Permit r
a CITY OF TIGARD BUILDING PERMIT
ill
• ' COMMUNITY DEVELOPMENT Permit #: BUP2009 -00060
T t GAR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/09/2009
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 150
Subdivision: Lot: 0
Project: Acceleration Chiropractor
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee - COM 04/09/2009 $400.30
#300 Tax - 12% State Surcharge 04 /09/2009 $48.04
PHONE: Plan Review 04 /09/2009 $260.20
Plan Review - Fire Life Safety 04 /09/2009 $160.12
Contractor:
PACIFIC REALTY ACCOCIATES LP
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300
FAX: 503- 624 -7755
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $57,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $868.66
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 is : • subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be • : e in accordan : ith a: • • ed plans. This permit will expire if work is not started within 180 days of issuance, or if work is spended fo more
the • 0 days. ATTENTION: 0 • on law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those e are se rth in OAR
95 '- 001 -0010 through OAR 00 • 00. You may obtain a •py of the rules or direct questions to OUNC by calling 503.24 69 or 1. 0.332.2344.
I sued By: / // ` ii / Permittee Signature:
I Call 503.639.4175 by 7:00 a.m. for an Inspection that bu Iness
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.
y
Building Permit Application l 1 �, ' CE% n l3% FOR OFFICE USE ONLY
111 City of Tigard DateBea Ammo Perm No. a 1 7 /` A /'
. ° 13125 SW Hall Blvd., Tigard, OR 97223 _ 9 2 009 Plan Review °1 � 'ji] �
Phone: 503.639.4171 Fax: 503.598.1960 p PR Date/B : may. A m g Other Permit:
TIGARD Inspection Line: 503.639.4175 �GPISD Date Ready /By: 171 See Attached Checklist for
Internet: www.tigard- or.gov c11 0? NI S t0N Notified/Method. P Supplemental Information
vi i SANG U
TYPE OF WORK REQUIRED DATA: 1- 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
A 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:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: New dwelling area: square feet
City/State/ZIP: Zd2 ��u w al Of
c i 79 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name/. ` %1 e ��.r . Covered porch area: square feet
Cross street/directions to job site: C/I Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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.
-
_XL. -1 f/7, A2- �.1 /7 Ai i cAft % ■ i- /l Valuation: $ 33? ��
R ec) tYl Existing building area: s quare feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: 1
Address: 15350 S.W. Sequoia Pkwy., Suite 300
Occupancy groups:
City /State/ZIP: Portland, OR 97224 Existing: _r4•Ji
Phone: (503)624 -6300 Fax: (503)624 -7755
New:
® APPLICANT ® CONTACT PERSON
NOTICE
Business name: PacTrust All contractors and subcontractors are required to be
Contact name: Dennis Pagni licensed with the Oregon Construction Contractors Board
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
City/ State/ZIP: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 624 -6300 Fax: : (503) 624-7755
E -mail: dennisp @pactrust.com
CON CTOR
Business name: Ile l t c_. 841-7 BUILDING PERMIT FEES*
Address: (Please refer to fee schedule
— Structural plan review fee (or deposit):
City/State/ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: /5,3 Q 3 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date
{ a-/J # r ds p /1i/ - / y * Fee methodology set by Tri-County Building Industry
r/ Service Board.
1:\ Building \PermitABUP- PermitApp.doc 03/21/06 440- 4613T(II /02/COM/WEB)
III Building Division
r l c n It Over - The - Counter (OTC) Building Permit
-�� Check List
Description of Project: 1 1
GENERAL INFORMATION
Class of Work:* Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: 1 Total sq ft.: N: S:
Stories: f Note: Combine total floor area for E: E: _
Height: all floors above third floor and Roof Construction: _
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: (r7., Handicap access:
Smoke detector: Protected corridors: W)
Fire alarm: _ Parking spaces ( #):
Notes:
Total Valuation: $ 67, Q
INSPECTIONS FEES DUE
Footing /foundation Firewall $ 4 , ? Permit Fee
Post /beam structural Smoke detector $ O State Surcharge
Shear wall Misc. inspection $ 7), 20 Plan Review Fee
Masonry Approach /sidewalk $ Pai. 1 ( — a_ FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ (f . L-,&, 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.
is \ Building \ Forms \OTC - BUP.doc 08/19/08