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Permit A CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2005 -00243 � DEVELOPMENT SERVICES DATE ISSUED: 6/7/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S113AD -01800 SITE ADDRESS: 16798 SW 72ND AVE B14 ZONING: I -L SUBDIVISION: OREGON BUSINESS PARK 1 LOT: 011 JURISDICTION: TIG Project Description: TI: Walls. 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: 5N : sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 23 BASEMENT: sf AREA SEP. RATED: STOR: 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: $ 43,600.00 Owner: Contractor: PACIFIC REALTY ASSOCIATES MATTHEW OLSON CONSTRUCTION 15350 SW SEQUOIA PKWY #300 -WMI 5320 SW DOVER LANE PORTLAND, OR 97224 PORTLAND, OR 97225 Phone: 503 - 624 -6300 Phone: 503 - 892 -0066 FEES Reg #: LIC 66070 Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 6/7/2005 $425.80 [TAX] 8% State Surchari 6/7/2005 $34.06 [BUPPLN] Pln Rv 6/7/2005 $276.77 [FLS] FLS Pin Rv 6/7/2005 $170.32 Total $906.95 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct • - ions to OUNC by calling 503 -24 99 0 1-800 -332 -2 4. Issued By t--- -- / ,jE., Permittee Signatur- -` _ r Call 503-639-4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans ate required on the job site at the time of each inspection. Building Permit AiWix �U E , D FOR OFFICE USE ONLY / City of Tigard 1 Dat Received e/B ►r ©�� % • AI ' Permit No. _...-00 = • .... , _ 13125 SW Hall Blvd., Tigard, OR 9722 (1' `,/ 2flfJ. Plan Revi t Ph 503.639.4171 Fax: 503.598.1960 /A,$p`n" e (I"I D ; Other Permit: Inspection Line: 503.639.4175 CHYOF' TIc AH0 3tL• a. . Date Ready/By: 0 $eeAttachedChecklistfor Internet: www.ci.tigard.or.us BU LoiNG unlis G Notified/Method: RE Supplemental Information !Y d U !J 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 ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY 'OF CONSTRUCTI.ON • . work indicated on this application. Valuation: $ ❑ 1- and 2- family dwelling Commercial /industrial ❑ 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 99f .5 9 ,. / Ade> New dwelling area: square feet City/ State/ZIP: 7,,,,A -L ' 94/ Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: lJt / e , ,t 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. J �� . B �, Gt' 24,0 1.1.0...,........– Valuation: $ �S �O 0 d STS - / Existing building area: square feet -7--- New building area: square feet — r1rOPERTY OWNER .. ❑ TENANT Number of stories: Name: G U.S. Type of construction: V Address: Occupancy groups: 5'Z City/ State/ZIP: Existing: 99 Phone: ( ) Fax: ( ) New: 6 C,/y 7 ❑. APPLICANT / ' ') ;Need PERSON • NOT Business name: _ ... 7 .e . r "7 L f ` . �,� �. All contractors and subcontractors are required to be Contact name: / licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/ State/ZIP: applicant is exempt from licensing, the following reasons apply: y: Phone: ( ) Fax: : ( ) P 16.9.-.< E -mail: C� CONTRACTOR Business name: "97 41.- # Gtr c, 1 r4�i✓ BUILDING PERMIT FEES* Address: I ' • Please refer to fee schedule. City/State/ZIP: Fees due upon application Phone: ( ) Fax:( ) Amount received CCB lic.: Date received: Authorized signature: r � This permit application expires if a permit is not obtained — 7 within 180 days after it has been accepted as complete. Print name: ,Ano•cAvt f ��J I ' Date: 6/°,/Q 5-- * Fee methodology set by Tri -County Building Industry Service Board. i:l BuildinglPemutsSBUP- PcnnitApp.doc 12/03 440- 4613T(11 /02/COM/WEB) • A lb Building Division ''" N�'a � li'i P lan Submittal Requirement Matrix ��' Commercial & Multi- Family - New, Additions or Alterations City of Tigard Type of Submittal # of Plans (Includes.new, additions and alterations.) Required at Submittal Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) • Site Work • 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* Fire Protection System 3 ** Mechanical 2 • • Plumbing (building fixtures) 2 • Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over -the- counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. . i:\ Bui lding\Forms \COM- PlanSubReq.doc 12/24/03