Permit CITY OF TIGARD BUILDING PERMIT
I I COMMUNITY DEVELOPMENT Permit #: BUP2012 -00053
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03!20/2012
Parcel: 15 136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY J
Project: Vanilla Shell Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Interior demo
- _ Contractor: WANG K PARK CONSTRUCTION Owner: PACIFIC CROSSROADS PROPERTIES IN
1102 SE 104TH AVE BY WYSE INVESTMENT SERVICES CO
VANCOUVER, WA 98664 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503 - 358 -8464 PHONE:
FAX:
FEES
•
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 03/20/2012 $241.01
Class of Work: ALT Demolition
Dwelling Units: 0 12 %State Surcharge - Building 03/20/2012 $28.92
Stories: 1 Height: 0 ft Plan Review 03/20/2012 $156.66
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Lg $2.00 (over 03/20/2012 $6.00
Value: $10,500 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $432.59
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No 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 = - • - 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. • TENTION: Oregon - requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 - 001 -0010 through OAR 952 -• • - 0091. V. :y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ Signature: � t�Z �N
Issued By: / 1 Permittee Si nature: .
Call 503.639.4175 by 7:00 a.m. for the next available Inspection 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.
1 l
Building Permit Application ,i
Commercial �\ FOR OFFICE USE ONLY
City g
Cit of Tigard � ,�� Received �� ®� � � ( j •i 1 .
�� rr � � �[ S (!
:� 13125 SW Hall Blvd., Tigard, OR 97 1,0�� Date1B Plan Review s' II • Phone: 503.718.2439 Fax: 503.598.1 60 \ca Date/B : ) , in meter Permit.
Inspection L ine: 503.639.4175 \k`� G . S\ Notified/Metho � O Dat Read y : !uric: ® See Page 2 for
i i it l_l O Q`� .
Internet: www.tigard- or.gov Supplemental Information
TT
TYPE OF WOR l 1,Av REQUIRED DATA: 1- AND 2- FAMILY DWELLING
Vs
❑ 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 applicatt.i.
❑ I- and 2- family dwelling "CommerciaUindustrial Valuation: $ ii -
❑ 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: 1 I l Q0 'P�a --tc .41,,\v t _ Jt le._, New dwelling area: square feet
City /State/ZIP: T i i 0 6 / • 2:1 Garage/carport area: square feet
Suite/bldgJapt. no.: J i / Project name: 144,0 YI G (n.,,,c gegkpc 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: 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.
Valuation:
���..1 • • .. 1 u i .
• I L& . % Vli $ r S7�
r
' iy c L Y _ 1 W� 1 UI 1 J I 11 , `t
I'll �.1 ' , Existing building area: square feet
1 j' ,11 c�a Y New building area: square feet
9 , 1 PROPERTY OWNER ❑ TENANT Number of stories:
Name: \ 1 Z , eQ *v-1 �+ Type of construction:
Address: � l s\,. T> 'L-01z S -T' S l Q�( Occupancy groups:
City / State/ZIP: T 0 ,c+Acc.4,y ol O 2 4 r+ - 2-0 S Existing:
Phone: l L} . 040 Fax: ( ) New:
❑ APPLICANT L5(CONTACT PERSON BUILDING PERMIT FEES*
Business name: a j }� oL l <`-T Q view e re (or d le)
A ,� 1 � 1
Structural plan review fee (or deposit):
Contact name: '` C
'l
Address: 0 0 04?) Sys -Ave, A�-_. S - r l� cell FLS plan review fee (if applicable):
City / State/ZIP: U� t R-----/,0 [� Total fees due upon ap Q
� �� t 2 t I ` Amount received: 4V3 l
Phone. J 1 Fax: : (� 3
E -mail: _ r _- - ., _.. rer, A, n ,` PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Comore ial and residential prescriptive installation of
CONTRACTOR • il�'l -1'. 1 .C• CA � goof -top *unted Photo Voltaic Solar Panel System.
Business name: VII ' vO i D V Submit two • sets of roof plan with connection de Is
and fire depart - t access, along with the t : ft regon
Address: t I D S _ l D� h-e. Solar Installation -cialty Code ch st.
City /State/ZIP: \ 1 � Permit fee (inc es eview $180.00 35g . 'T I �� `Y.��� and ad five fees):
Phone: 1 —
$ F ax : ( ) State sure ..e (12% of pe ee): $21.60
CCB lic.: 282 0 5/2 sit
otal fee due upon application` $201.60
Authorized sign re: This permit application expires if a permit is not obtained
. • ■ within 180 days after it has been accepted as complete.
wimg.1-15m Date: It IMI WI * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 02/ 24/2011 440- 4613T(II /02/COM/WEB) /
C ° Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
0--k- Check List
Project Description: VA /3I �E
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: f p Ce- Occupancy Group: !'.k, Type of Construction:
*Type of Use: einAi. Occupancy Load: Oregon Specialty Code:
SPECIFICS
Number of Stories: t 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: k5e) Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ t() C I FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ -- 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: $ TOTAL FEES DUE \ \l i t ,
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo; .
FND = foundation; FPS = 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