Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: c Total sq ft.: N: S:
Stories: Note: Combine total floor area for E: E:
Height: all floors above third floor and Roof Construction:
Floor Load: add to the third floor sg. ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: Handicap access:
Smoke detector: Protected corridors: c?r
Fire alarm: Parking spaces ( #):
Notes:
Total Valuation: $ 24' .•
INSPECTIONS FEES DUE
Footing /foundation Firewall $ tj , rj'j Permit Fee
Post /beam structural Smoke detector $ 2(( ,C1 State Surcharge
Shear wall Misc. inspection $ (I 70, Plan Review Fee
Masonry Approach /sidewalk $ 720 ' ZZ FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ 2-.58 ,CC) Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ I- Iourly Rate State Surcharge
$ Other:
$ Total 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.
1: \Building \ Forms \OTC- BUP.doc 08/19/08