Permit a CITY OF TIGARD BUILDING PERMIT
8 COMMUNITY DEVELOPMENT Permit #: BUP2012 -00078
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04118/2012
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 214
Project: Gerald Miller Subdivision: 1991 -055 PARTITION PLAT Lot: 1
Project Description: TI
Contractor: RUSSELL CONSTRUCTION INC Owner: LINCOLN CENTER LLC
20915 SW 105TH AVE BY SHORENSTEIN PROPERTIES LLC
TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 228 -3413 PHONE: 503 -619 -3200
FAX: 503 - 228 -2770
FEES
Specifics:, Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 04/18/2012 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 04/18/2012 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 04 /18/2012 $423.53
Stories: 12 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 04/18/2012 $50.82
Value: $22,450 Plan Review 04 /18/2012 $275.29
Plan Review - Fire Life Safety 04118/2012 $169.41
Info Process /Archiving - Lg $2.00 (over 04/18/2012 $6.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $998.05
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 Center. Those rules are set forth in OAR
952- 001 -00 • e •AR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. . 987 r 1.800.332.2344.
Issued =y: � �� / Permittee Signature:
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.
Building Permit Application
Commercial Ft1R OFFICE liSE ()NI.,
City of Tigard ceived / P No.: r — G�BQ
y Received
: ,/ a �� 7 $
13125 SW Hall Blvd. �Rn97223 �1. Plan Review ►�� v
C Phone: 503.639.4171503.598 I 0�� Date/B : �� � � Other Permit:
Inspection Line: 503.634.4175 CL �® Date Ready : : kris: RI See Page 2 for
T I G A It D
Internet: www.tigard- or.gov Q Q�j I `u �, ° Supplemental Information
1 � N otified/Method: Su PP
TYPE OF W REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction " '` J 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 application.
❑ 1- and 2- family dwelling ® Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: Four Lincoln -10250 SW Greenburg Road New dwelling area: square feet
City/State/ZIP: 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: 214 I Project name: Gerald Miller Covered porch area: square feet
Cross street/directions to job site: SW Locust Street 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: $$22,450.00
Existing building area: 1893 square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 12
Name: Shorenstein Realty Services Type of construction: II -FR
Address: 5335 Meadows Road, Suite 300 Occupancy groups:
City /State/ZIP: Lake Oswego, Oregon 97035 Existing: B
Phone: (503)619 -3200 Fax: (503)619 -3210
New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: GBD ARCHITECTS All contractors and subcontractors are required to be
Contact name: Whit Middlecoff licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1120 NW Couch Street, Suite 300 jurisdiction in which work is being performed. If the
City / State/ZIP: Portland, Oregon 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9656 I Fax: : (503) 299 -6273
E -mail: whit @gbdarchitects.com
CONTRACTOR
Business name: Russell Construction BUILDING PERMIT FEES*
Address: 20915 SW 105 Avenue (Please refer to fee schedule)
City /State/ZIP: Tualatin, Oregon 97062 -9511 Structural plan review fee (or deposit):
Phone: (503) 692 -9002 I Fax: (503) 692 -9008 FLS plan review fee (if applicable):
CCB lic.: 58918 Total fees due upon application:
Amount received: $
Authorized signature: T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
L Print name: Whit Middlecoff, AIA I Date: 04 /18/2012 * 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
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: �ozf P 4'l / a — 000 7 r lEt,xpedited Review
Plan Submittal Date: Vi 8/% Y
/0z 1w G/- is-y Z/ s
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 at 503-718-2 Oil) or - 10 @tigard - or.gov)
❑ Zoning / 1 12_ 1 Permitted Use Yes I No ❑
['Land Use Required: Yes. ❑ No [B (explain below)
Notes:
__dJ i .1 0# iii ` / 1 • !i4' AisG..4 '- LA d._..1 /
Et ❑ Not Approved Date: W g
Permit Coordinator Review (contact Albert Shields at 503 - 718 - 2426 or albert@tigard or.gov)
Notes: J/
/V`
Routed back to Building Division Date:
I:ACURPLN
Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: � C
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION ,.
*Class of Work: /�lT Occupancy Group: ' Type of Construction: Z
*Type of Use: �j� Occupancy Load: , h Oregon Specialty Code: 20(0
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: f 4 Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 2242aD FEES DUE
J $ IWO DC Prov Rvw, COM TI — Ping
$ , CIO DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 2-3 Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ " "j' ' Z 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ Z %" Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ nal Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ , Pie 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: $ o f 99,CtS FEES DUE
*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.
1: \ Building \ Forms \OTC - BUP.docx 01/13/2011