Permit a-- CITY OF TIGARD BUILDING PERMIT
7
PERMIT #: BUP2008 -00026
COMMUNITY DEVELOPMENT DATE ISSUED: 1/31/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 101 AD - 03200
SITE ADDRESS: 12909 SW 68TH PKWY 200 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: .TIG
PROJECT: ACE INSURANCE
Project Description: TI
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 48 BASEMENT: sf AREA SEP. RATED:
STOR: 4 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 8,000.00
Owner: Contractor:
PACIFIC REALTY ASSOCIATES MATTHEW OLSON CONSTRUCTION
15350 SW SEQUOIA PKWY #300 -WMI 5320 SW DOVER LN
PORTLAND, OR 97224 PORTLAND, OR 97225
Phone: 503 - 624 - 6300 Contact #: PRI 503 - 892 -0066
FAX 503 - 892 -0067
Reg #: LIC 66070
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 1/31/2008 $105.40
[TAX] 12% State Surch 1/31/2008 $12.65
[BUPPLN] Pln Rv 1/31/2008 $68.51
[FLS] FLS Pin Rv 1/31/2008 $42.16
Total $228.72
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 than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the
Or • •n Utility o ' ation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 9 2- 001 -0100 - may obtain a copy
these rules or direc • • - ions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: /j �� / _ ; Permittee Signature: r ,
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 Applicati Tl EDEIVED FOR OFFICE USE ONLY
,
City of Tigard J AN 3 RDat eceived r 5 e
PermitNo.: ' g• Ao /
: 5 D
13125 SW Hall Blvd., Tigard, OR 97223 1 20 Plan Revie ,
C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : I Other Permit:
TIGARD Inspection Line: 503.639.4175
CITY OF TIGARD Date Ready : y: Juris: ® See Attached Checklist for
Internet: www.tigard or.gov 0N o tified/Method: Supplemental Information
BUILDING DI V 1� 71 N
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
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: $
El Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address >I 967 GO M4 P14,.../ ..ali( c/�D New dwelling area: square feet
City/State/ZIP: 0,e )_) IJ 1/ D2 7.2.2.42.' Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: , .. 1? �� , 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: I 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
DESCRIPTION OF WORK work indicated on this application.
A il a,�.4 �� ,Cv z�4s -4„--- Valuation: $ lta0
f 0.0... IFCR7W) Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: � "�
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: 2J
City /State/ZIP: Portland, OR 97224
Existing: /2 L /e
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: .0-70-i�i J O 1 f... 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 lic.: 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: s �` H� 7 I Date: f /� /Q U p' • Fee methodology set by Tri-County Building Industry
Service Board.
I: \ Building \Permits'BUP- PermitApp.doc 03/21/06 440- 4613T(II /02/COM/WEB)
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: BUP2008-00026
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/31/2003
Phone: (503) 639 -4171
t ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 :4—, '`___.
INSPECTION WORKSHEET FOR DATE: 3/2 2008' TIME: 7:02AM PAGE: 1
SITE ADDRESS: 12909 SW 68TH PKWY 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: ACE INSURANCE
DESCRIPTION: 11
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624 -6300
CONTRACTOR: MATTHEW OLSON CONSTRUCTION PHONE #: 503 -892 -0066
Inspection Request Scheduled For: Date: 3/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 06705 &01 503-958 -8290 n Ta—
Corrections /Comments/ Instructions:
•
, %G PA = /, : RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL M CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/ ''' ?, Z44
Inspector: Date. �� N Phone #: (503) 718 -
A
CITY OF TIGARD - ._
BUILDING DIVISION PERMIT #: BUP2008 -00026
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/31/2008
Phone: (503) 639 -4171 ate'
Inspection Requests (24 Hrs.): (503) 639 -4175 "' �..
INSPECTION WORKSHEET FOR DATE: 3/19/2008 • TIME: 7:01AM PAGE: 16
SITE ADDRESS: 12909 SW 613TH PKWY 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: ACE INSURANCE
DESCRIPTION: TI
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624-6300
CONTRACTOR: MATTHEW OLSON CONSTRUCTION PHONE #: 503 -092 -0066
Inspection Request Scheduled For: Date: 3/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 066963 -01 503 -307 -2105 N
Corrections /Comments/ Instructions:
— Z c7ye, — a oo 4 l ►= r,.s/4 4.-- C-4-7(-44 _ all
test ‘, i t , C+4Z Go ivr»�e'' $ /Jb d4 - .IJb J e i
p( p'fc.� .72 c �-6.t� =7._1 St° -- /.. /o TiZ��4- - 1
❑ PASS U PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
�Clg 1g,4 A R INSPECTI� ❑ ADDITIONAL FEES ASSESSED
Inspector: _ _ _ — Dated i 1 /bc Phone #: (503) 718 - 7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2008 -00026
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/31/2008
Phone: (503) 639- 4171Ai�l
Inspection Requests (24 Hrs.): (503) 639 -4175 1..
INSPECTION WORKSHEET FOR DATE: 2/27/2008 TIME: 7:OOAM PAGE: 31
SITE ADDRESS: 12909 SW 68TH PKWY 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: ACE INSURANCE
DESCRIPTION: TI
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 6246300
CONTRACTOR: MATTHEW OLSON CONSTRUCTION PHONE #: 503-892 -0066
Inspection Request Scheduled For: Date: 7/2 7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Messa•e
275 Framing 065727 -01 503 - 956 -6290 ��
Corrections/Comments/Instructions: �p
6 G 0011 C�� 1- / f 9 - ar 4 Ks2) v' -
❑ PASS '71 ':: I • - "• : ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Z 7195 Phone #: (503) 718- �‘�