Permit CITY OF TIGARD BUILDING PERMIT
c COMMUNITY DEVELOPMENT Permit #: BUP2009 -00069
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2009
Parcel: 1 S136DB00201
•
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Adding mezzanine for storage.
Owner: FEES
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO Permit Fee - COM 10/15/2009 $486.70
BOX 35547 Tax - 12% State Surcharge 10/15/2009 $58.40
PHONE: Plan Review 04 /30/2009 $316.36
Plan Review - Fire Life Safety 04 /30/2009 $194.68
Contractor:
BROCKAMP & JAEGER INC
15796 S BOARDWALK ST
OREGON CITY, OR 97045
PHONE: 503 - 655 -9151
FAX:
Specifics:
Type of Use: COM
Class of Work: ADD
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $75,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 902
Total $1,056.14
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This perm' ' - d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a • • all of - r applicable law. All work will
be • • e in accordance • approved plans. This permit will expire if work is not started within 180 days of issuance • r if work is uspend =d for more the 180
• . ys. ATTENTION: Oregon I- . - • - you to follow the rules adopted by the Oregon Utility Notification Center. ' ose rules ar= set fo in OAR
952- 001 -0010 through OAR • - 001 -01 0 • may obtain a copy of the rules or direct questions to OUNC by ca ing 503.246.-99 or' 800.332.2344.
r
ssued By: ••- / r Permittee • Signature: / � •
Call 503.639.4175 by 7:00 a.m. for an Inspection that bu Mess day.
This permit card shall be kept in a conspicuous place on the job site until completion of • oject
Approved plans are required on the Job site at the time of each Inspection.
_ r - 1 -3 itiO `RIC- f (o)
Building Permit Application .
Commercial FOR OFFICE USE ONLY
1,1 City of Tigard REC� D Received 1 / n
Date : d 1 � �� Permit No.: I a 0.01,41 6004, ° 1 3125 SW W Hall Blvd., Tigard, OR 9722 Plan �/ ,
Phone: 503.639.4171 Fax: 503.598.1960 APR p t 7 g � Other Permit:
TIGARD
Inspection Line: 503.639.4175 0 2009 Date Ready : y: // r t ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method:.. of 7 �� ICI Supplemental Information
CITY OF TIGARD ,� y o-e_ wy /6-A -'‘'‘
TYPE oP4811ING DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
. ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
]$t Addition/alteration /replacement ❑ Other: • equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ID 1- and 2- family dwelling Commercial /industrial
Valuation: $
173 Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: f' 5(p 5 S 1tj 1?AC_ F-I KIG446)Ake New dwelling area: square feet
City/State /ZIP: T6Ap_o ca. C7 223 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: fQ _,, l/ i yf L - -t s; Az Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW 7 2 Ilta 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.
AbD A S T Rscs i''le.2zAA1(sag Valuation: $ �f s ���
Existing building area: square feet
New building area: square feet
rir PROPERTY OWNER ❑ TENANT Number of stories: a
Name: FIRED May Type of construction:
Address: ? O t S a 72' A t Occupancy groups: j
City/State/ZIP: ForL_1AI 0 ' (DP Existing: II
Phone: ( ) Fax: ( )
New: 13 p CRAK) era
54 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: pES /6,V 1,'P All contractors and subcontractors are required to be
Contact name: I k) ��� (✓� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4-012_ N I (N Nfc � ,1Q ,.c--1 jurisdiction in which work is being performed. If the
City/State/ZIP: vAA)C.oJ a�R W A L�$t'6 / applicant is exempt from licensing, the following reasons
apply:
Phone: (34 (499 - 53/ 7 I Fax: : (36,o) (04 Q ` — OS(1
E -mail: KI4I NO; 110 ( WeSTi DgS /6))g Qof . It)ET
CONTRACTOR
Business name: T. &a pe► K■HP .- JikteoP2 I i.)C. BUILDING PERMIT FEES*
•
Address: (Please refer to fee schedule)
Structural plan review fee (or deposit): 3 /4. %,
City/ State/ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): r 91(.1
Total fees due upon application: /
CCB lic.: Zo l .611
Amount received:
Authorized signature: ^\ This permit application expires if a permit is not obtained
Print name: (a ��(+�(� Date: /}I3pl * within 180 days after it has been accepted as complete.
Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 2/23/07 440 -4613T(I1 /02 /COM/WEB)
i