Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP201000219
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15940 SW 72ND AVE B17
Subdivision: OREGON BUSINESS PARK I Lot: 17
Project: MAX VIZ
Project Description: TI
Owner: FEES
PACTRUST Description Date Amount
15350 SW SEQUOIA PKWY SUITE 300 Permit Fee - Additions, Alterations, 09/30/2010 $149.75
PORTLAND, OR 97224 Demolition
PHONE: 503- 624 -6300 12% State Surcharge - Building 09/30/2010 $17.97
Plan Review 09/30/2010 $97.34
Plan Review - Fire Life Safety 09/30/2010 $59.90
Contractor:
DURUS CONTRUCTION LLC
15806 UPPER BOONES FERRY RD
LAKE OSWEGO, OR 97035
PHONE: 503 - 320 -8601
FAX: 503 - 244 -4318
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $5,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $324.96
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
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 rut = re set forth i • -
952- 001 -0010 through 0 952- 001 -0100. You may obtain a c les or direct questions to OUNC by calling 5e • •.6699 or .:00.332.2344
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Issued By: Permittee Signature:
all 503.639.4175 by 7:00 a.m. for an inspection that . -s 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 FOR OFFICE USE ONLY
City of Tigard a 4
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q 13125 SW Hall Blvd., Tigard, OR 97223 city ateB ce : C t Permit No.: r (� `v ,_ a inb g Plan Review .� I
Phone: 503.639.4171 Fax: 503.598.1960 0ateB : �iC •ie 1 Other Permit:
TIGARD Inspection Line: 503.639.4175 r o c., U ( Sate Ready :y: Jura ® See Attached Checklist for
Internet: www.tigard - or.gov j t_ Notified/Method: ' I.& Supplemental Information
pf M° N
TYPE OF WORK QQ D 11∎ 1 . TAN REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demoliti8"n Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
AAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- 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: .. / . 6 -- 94/// SL_ Og et, - New dwelling area: square feet
City /State /ZIP: ?p . d , � 9�.,..Q y Garage /carport area: square feet
Suite/bldg. /apt. no.: e 6 /- Protec / t name: ' �f _� V - 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.
/� /� / Valuation: $
C�� r�r /3c�c -t-, vt f`Y
7 e, 2 / +` er�i5 Existing building area: square feet
T- 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: ti A
City /State /ZIP: Portland, OR 97224 Existing:
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: St /7 ��" BUILDING PERMIT FEES*
Address: i s14 L4� r C" 5 F Key ] (Please refer to fee schedule
City/State/ZIP: �` (/ Structural plan review fee (or deposit):
L P ( �`�` �� f ' !v � FLS plan review fee (if applicable):
Phone: (5 ) 3 ._ Cr_ I Fax: ( )
CCB lic.: / ' ' S1 a Total fees due upon application: !_)
Amount received: $ 3 a� ` C(,1
Authorized signature: This permit application expires if a permit is not obtained V
within 180 days after it has been accepted as complete.
Print name: ' _ e. ' Date: _ A • Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Permits \BUP- PennitApp.doc 03/21/06 440- 4613T(11/02/COM/WEB)
71 e ° Building Division
Over- The - Counter (OTC) Building Permit
riGnizn Check List
Description of Project: • t
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GENERAL INFORMATION
Class of Work:* Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: • N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: Total sq ft.: N: S:
Stories: 1 Note: Combine total floor area for E: E:
Height: all floors above third floor and _Roof Construction:
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: 7 Handicap access:
Smoke detector: Protected corridors:
Fire alarm: ceff, Parking spaces ( #):
Notes:
Total Valuation: $ 5�
INSPECTIONS I FEES DUE
Footing /foundation Firewall $ [ A , j Permit Fee
Post /beam structural Smoke detector $ . State Surcharge
Shear wall , Misc. inspection $ onnik Plan Review Fee
Masonry Approach /sidewalk $ ,'1'.' • 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:
$ 3 Z4—, '94:, Total Fees Due
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*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