Permit • CITY OF TIGARD BUILDING PERMIT
• n COMMUNITY DEVELOPMENT Permit #: BUP2009 -00192
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2009
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 200
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: HealthNet
Project Description: TI, demo, new walls, demising walls, doors, relites.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
PO BOX 2096 Permit Fee - Additions, Alterations, 10/15/2009 $1,190.51
WARREN, MI 48090 Demolition
PHONE: 12% State Surcharge - Building 10/14/2009 $142.86
Metro Const. Excise Tax - Commercial 10/14/2009 $136.80
Use
Contractor: Plan Review 10/15/2009 $773.83
R & H CONSTRUCTION CO Plan Review - Fire Life Safety 10/14/2009 $476.20
1530 SW TAYLOR ST
PORTLAND, OR 97205 -1819
PHONE: 503 - 228 -7177
FAX: 503 - 224 -3638
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 5 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $114,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,720.20
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. 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 rules are set forth in OAR
952- 001 -0010 throug OAR 952-001-0100. You ou may obtain a co / py � of the rules or direct questions to OUNC by calling 503 46.6699 or 1.800.332. , 44.
' 'l'
Issued By: � V/( �� V `� Permittee Signature: _ /7
Call 503.639.4175 by 7:00 a.m. for an inspection that business • .
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
Commercial RECEIVED Received FOR OFFICE USE ONLY
City of Tigard DateB : ) Permit No.:` • cog • 72
° 13125 SW Hall Blvd., Tigard, OR 97223 OCT 1 4 2009 Plan Reviewer I.. ,
SI Phone: 503.639.4171 Fax: 503.598.1960 DateB : i.jn �� Other Permit:
TIGARD Inspection Line: S 03 CITY OF TIGARD Date Read h , � � , ' n/1 ® See Page 2 for
Internet: www.ti and -or. ov Notified/Method: vl , Supplemental Information
BUILDING DIVISION
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
® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ID 1- and 2- family dwelling ® Commercial /industrial
Valuation: $
❑ 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: Triangle III, 13221 SW 68th Parkway New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: 200 &300 Project name: HealthNet 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
DESCRIPTION OF WORK work indicated on this application.
Interior Tenant Improvement Valuation: $114,000
Work to include minor demolition, new walls, demising walls, doors, and relites Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 5
Name: GKTriangle Corp Park III LLC, c/o CB Richard Ellis Type of construction: I -B
Address: 1300 SW 5 Ave. Suite 200 Occupancy groups:
City /State /ZIP: Portland, OR 97201 Existing: B
Phone': (503)221-1900 Fax: (503)221 -4873 New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Group Mackenzie All contractors and subcontractors are required to be
Contact name: Jane Catalano licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1515 SE Water Ave Suite 100 jurisdiction in which work is being performed. If the
City/ State/ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9560 Fax: : (503) 228-1285
E -mail: jatalano@grpmack.com
CONTRACTOR
Business name: R & H Construction BUILDING PERMIT FEES*
Address: 1530 SW Taylor Street
(Please' refer to fee schedule)
Structural plan review fee (or deposit):
City/State/ZIP: Portland, OR 97205
Phone: (503) 228 -7177 Fax: (503) 224 -3638 FLS plan review fee (if applicable):
CCB lic.: 38304 Total fees due upon application:
I'.
Amount received: � O ` a 4
Authorized signatu e: This permit application expires if a permit is not obtained
• within 180 days after it has been accepted as complete.
Print name: Jane Catala o Date: 09/22/09 * Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440 4613T(11 /02 /COM /WEB)
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
: . q
71 BUILDING DIVISION
TIGARD TRANSMITTAL LETTER
a
TO: Oa rl DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVED
FROM: k ASO 1 i A - \p1 flE _ DEC 15 2009
COMPANY: c( e C �Stp,n � C � vet\ CITY OF
BUILDING DIMS DIVIS ON
PHONE: 54 1 $SO (, /' By.
RE: P2-00a • a2
(Site Address) (Permit/Case Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. X Engineer's calculations.4 -dQ- t
Other (explain):
REMARKS:
FOR O FICE IISE ONLY
Routed to Permit Technici Date: 124 -2__--z, 1 Initial .
Fees Due: El Yes [ io Fee Description: Amount ue:
$
$
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I. \Building\ Forms \TransmittalLetter - Revisions doc 4/4/07