Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Date Issued: 01/10/2012 Permit#: BUP2012-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: TI. 1/13/12,reprint to correct address.
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES LP
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-892-0066 PHONE:
FAX: 503-892-0067
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee-Additions,Alterations, 01/10/2012 $1,075.83
Class of Work: ALT Demolition
Dwelling Units: 0 12%State Surcharge-Building 01/10/2012 $129.10
Stories: 1 Height: 0 ft Plan Review 01/10/2012 $699.29
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 01/10/2012 $430.33
Value: $96,000 Info Process/Archiving-Lg$2.00(over 01/10/2012 $12.00
11x17)
DC Provision Review,COM TI-Ping 01/10/2012 $160.00
Floor Areas: DC Provision Review,COM TI-LRP 01/10/2012 $24.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,530.55
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 a • •. 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. AT TION: Oregon law,requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 0010 through OAR 952-001- 0 You may obtain a copy of the rules or direct questions to OUNC b calli.. • .'32.1987 or 1.800.332.2344.
Issue, By: Permittee-ignature: „„) i iI�1
Call 503.639.4175 by 7:00 a.m.for the next available i s• .on date.
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.
a' . ,� CITY OF TIGARD BUILDING PERMIT
°'- COMMUNITY DEVELOPMENT Permit #: BUP2012 -00003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/10/2012
Parcel: 2S113AB00600
g 95 Jurisdiction: Tigard
Site address: -46 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: TI
•
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES LP
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 892 -0066 PHONE:
FAX: 503 - 892 -0067
FEES
Specifics:
Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 01/10/2012 $1,075.83
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 01/10/2012 $129.10
Stories: 1 Height: 0 ft Plan Review 01/10/2012 $699.29
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 01/10/2012 $430.33
Value: $96,000 Info Process /Archiving - Lg $2.00 (over 01/10/2012 $12.00
11x17)
DC Provision Review, COM TI - Ping 01/10/2012 $160.00
Floor Areas: DC Provision Review, COM TI - LRP 01/10/2012 $24.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,530.55
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 -r. Those s are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a cop or direct questions to OUNC by calling 503.2 :87 or 1.8 . 32.2344.
Issued By: /� Permittee Signature: ,
03.639.4175 by 7:00 a.m. for the next availabl • spe date.
i el IV
This permit card shall be kept in a conspicuous place on the job site unti j •letion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
r �; RECEIVED � ` , OFFIC U SE 9 NL Y h : ,,f, } , ` ` ` ''
Commercial -
�. . City . of Tigard a PermitNo 44 4 - .a R
Y g Deceiv r /d /
Iv ' ' 13125 SW Hall Blvd , Tigard, OR 97223 IAN O �U�L Plan Review
' [ Other Permit: Phone: 503.639.4171 Fax: 503.598.19610 Date/13 . al ��
Inspection Line: 503.639 4175 Date Ready/By furs El See Page 2 for •TIGARD g g CITYOFTIGARD Notified/Method:/ T y Supple Information
Internet: www.ti and -or. ov BUILDING DIVISION
`, . _, ,-:-,:„-:,,,,,,,-,4,-,-: TYPE OF'WORK RE` DATA Ali ' AND 2 FAMILY D '§
- �,. ,. . .� ., . _ a. P, a.:om , r .? ... .i � 4t mom, - r
❑ 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
CATEG CONSTRUCT N . l r work indicated on this application.
Valuation $
❑ 1- and 2-family dwelling mmercial /mdustral
❑ Accessory building 11] Multi-family Number of bedrooms:
111 Master builder El Other:
Number of bathrooms:
* , vJOB SITEOANFORMATION AND2LOCA'i'ION - ., Total number of floors:
Job site address: , . , .----- ���../ 29 1 ' ✓ -P .,e__, New dwelling area: square feet
City /State /ZIP: �,. �/� / _ // Of? � X Garage /carport area: square feet
Suite /bldg. /apt. no.: Project nJ e: �2 j 1 /,-� 4 �� - Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIREI).DATA COtMMER CIAL VSE 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
` DE
1- SCRIPTIOhOFPWORKr ' g ',� . work indicated on this application.
.' 1 . „ . W. �..:... ,
,: - :b �: - , ., „„,. ,.., .. . .
l 1 Valuation: $ '
Existing building area: square feet
New building area: square feet
r� ❑_ PROPERTY, OWNER , ®. TENANT , 4 _ Number of stories:
Name: PacTrust Type of construction j ./,.---. -■15
Address: 15315350 SW Sequoia Pkwy., Suite 300 Occupancy groups:
City /State /ZIP: , Portland, OR 97224 Existing: / 7 9
Phone: (503) 624 -6300 Fax (503) 624 7755
, .' ®TAPPLIGANT G ®: CONTACT PERSON r a =ii New: x
w. w w. . '.mot ,z -,,. .. ,.°
, ,. . . .. NOTICE ,. z , . _
. I
_
:Business name: PacTrust All contractors and subcontractors arc required to be
Contact name: Dennis Pagni licensed with the Oregon Construction Contractors Board
under ORS 701 and may he required to be licensed in the
Address: 15350 SW Sequoia Pkwy jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: Portland, OR 97224
apply:
Phone: (503) 624 -6300 Fax: : (503) 624 -6300
E -mail: dennisp @pactrust.com
' �' ., 'i - :...4g , it. s ^Z ,..a CONTRACT ,. f t:,:. r `:: '" ,40;
Business name: - . _BUILD1IGfPER1VIIT FEES* `
Address: S 3� 5L) arll�� (A/ ' , ..F:(P,lease iefe r iofeeschedu7 �� u_ , ., ;'s
City /State /ZIP: Structural plan review fee (or deposit):
�d 7J, 4' U/e. - 9 ` - V-J- -�
j FLS plan review fee (if applicable):
Phone: (5 ) ). _ c L• ) Fax: ( )
CCB lie.: 3 �CC�U7� vVID / 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:
,� J AI 1 Date: _ * Fee methodology set by Tri -County Building Industry
. - Service Board.
I:\Building\Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: t
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: � Occupancy Group: Type of Construction:
*Type of Use: � � Occupancy Load: ' Oregon Specialty Code: 20 10
SPECIFICS
Number of Stories: >� Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access. Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: )� Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ Ildj £r FEES DUE
$ 1 6 r CO DC Prov Rvw, COM TI — Ping
$ a , • DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ y ' s Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 0 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ - Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ Q,` Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ !Z,dj Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $256.00 $38.00 $ Info Proc/Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ 2. jcD,rj5TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; END = foundation; DEM = demo;
END = foundation; EPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \Building \Forms \OTC - BUP.docx 01 /13/2011
_ 11 Building Division
• Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: (-t-P d o l a -6 [[12'EXpedited Review
Plan Submittal Date: f — ,12 "
/ 7 - - - -
5 u 1 - 7 7 , - - 4 , 46405
To the Applicant:
)>. If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
➢ If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved. > ,/
Planning Review (contact /. --(ae at 503 -7182 , Y 0or �i144@tigard- or.gov)
Dar—Zoning s - I— Permitted Use Yes i No ❑
g Land Use Required: Yes ❑ No Li' (explain below)
Notes: cis a , f-1 z 4,a/46/W- 3,C�
j29 G ='Y
It Approved ❑ Not Approved Date: / - 7---
i ir,
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
f (
Routed back to Building Division Date:
I: \CURPLN