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Permit C BUILDING PERMIT OF TIGARD PERMIT #: BUP2005 -00495 lli DEVELOPMENT SERVICES DATE ISSUED: 9/27/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101 DA -00102 SITE ADDRESS: 13221 SW 68TH PKWY ZONING: MUE SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 002 JURISDICTION: TIG Project Description: TI, walls (2 office spaces and conference room) 3 fl.D FLOOR /U 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: 2FR : sf N: S:. E: W: OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 26 BASEMENT: sf AREA SEP. RATED: STOR: 1 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: $ 3,500.00 Owner: Contractor: TIGARD TRIANGLE I LLC R & H CONSTRUCTION 4650 SW MACADAM AVE STE 220 1530 SW TAYLOR PORTLAND, OR 97201 PORTLAND, OR 97219 Phone: Phone: 503 - 228 -7177 FEES Reg #: LIC 38304 Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 9/27/2005 $81.70 [BUPPLN] Pin Rv 9/27/2005 $53.11 [TAX] 8% State Surcharl 9/27/2005 $6.54 [FLS] FLS Pin Rv 9/27/2005 $32.68 Total $174.03 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 require follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 01 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by c ling 503 - 246 -6699 1 332 -2344. Is ued B _ j Permittee Signal _1 _ By :k. '_— j i ice_ 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. Buildin ‘P ermit A • ` \ FOR OFFICE USE ONLY Cl of Tigard Received e // Permit No. 4 1 1 4 9 s City g g f+ ^oO� DateB . . w . A /✓ i 13125 SW Hall Blvd., Tigard, OR 97223 r'� L /l Phone: 503.639.4171 Fax: 503.598.196(��Q r /71,010,11r, ��� ,, � A Date/B Plan Review : f - i Other Permit: Line: 503.639.4175 J 1 _ - " -' Date Ready/By: ter ® See Attached Checklist for Internet: www.ci.tigard.or.us V e Notified/Method: l e Supplemental Information B IH 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. ❑ 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: 13221 SW 68 Parkway New dwelling area: square feet City/State/ZIP: Tigard, Oregon 97223 Garage/carport area: square feet Suite/bldg. /apt. no.: 300 Project name: Health Net Plan of Oregon T.I. Covered porch area: square feet Cross street/directions to job site: Hwy 217 & 1 -5 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. Tenant Improvement Valuation: $$3,500.00 Existing building area: square feet New building area: 777 square feet ❑ PROPERTY OWNER IS TENANT Number of stories: 5 Name: Health Net Plan of Oregon Type of construction: I -B Address: 13221 SW 68 Parkway Occupancy groups: City/State/ZIP: Tigard, Oregon 97223 Existing: Phone: ( ) Fax: ( ) New: B ® APPLICANT ❑ CONTACT PERSON NOTICE Business name: Group Mackenzie All contractors and subcontractors are required to be Contact name: Peter Kim licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 0690 SW Bancroft St. jurisdiction in which work is being performed. If the City/ State/ZIP: Portland, Oregon 97239 applicant is exempt from licensing, the following reasons apply: Phone: (503) 224 -9560 Fax: : (503) 228-1285 E -mail: pmk @grpmack.com CONTRACTOR . Business name: R &H Construction BUILDING PERMIT FEES* Address: 1530 SW Taylor St. Please refer to fee schedule. City/State/ZIP: Portland, Oregon 97205 Fees due upon application Phone: (503) 228 -7177 Fax: (503) 224 -3638 Amount received CCB lic.: 38304 i Date received: Authorized signatu — _ , =�� This permit application expires if a permit is not obtained - � . within 180 days after it has been accepted as complete. Print name:. %?'' Date: 9/26/2005 * Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Pemtits \BUP- PermitApp.doc 12/03 440- 4613T(1I/02/COM/WEB) CITE( OF TIGARD _ • BUILDING DIVISION PERMIT #: BUP2005 -00495 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/200; Phone: (503) 639 -4171 Vit Inspection Requests (24 Hrs.): (503) 639 -4175 .�� INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 78 SITE ADDRESS: 13221 SW 68TH PKWY eft CLASS OF WORK: SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE: PROJECT NAME: HEALTH NET OF OREGON DESCRIPTION: TI, walls (2 office spaces and conference room) OWNER: TIGARD TRIANGLE I LLC, PHONE #: CONTRACTOR: R & H CONSTRUCTION PHONE #: 503-228 -7177 Inspection Request Scheduled For: Date: 10/20/2005 Pour Time: Code # z Inspection Description Confirm # Contact # Message 275 Y Framing 01:116-01 503 - 849-9466 Y Corrections /Comments/ Instructions: q°9 4 �l 0 k PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Wh Phone #: (503) 718- CITY Of TIGARD BUILDING DIVISION PERMIT #: BUP2005-00495 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2005 Phone: (503) 639 -4171 4,00,0,i4 Inspection Requests (24 Hrs.): (503) 639 -4175 ; I.. INSPECTION WORKSHEET FOR DATE: 11/2/2005 TIME: 7:04AM PAGE: 78 SITE ADDRESS: 13221 SW 68TH PKWY CLASS OF WORK: SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE: PROJECT NAME: HEALTH NET OF OREGON DESCRIPTION: TI, walls (2 office spaces and conference room) OWNER: TIGARD TRIANGLE I LLG, PHONE #: CONTRACTOR: R & H CONSTRUCTION PHONE #: 503- 228 -7177 Inspection Request Scheduled For: Date: 11/2/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 287 Suspended ceiling 020059 -01 503 - 849.9466 Y Corrections /Comments/ Instructions: LATE- ks t ©%s(13L Id ., . .---- A 1p . f PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL II CALL FOR INSPECTION ❑ ADDITI NAL EES ASSESSED A ) Inspector: elk Date: Phone #: (503) 718 -