Permit CITY OF TIGARD BUILDING PERMIT
114
- COMMUNITY DEVELOPMENT Permit #: BUP2012 -00128
T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 300
Project: Spec Vacancy Subdivision: 1996 -048 PARTITION PLAT ' Lot: 2
Project Description: Demo /Spec space cleanup of existing office
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SW 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, 06/28/2012 $317.06
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 06/28/2012 $38.05
Stories: 3 Height: 0 ft Plan Review 06/28/2012 $206.09
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 06/28/2012 $126.82
Value: $15,350 Info Process /Archiving - Sm $0.50 (up to 06/28/2012 $1.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $689.02
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio, Center. Those rules are set forth in OAR
952 -001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by call',03.23 •87 or 1.800.332.2344.
Issued By: Permittee Signature: 121■'
Call 503.639.4175 by 7:00 a.m. for the next available Ins' n te.
This permit card shall be kept In a conspicuous place on the Job site until • ... • of the pro,: t.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
RECEIVE : �.
Commercial FoR OFFICE: USE ONI.1'
City of Tigard JUN 2 8 ReceiDat ved 0
`J ag �L u PermitNo.$u P a� a� V
:� ° g 2012 13125 SW Hall Blvd.; Tigard,OR 97223 Plan Revie b ll Phone: 503.718.2439 Fax: 503.598.1960 C O TIti ARD Date/By: � • erPermit:
T G �t 0 Inspection Line: 503.639. g' q t . 7� r D ate ReadyBy: June. ® See Page 2 for
Internet: www.tigard -or.gov BUILDING 1 y �Sl® Notified/Method: TIC" Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction 4 )emolition 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 Eakommercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 . � - 00 (0. New dwelling area: square feet
City /State /ZIP:
r a 6 / .7 Z2 Garage /carport area: square feet
Suite/bldg. /apt. no.: OT I Project name: PCL 2 -1 "" 1 ci o Covered porch area square feet
Cross street/directions to job site: \ O. cimA C 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 WORK ((� �M work indicated on this application.
be 4AI o / �? '10 oiocU e o (r� r Valuation: $ I S 3
p l C 1S 0 1 Existing building area square feet
v New building area: square feet
/PROPERTY OWNER I ❑ TENANT Number of stories:
Name: f) CXry S -I-- (� - Type of construction:
Address: 1 <� S tJ �t/` J v O 10 43O - D Occupancy groups:
City /State /ZIP: Pdr ( 0( - el 7 Existing:
Phone: (s ,V2_ ^ 1Q30-00 Fax: ( - ) New:
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business nam
Structural plan review fee (or deposit):
Contact name: C6 U Cv ° L_.
9 1 FLS plan review fee (if applicable):
Address:
City/State /ZIP: Total fees due upon application:
Phone: ( ) I Fax: : ( ) Amount received:
E -mail: 1r 1 { ky\ S� I Low% PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CO RA —CTOR Commercial and residential prescriptive installation of
• roof -top mounted Photo Voltaic Solar Panel System.
Business name: Ma A,J .CA yl l ' +' S V 1 Submit two (2) sets of roof plan with connection details
�- and fire department access, along with the 2010 Oregon
Address: , c� / Solar Installation Specialty Code checklist.
City /State /ZIP: d 1.2- '^' 77 Permit fee (includes plan review $180.00
c + �� 4 ( � [ g — C) C e, 7 and administrative ffe):
Phone: l l Fax: State s urcharge (12% of permit fee
$21.60
CCB lic.: G (d _ , Total fee due upon application: $201.60
�
Authorized signature: •• I t This permit application expires if a permit is not obtained
n within 180 days after it has been accepted as complete.
Print name: 1 ,`,- ' V f Date: � f 2 I �, ' Fee methodology set by Tri -County Building Industry
•••"`"'--- Service Board.
I:\Building\Pennits\B •-COM PermitApp:doc 02/ 24/2011 440- 4613T(11/02 /COM/WEB)
1,11 q B uilding Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List Bit AV( a.r -60/
Project Description: T(
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: NCI Occupancy Group: ;'-' Type of Construction:
*Type of Use: _ C07,,CiL Occupancy Load: l A Oregon Specialty Code: -ZOO
SPECIFICS
Number of Stories: `3 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: *I72 Fire Alarms: V Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 1 - FEES DUE
$ DC Prov Rvw, COM TI - Ping
$ DC Prov Rvw, COM TI - LRP
DC Provision Review Fee for COM TI $ - ;l:7. C'(., Permit Fee - Add, Alt, Demo
Project Valuation Planning LRP $ �jCJ,( 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 2cx, .09 Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ ' 242,.Pz — 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 $ ( ,Cn 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: $ (.61, 0 a. TOTAL 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