Permit a CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2009 -00068
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2009
Parcel: 1S136 DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Remodel existing public and employee bathrooms.
Owner: FEES
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO Permit Fee - COM 06/04/2009 $510.70
BOX 35547 Tax - 12% State Surcharge 06/04/2009 $61.28
PHONE: Plan Review 04 /30/2009 $331.96
Plan Review - Fire Life Safety 04/30/2009 $204.28
Contractor:
INTERSTATE CONSTRUCTION GROUP INC
437 29TH ST NE STE F
PUYALLUP, WA 98372
PHONE: 253- 435 -0949
FAX:
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $80,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,108.22
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: 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. ATTENTI . Ore on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -001 hrough AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344.
•
cL 011.44 ,//e Lirfae dtu
Call 503.639.4175 by 7:00 a.m. for an Inspection that business ay.
This permit card shall be kept In a conspicuous place on the job she until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
[4a it/tE (( 9
A Building Permit Application
Commercial RECEIVED FOR OFFICE USE ONLY
APR 9 Recei
City 15p D fl f Permit No.: n '- ,,'�,/
11 ( �
131 of Tigard SW Hall Blvd., Tigard, OR 97223 8 0 2009 Date : off/ �� u G J9 (�l�(U
g Plan Revie � . " I(, Other Permit:
e Phone: 503.639.4171 Fax: 503.598.1 / D ate/B , � j `��
T 1 G A R D Inspection Line: 503.639 "� + j DI" j D D R ea. y : y: 1- ® See Page 2 for
Internet: www.tigard -or.gov BUILD INGDN �ISION Not ed/ , c/7 a�9 4 / t( Supplemental Information
TYPE OF WORK "` REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El 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 RC ommercial /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: HS—(" S ,J PING - Fj� H( 4j()A / New dwelling area: square feet
"
City/State/ZIP: , G4 /Qf oA ? Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: tQgn N f if E fL a --1 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
54/ 72 _A-V{ 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.
g3HOI�C. Ex /Srmic, pow CAF Akio �l4PGoyiEiE Valuation: $ � Q 1 O0O
Rg rR - MS . PPPV to tNCr 4 AIEW PAMtei R Existing building area: square feet
New building area: square feet
N, PROPERTY OWNER ❑ TENANT Number of stories:
Name: No MO Type of construction:
Address: tx) -2 A-ve Occupancy groups: f?
City/State /ZIP: poct`ewd , OA Existing:
Pi
Phone: ( ) Fax: ( ) __ II
New: 11./D eNRKS.e
APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: tik5je /", a, 5.117,1 e i. o(1 All contractors and subcontractors are required to be
vrh licensed with the Oregon Construction Contractors Board
Contact name:
) + / under ORS 701 and may be required to be licensed in the
Address: Il6/Z N� a!�;hn,z hghe S. jurisdiction in which work is being performed. If the
1/44,1004-€ /1 applicant is exempt from licensing, the following reasons
City/State /ZIP: r / W,4 9866 / apply:
Phone: (Up 6g5 - 531'1 I Fax: : (360) 6W-0571
E -mail: KK, z,,d e, kee,yter cles.yn 9 r'cx. / o . "e '-
CONTRACTOR n/�� ,,,,
Business name: �1J�t/e 5 C_'o,0 ST2GC7T( Oat) &Ot. / BUILDING PERMIT FE
Address: 1 { 2 5 '7 e'�9 L'' ,COT �e 5 r- e (Please refer w fee schedul
City/State/ZIP: Puy 41.4Ai P /A)",". a 1. 7'j. Structural plan review fee (or deposit): 35/ . `l�
�1 t FLS plan review fee (if applicable): ag
Phone: ( ,25 ! 3 1 Lt! 3S., 0 ?47 F ax: ( ) y ' -
CCB lic.: / -/�7/� 9 �SO / 3� Total fees due upon application: 536 .Ay
/
Amount received:
Authorized signature: ,Q,K. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: KgV Kt AkA 10 Date: L(gp /pe? * Fee methodology set by Tri Building Industry
/ Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 2/23/07 440 -4613T(I1 /02 /COM/WEB)
\ - RECEIVED
APR 3 0 2009
Building Divisio
. • CITY OF TIGARD
Accessibility: Barrier Removal Improvement P
TIGARD BUILDING DIVISION
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $ CA0
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
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1: \Building \ Permits \BUP -COM PermitApp.doc 10/30/07