Permit V CITY OF TIGARD BUILDING PERMIT
o COMMUNITY DEVELOPMENT Permit #: BUP2010 00233 •
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
T[ G A R D Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 601
Subdivision: LINCOLN THREE Lot: 0
Project: Matrix Absence Management
Project Description: TI
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Permit Fee - Additions, Alterations, 10/26/2010 $752.04
CALIFORNIA ST 49TH FL Demolition
PHONE: 12% State Surcharge - Building 10/26/2010 $90.24
Plan Review 10/26/2010 $488.83
Plan Review - Fire Life Safety 10/26/2010 $300.82
Contractor:
RUSSELL CONSTRUCTION INC
•
20915 SW 105TH AVE
TUALATIN, OR 97062
PHONE: 503 - 228 -4898
FAX: 503 - 228 -2770
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 6 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $52,875
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,631.93
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 s • re • et forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain : -• • I _ _ • r direct questions to OUNC by calling r : • • • r 1.800.332.2344.
Issued By:.. Permittee Signature: _
C �� 8 9.4175 by 7:00 a.m. for an inspection that businesa y.
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 F t R t)rFICl 1JSI.: ONLY
City of Tigard Received Date/B : U Permit No.: // 1i
ill
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
II Phone: 503.639.4171 Fax: 503.598.1960 Date/B : g � ( Other Permit:
T I G A R p Inspection Line: 503.639.4175 Date Ready/By: HI Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
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.
❑ 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: 3 Lincoln - 10220 SW Greenburg Road New dwelling area: square feet
City / State/ZIP: 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: 601 I Project name: Matrix Absence Management Covered porch area: square feet
Cross street/directions to job site: SW Locust Street 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: $$52,875.00
Existing building area: 10020 square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 6
Name: Shorenstein Realty Services Type of construction: II -B
Address: 5335 Meadows Road, Suite 300 Occupancy groups:
City / State/ZIP: Lake Oswego, Oregon 97035 Existing: B
Phone: (503)619 -3200 Fax: (503)619 -3210 New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: GBD ARCHITECTS All contractors and subcontractors are required to be
Contact name: Whit Middlecoff licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1120 NW Couch Street, Suite 300 jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, Oregon 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9656 I Fax: : (503) 299-6273
E -mail: whit @gbdarchitects.com
CONTRACTOR
Business name: Russell Construction BUILDING PERMIT FEES*
Address: 20915 SW 105 Avenue (Please refer w fee schedule)
Structural plan review fee (or deposit):
City /State/ZIP: Tualatin, Oregon 97062 -9511
Phone: (503) 228 -3413 Fax: (503) 228 -2770 FLS plan review fee (if applicable):
CCB lic.: 58918 Total fees due upon application:
(..i Amount
expires received:
Authorized signature: T his permit applicatpires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Whit Middlecoff, AIA Date: 10/22/2010 * Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building\Permits\BUP -COM PetmitApp.doc 10 /01/09 440- 4613T(11 /02/COM/WEB)
I
e ° Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
. Description of Project: Ti
GENERAL INFORMATION
Class of Work:* 't- Floor Areas (sq. ft): Exterior Wall Construction:
Type of Use:* COX First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: 1 Total sq ft.: N: S:
Stories: p 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: Cj Handicap access:
Smoke detector: Protected corridors:
Fire alarm: Parking spaces ( #):
Notes:
Total Valuation: $ Q)
INSPECTIONS 1 FEES DUE
Footing /foundation Firewall $ 7 Permit Fee
Post /beam structural Smoke detector - $ .0.24- State Surcharge
Shear wall Misc. inspection $ 4f :,� J Plan Review Fee
Masonry Approach /sidewalk $ _0_// i Ser 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:
$ I (rot ,e-:? Total Fees Due
*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