Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00223
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9619 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE MALL Lot:
Project: POTTERY BARN
Project Description: Office addition.
Owner: FEES
Description Date Amount
Permit Fee - Additions, Alterations, 10/14/2010 $453.95
Demolition
PHONE: 12% State Surcharge - Building 10/14/2010 $54.47
Plan Review 10/14/2010 $295.07
Plan Review - Fire Life Safety 10/14/2010 $181.58
Contractor:
BE AREBE ENTERPRISES INC
5699 SE INTERNATIONAL WAY STE E
MILWAUKIE, OR 97222
PHONE: 503 - 652 -8825
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 2 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $25,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $985.07
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 se forth in OAR
952- 001 -0010 through OAR 952- 001 -0100. You 1 • • - • - - or direct questions to OUNC by calling 503.246.66 or 1.800.33 344.
Issued By: t � Permi'eeSignature:
/. •
411 9.4175 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 Application c �
ti
Commercial F OR OFFICE USE ONLY'
City of Tigard . -V)6 1 r Received // �, i p Permit No.: L ■20 i _ , .
13125 SW Hall Blvd, Ti OR 97223 1 r�
Phone: 503.639.4171 Fax: 503.598.1960 � \ �G I L `� *M AW ZIP; Other
[ c A R n lnspedion Line: 503.639 rx v `vl • - �. Ready : : RI See Page 2 for
Internet: www.tigard-or.gov C Notified/Method: Supplemental Information
TYPE OF WORK ��,��, REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑
construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addi tion/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 [ 12 mmercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
-- 'D 1TE INFORMATION AND LOCATION Total number of floors:
Job site address: , Q t- c ' / A . . . ) / , 4 + / / 76/ 44/4 New dwelling area: square feet
City/State/ZIP: 12 -- t C) CJ 7Z27 - 44 ..e_ Garage /carport area: square feet
Suite/bldgJapt. no.: I Project name:/?, /.. Covered porch area: square feet
Cross street/directions to job site: /VL / f' J S , S' ‘ Lt _ 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.
e /i Valuation: $ 'IS aro
Existing building area: square feet
,/ New building area: square feet
❑ PROPERTY OWNER I I3I NANT Number of stories:
Name: 4 � d � /l Type of construction:
Address: A SPS- S Gc) /AtdiC /� y / d-zpii �- 5,46- (ti A Occupancy groups:
City/ State/ZIP: 77 Cl�, a 2 3 , Existing:
Phone: (5.03 ) d 3 - // 3 Fax: (6-p ) -f - D 2 0 r � New:
( 1 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 4 / , ¢ i t t c .6 3 i G i J / C All contractors and subcontractors are required to be
Contact name: /_4 j /...//f4,..‘„ licensed with the Oregon Construction Contractors Board
r under ORS 701 and may be required to be licensed in the
Address: C�j '' - s &- / N7g ��` /� �L ` / J. /hp; 4 jurisdiction in which work is being performed. If the
- (� 9'' �"' � �/ t applicant is exempt from licensing, the following reasons
City/ State/ZIP: / . ,./1 J giez, , ) . ,9 ) 2_ z Z apply:
Phone: (1223 2v 35 / (o I Fax: : („513) ,5Z- l''F /
E -mail:
CONTRACTOR
Business name: S.
A Ater- BUILDING PERMIT FEES*
Address: 4'� ('lease refer to fee schedule)
Structural plan review fee (or deposit):
City/ State/ZIP:
FLS plan review fee (if applicable):
Phone: ( ) I Fax: ( )
CCB lic.: / 2...."7 tea/ Total fees due upon application: � 4 61,67
(( Amount received: y G 5-- �r
Authorized signature: his permit application expires ifs perm is not obtained
within 180 days after it has been accepted as complete.
I Print name: / /L7 /t3 /tr it ' I Date: /D - / L i - - / D 1 • Fee methodology set by Tri- County Building Industry