Permit CITY OF TIGARD BUILDING PERMIT
3!.:F1: COMMUNITY DEVELOPMENT Permit #: BUP2010 -00082
TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2010
Parcel: 2S112DD00700
• Jurisdiction:
Site address: 15780 SW UPPER BOONES FERRY RD
Subdivision: OREGON BUSINESS PARK II Lot:
Project: Professional Eye
Project Description: TI to add interior partitions
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 04/21/2010 $195.38
PORTLAND, OR 97224 Demolition
PHONE: 503 - 624 -6300 12% State Surcharge - Building 04/21/2010 $23.45
Plan Review 04/21/2010 $127.00
Plan Review - Fire Life Safety 04/21/2010 $78.15
Contractor:
MATTHEW OLSON CONSTRUCTION
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: $7,500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $423.98
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No 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. 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 rul =- =re set forth i
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5 • 6.6699 0 . 00.332 44.
Issued By: L % 1 Permittee Signature: .9
Call 503.639.4175 by 7:00 a.m. for an inspection that b 6 • =ss 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 R ECE/T FOR OFFICE USE ONLY
City of Tigard Received z/ �[�_
APR 212010 Date/By: / c2///19 i(� /Y Permit No ,20/Q _
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie Phone: 503.639.4171 Fax: 503.598.1960 CITY QF TdGA Inspection Line: 503.639.4175 Date ReadyDate/By: / 0,/
Q Other Pe mil TI Ready/By: Juris: ® See Attached Checklist for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK - - • REQUIRED DATA: 1- AND 2- FAMILYDWELLING •
CD 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
CATEGORY OF CONSTRUCTION work indicated on this application.
12 I- and 2- family dwelling Z Commercial /industrial
Valuation: $
Accessory building Number of bedrooms:
El ry g ❑ M ulti- family
1=1 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION. Total number of floors:
Job site address: /— 2 G New dwelli area: square feet
City/State /ZIP: _A i f ,/_ e _ 0 ,..s . k ,� e— 014 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 0 2 d d e .(7- /Urti 40 „/ / ....., h area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA,COMMERCIAL -USE CHECKLIST
Subdivision: I 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. -
.4d , /l.rrr /l, 7{ - -iv (1ytr Valuation / Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories: /
Name: PacTrust Type of construction: l� -U"
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups:
City /State /ZIP: Portland, OR 97224
Existing: I/ -Z�
- Phone: (503)624 -6300 Fax: (503)624 -7755 New: C7=2'-
0 APPLICANT _ 0 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 I Fax: : (503) 624-7755
E -mail: dennisp @pactrust.com
CONTRACTOR
Business name: ��c�---- OA® /IlS712e10 - 7 ,BUILDWG,PERMIT EES*
Address: s3 fit/ e-w (P.fe`ase refer io fee schedu'!e)
City/State/ZIP: ,a�/ - Zi A 7 � � aa�' Structural plan review fee (or deposit):
Phone 3) q a ._ LSD 4 (ci Fax: ( )
CCB lic.: FLS plan review fee (if applicable):
6 / v � C/ Total fees due upon application:
Amount received: lf� 3 , / t�
Authorized signature: This permit application expires if a permit is not obtained
�� within 180 days after it has been accepted as complete.
Print name: 0 Date: 4 // 7` /14
e 7).--74_ �- � f _, * Fee methodology set by Tri -County Building Industry -
/ Service Board.
1:\ Building \Permits \BUP- PermitApp.doc 03/21/06 440-4613T(1 I /02/COM/WEB)
C " Building Division
TIGARD Over - The - Counter (OTC) Building Permit
Check List
Description of Project: —1 ( a u/ ,2O /U -6000e.2._
GENERAL INFORMATION
Class of Work:' I. F loor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* L First floor: N: S:
Type of Construction: 5 Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: ' 1 Total sq ft.: N: S:
Stories: Note: Combine total floor area E: E:
_ for
Height: _ all floors above third floor and Roof Construction:
Floor Load: add to the third floor sq. ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: Handicap access:
Smoke detector: Protected corridors: On
Fire alarm: PC) Parking spaces ( #):
Notes:
Total Valuation: $ . .5 tzu
INSPECTIONS 1 FEES DUE
Footing /foundation Firewall $ Permit Fee
Post /beam structural Smoke detector $ 2 6. State Surcharge
Shear wall Misc. inspection / $ (27,00 Plan Review Fee
Masonry Approach /sidewalk ./$ , ( FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ 4z3 t ce 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.
I: \Building\Forms \OTC- BUP.doc 08/19/08