Permit CITY OF TIGARD BUILDING PERMIT
° COMMUNITY DEVELOPMENT Permit #: BUP2012 -00061
T I G A R T_) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: Perlo Constrution Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: TI
Contractor: PERLO CONSTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES LP
7190 SW SANDBURG ST ATTN: N PIVEN
PORTLAND, OR 97223 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
•
PHONE: 503 - 624 -2090 PHONE: 503 - 624 -6300
FAX:
FEES
Specifics:, Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 03/29/2012 $256.00
Class of Work: ALT DC Provision Review, COM TI - LRP 03/29/2012 $38.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 03/29/2012 $1,407.95
Stories: 2 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 03/29/2012 $168.95
Value: $150,000 Plan Review 03/29/2012 $915.17
Plan Review - Fire Life Safety 03/29/2012 $563.18
Info Process /Archiving - Lg $2.00 (over 03/29/2012 $10.00
Floor Areas: 11x17)
Metro Const. Excise Tax - Commercial 03/29/2012 $180.00
Total Area: 0 Use
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,539.25
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE . •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0. 0 through 0 - 952 -0 •090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 • r 1.800.332.23 • •
Issued : : !a Permittee Signature: 4L/
Call 503.839.4175 by 7:00 a.m. for the next available Inspection te.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
Commercial RECEIVED ED FOR OFFI(. t'Sl ONI.,
City of Tigard �R 2 9 2012 Dat�� .. /, .$ ,.i Permit No.: ,, j % ,0 / o ?— p0d(Q/
;� • 13125 SW Hall Blvd., Tigard, OR 97 Plan Revie j7I I^ i� 1
I Phone: 503.718.2439 Fax: 503.529,9 Date/B : MAL_ Other Permit:
I - [ �. R t) Inspection Line: 503.639.4175 I F TIGARD Date Ready : y: hair ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
' . - TYPE OF WORK: - . REQUIRED DATA: I. 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
K Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
. ' 'CATEGORY'OF CONSTRUCTION` ; 'S;;`,-'.-- , work indicated on this application.
❑ 1- and 2- family dwelling rr►ercial/industrial
Valuation: S
❑ Accessory building ❑0 Multi- family Number of bedrooms:
❑ Master builder ❑ Other: 1 Number of bathrooms:
• " • • - JOB SITE INFORMATION AND LOCATION . ' ` : - Total number of floors:
Job site address: A,,/d J � j j 2^J New dwelling area: square feet
City/State/ZIP: D I /0 4 i/2 d 9' �� y,/ Garage/carport area: square feet
Suite/bldg. /apt. no.: 0 440 I Project name -� /o /1. j ' //44rr 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.
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 WORKw -, . . - _„ work indicated on this application.
rte) P7/7 �PNn G )� Valuation: $ ��—Q 61,6) !Y Existing building area: square feet
New building area: square feet
. ❑, PROPERTY OWNER . ; ❑ TENANT , -. Number of stories: a
Name: PacTrust Type of construction: . /j
Address: 15350 S.W. Sequoia Pkwy., Suite 300 Occupancy groups: ...e
City/State/ZIP: Portland, OR 97224 Existing: �9 �'3
Phone: ( 503 ) 624 -6300 Fax: ( 503 ) 624 -7755 New:
W APPLICANT' [ '_CONTACT' PERSON :a f, N OTICE " •
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
Denni S Pa gni under ORS 701 and may be required to be licensed in the
Address: 15350 S.W. Sequoia Pkwy.. Suite 300 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 I Fax: : ( 503 ) 624 -7755
E -mail:
., . - `'s - CON'I'NACTOIt'P. 4,:.,,,.. ",;.,- t,
Business name: � /� Al 7—o'c— 7' x - ' BUILDING PERMIT FEES! ; ?, :`.w. _ • Address (Plea iitifertoleeschitatt _- ' !', :
City/ State/ZIP: Structural plan review fee (or deposit):
Phone: ( ) I Fax:'( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature: (7:;;::::---
This permit application expires if a permit is not obtained
/ , , Date: /-
* within 180 days after it has been accepted as complete.
Print name:
pff/ , :i....... / e C y r, I � � Fee methodology set by Tri County Building Industry
Service Board.
1 :\Building\Permits\BUP -COM PermitApp.doc 09 /09/10 440- 4613T(11 /02/COM/WEB)
Building Division
Accessibility: Barrier Removal Improvement Plan
TIGi\l&D
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 town- altered area may be 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] $
• 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): $
•
•
•
V n
I: \Building \Permits \BUP -COM PemmitApp.doc 06 /25/08 • " /
•
e III a Building Division -
Development Code Provision Review
T i c n ►z Commercial Projects - No Associated Land Use Case
Building Permit No: 66t I .66 _40661 Expedited Review
Plan Submittal Date: W.> -g4,
To the Applicant: 1 �J °/ ) 7 it
> 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 /4 y at 503 - 718 - 2 or @tigard- or.gov)
Ti T. — L- Permitted Use Yes Oi" ❑
(Land Use Required: Yes ❑ No Lg.' (explain below)
Notes: f
r
A/p e fita4,14.
MV-Approved ❑ Not Approved Date: 3
P
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes: NM'
Routed back to Building Division Date:
I. \CURPLN
C Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work:
g:j Occupancy Group: Type of Construction: � *Type of Use: Occupancy Load: j Oregon Specialty Code: ! 0
SPECIFICS
Number of Stories: Z 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: L � Fire Alarms: i S Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ I - X') FEES DUE
$ 2-" ,. /• DC Prov Rvw, COM TI — Ping
$ {ji r DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ • .a Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ ' Rj 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ ° ,( Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ ' ' • f:► Plan Review, Fire Life Safety
• $75,000 - $149,999 $160.00 $24.00 $ i('7, OCI 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)
$ /e0.-c) 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: $ OTAL FEES DUE
3 6Y).
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