Permit CITY OF TIGARD BUILDING PERMIT
0 COMMUNITY DEVELOPMENT Permit #: BUP2009 -00140
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009
Parcel: 2S 10X000500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 90
Subdivision: Lot: 0
Project: Spec Space
Project Description: Create new tenant space.
Owner: FEES
13500 PACIFIC CORP Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS Permit Fee - COM 07/28/2009 $305.21
INC, 21500 HAGGERTY ROAD, SUITE 100 12% State Surcharge - Building 07/28/2009 $36.63
PHONE: Plan Review 07/28/2009 $198.39
Plan Review - Fire Life Safety 07/28/2009 $122.08
Contractor:
CREATIVE CONTRACTORS & DESIGN
15357 UNION SCHOOL RD
WOODBURN, OR 97071
PHONE: 503 - 984 -3220
FAX: 503 - 981 -7784
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0 •
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $39,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
• Garage: 0
Mezzanine: 0
Total $662.31
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: 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 • more the 180 -
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are s R�
952 - 001 -0010 tl• , ugh 'AR 952 -Q01 -0100. You ma obtai a copy _ of the rules or direct questions to OUNC by calling 503.24. = • - • ° 0 3 .
Issued By: Ns 44 .\ ll /1 _ I ^ 1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an Inspection that, - ne - • • ay.
This permit card shall be kept In a conspicuous place on the Job unti omptetion of the p • ect
Approved plans are required on the Job site at the time of each Inspection.
Buildibg Permit Application
Commercial Fc)R (FFicl liSI ONLY
- -. City of Tigard RECEIVED � ed �.j PermitNo.: Pw.•
0 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi ,• �
Phone: 503.639.4171 Fax: 503.598.1969 UL 2 3 2009 DatefB : i ` ,I I y rr� Other Permit:
T G n It n
Inspection 503.639.4175 Line: Date Ready y: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: c Supplemental information
CITY OF TIGARD
OFB{{��'UOING DIVISION, REQUIRED DATA: 1- AND 2- FAMILY DWELLING
• if New construction ❑ Demolition Permit fees* are based on the value of the work performed.
❑ Addition/alteration/replacement ❑Other: Indicate the value (rounded to the nearest dollar) of all ..
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ID 1- and 2- family dwelling 2 Commercial/industrial
Valuation: $
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB STTE INFORMATION AND LOCATION , Total number of floors:
Job site address: t 3S 0 0 ?o. L; f i L I-,./ U New dwelling area: square feet
City / State/ZIP: 1 F d � t 0y, 4-72 �] Garage/carport area: , square feet
Suite/bldg. /apt. no.: -J etc Project name: 4 . 121 .. (2,„&, Covered porch area: square feet
Cross street/directions to job site: 1`1-0,4-6 M / � + (1 . G Q, 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.
Indicate the value (rounded'to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
G rlec�.f"e, l0 Q , Tev.a... " SFk t� Valuation $ 3 5; c
1 ✓t Side eics r c f' ✓� 6 u r (cA ,n q Existing building area: �s0 square feet
�J New building area: , square feet
53 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Elio 0— i4S S 8G u:.- r _ -`p Type of construction:
Address: q 0 1 N• (2 ( 1 h S T Occupancy groups: 6 .
City / State/ZIP: p r + ( ( o Q e, 9 "1 Z3 Z Existing: 15
Phone: (5,3 ) 1-Z C{ (:, 7Gj ( Fax: (53) Z Z.? 3/69' New: 43
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: C re_c }- d ve c 5 L S t All contractors and subcontractors are required to be
Contact name: , p S r "r f .} 1-e— under with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 5.3 5? U Lt,,'0t.. S G I!. oA ( Qe',A jurisdiction in which work is being performed. If the
City /State/ZIP: WO 0 (3 0 Q N O c 70 7 I applicant is exempt from licensing, the following reasons
U
apply:
Phone: ($b3) / g13.4 � 3 Z,ZI� Fax: (Sts3)�( Sv._ 7 78 y 1
E -mail: 415, 1 „ ) .
CONTRACTOR 1`[ //1
Business name: G (Z C...t 1 C led" felt.L70f S t te 5 t fr BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address: 1' S3 57 U n t`oi, S c2.601 n 1 �J Structural plan review fee (or deposit):
City /State/ZIP: t ,,, Oc 013 u R w 0 R. c -707 (
FLS plan review fee (if applicable):
Phone: (50.3) G ) 1$9' 3ZZO Fax: (S ° 3) `l$1 - 778 t i
CCB lic.:
i 2, . Total fees due upon application:
���� Amount received:
Authorized signature: This permit application expires if a permit is not obtained
• / within 180 days after it has been accepted as complete.
Print name: 3-051,‘ at T is + +14_ Date: '7/2 3/o9 • Fee methodology set by Tri- County Building Industry
Service Board.
I :tBuilding\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB)