Permit CITY OF TIGARD BUILDING PERMIT
II I COMMUNITY DEVELOPMENT Permit #: BUP2012 -00010
T f G ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2012
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: YARNS ACRES Lot: 9
Project Description: TI
Contractor: R & H CONSTRUCTION CO Owner: GK TRIANGLE CORPORATE PARK III L
1530 SW TAYLOR ST BY THOMSON REUTERS INC
PORTLAND, OR 97205 -1819 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 228 -7177 PHONE: 503 - 221 -1900
FAX: 503 - 224 -3638
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 02/23/2012 $2,253.55
Class of Work: ALT Demolition
Dwelling Units: 0 Plan Review 01/20/2012 $1,464.81
Stories: 4 Height: 0 ft Plan Review- Fire Life Safety 01/20/2012 $901.42
Bedrooms: 0 Bathrooms: 0 DC Provision Review, COM TI - Ping 02/23/2012 $256.00
Value: $290,000 DC Provision Review, COM TI - LRP 02/23/2012 $38.00
12% State Surcharge - Building 02/23/2012 $270.43
Info Process /Archiving - Lg $2.00 (over 02/23/2012 $12.00
Floor Areas: 11x17)
Metro Const. Excise Tax - Commercial 02/23/2012 $348.00
Total Area: 0 Use
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $5,544.21
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
Smoke Detectors: Yes 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 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: .
Cal . 175 by 7:00 a.m. for the next available inspectionTe.
This permit card shall be kept In a conspicuous place on the Job site until comp ,, tion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FOR OFFICE USE ONLY
City of Tigard Received / �
1 e 13125 SW Hall Blvd., Tigard, OR 97 _ - t -v Plan Review �� to
Phone: 503.639.4171 Fax: 503. 'T!.. ,;`�
t, Date/B 42 % � • tier Permit:
I" I G n It D Ins Line: 503.639 'l0,'� Date Ready : y: Juris: ® See Page 2 for
Internet: www.tigard or.gov ^w , 19 Notified/Method: o f Supplemental Information
' A po f', pa L(,� der . , ai /fie_
TYPE OF W( p0 A REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction 41kMn 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.
El 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: Triangle III, 13221 SW 68th Parkway New dwelling area: square feet
City /State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: 460 I Project name: State Farm 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.
Interior Tenant Improvement Valuation: $290,000
Work to include demolition, new walls, ceilings, doors, relites, and cabinetry Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 5
Name: GKTriangle Corp Park III LLC, do CB Richard Ellis Type of construction: I -B
Address: 1300 SW 5' Ave. Suite 200 Occupancy groups:
City/State/ZIP: Portland, OR 97201 Existing: B
Phone: (503)221 -1900 Fax: (503)221 -4873 New: B
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Group Mackenzie All contractors and subcontractors are required to be
Contact name: Jane Chambliss licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1515 SE Water Ave Suite 100 jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9560 I Fax: : (503) 228 -1285
E -mail: jchambliss @grpmack.com
CONTRACTOR 01131tj
Business name: Q I. cdft c -A BUILDING PERMIT FEES*
1 Address: 0 / w(/� /�1u r (Please refer to fee schedule)
City/State/ZIP: l P r , . ( jd i O R C('� -� Structural plan review fee (or deposit):
�
� –/� / n? J g FLS plan review fee (if applicable):
Phone: (563 n 0 - -7 1 i 7 I Fax :(5;9 ) �" _/ — 3 `C
CCB lie.: Total fees due upon application:
C
Amount received: is . 2L4„. This permit a pplica . 73
Authorized signature � - �5'
application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Jane Cham '
, I Date: 01/19/2012
* Fee methodology set by Tri-County Building Industry
- - -• " _ Service Board.
I:\BuildingTermits\BUP -COM PermitApp.doc 2/23 /07 440- 4613T(I1 /02/COM/WEB)
REC EIVE D
Ii
II ° Building Division JAN 19 2012
CITY
Development Code Provision Review B OF TIGf1RD
r i c n Commercial Projects - No Associated Land Use ICaseG DIVISION
Building Permit No: Pao t a-ex2Din ❑ Expedited Review
Plan Submittal Date: i(11/1X
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 a proved. / /� ,
Pla •, ng Review (contact at 503 -718 D or l/�-� @tigard- or.gov)
12 ,ning / Permitted Use Yes No ❑
LE Use R quired: Yes ❑ No V (explain below) -- 4 Notes: tyltk --
fib d ijiiitC14/4;
N
v�
Approved ❑ Not Approved Date: 1 / 3 /i of
1r
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes: , A
k.
Routed back to Building Division Date: t h9N 3 /i2 —
I:\CURPLN
i
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
II
City of Tigard
= . Buildin g Division - .
TIGARD
TRANSMITTAL LETTER
TO: 0 DATE RECEIVED:
DEPT: BUILDING DIVISION RECVED
(644.-x-r \ MAR 9 2ot2
` cJ, CITY OF TIGARD
I �/O OI AYt --,(:)Y13 BUILDING DIVISION
COMPANY: q)b1 l -L C_
PHONE: � 224- q6 p • /
By. ` 7f
RE: 1322 i Svv 4' po i . OR_ i %' ( ...b i r to
(Site Address) 6 17 Da3 mtt 1 um I e ,'
S fait r .t. Tom . 4 - -
'roject name or su o • Ivtston name an' of , m . er
ATTACHED ARE THE FOLLOWIN .
Copies: Description: o +e:: Descrip on:
Additional set(s) of p . ns. 3 Revisi 4 ns: ( l
oil c e
Cross section(s) an. details. Wall .racing and/or lateral analysis.
Floor /roof framin:. . Ba -ment and retaining walls.
Beam calculatio .. E _ineer's calculations.
Other (explain): /
REMARKS: ) (
\ :),Ii
r OFFICE USE ONLY .
uted to Per_iit T- hnician: Date: C �
f 5 (`Z.... Initials:
Fees Due: V Yes ❑ No Fee Description: Amount Due:
W (Tf 4— -k-21/( L—_ $ 90. 00
$
$ .
$
Special —_,
Instructions: -,----.-
Reprint Permit (per PE): ❑ Yes Rio ❑ Done
Applicant Notified: Date: / /may Initials:(
w u,) ./ ,;,, - r ' 1I' ►c�'dh x+
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