Permit CITY OF TIGARD BUILDING PERMIT
.11‘
® : COMMUNITY DEVELOPMENT Permit #: BUP2010 -00022
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/02/2010
Parcel: 2S112DA00800 •
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Subdivision: Lot: 0
Project: Spec Space
Project Description: TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - Additions, Alterations, 02/02/2010 $453.95
PORTLAND, OR 97224 Demolition
PHONE: 503- 624 -6300 12% State Surcharge - Building 02/02/2010 $54.47
Plan Review 02/02/2010 $295.07
Plan Review - Fire Life Safety 02/02/2010 $181.58
Contractor:
BNK CONSTRUCTION INC
45 82ND DR SUITE 53B
GLADSTONE, OR 97027
PHONE: 503 - 557 -0866
FAX: 503 - 557 -1085
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 2 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $24,800
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $985.07
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: No
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 don ' cco an • h 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
day . ATTENTION: Oregon re. ' you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ar = forth in OA;
9 - 001 -0010 through OAR 95 •01 -0 ' 1 'ou may obtain a copy of the rules or direct questions to OUNC by calling 503.24•. • • or 1.80'. 32.2344.
sued By: 0 A`� / Permittee Signature: ',
Call 503.639.4175 by 7:00 a.m. for an inspection that b - Ines-V.
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
•
FOR OFFICE USE ONLY
City of Tigard P ; I �VED Received a
° 2 . to �✓ 1 T,� PermitNo.: ,
131 SW Hall Blvd., Tigard, OR `9 �' :.� Plan Re : t� 4 ,.. ..
I . Phone: 503.639.4171 Fax: 503.598.1960 Date/Bv li
Other Permit:
TIGARD Inspection Line: 503.639.4175 FEB 0 2 2010 Date Rea.' : Jura: ® See Attached Checklist for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE C'UV G DIVISION 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
AAddition/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 Valuation: $
❑ y g ®Commercial /industrial
❑ 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 � v , `, _ New dwelling area: square feet
City/State/ZIP: 04 +/et N d '2 5267 a Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: '` Pee._ rtc_i_ 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: $
Existing building area: square feet
• New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction: JJ,
Address: 15350 S.W. Sequoia Pkwy., Suite 300
Occupancy groups: jg s
City/ State/ZIP: Portland, OR 97224 �
Existing: ,
- - 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 I Fax: : (503) 624 -7755
E -mail: dennisp @pactrust.com
CONTRACTOR
Business name: 4, f/C 457p G . 7":7/ 1 —** ) BUILDING PERMIT FEES*
Address: (Please refer to fee schedule
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: cfg5, a 7
Authorized signature: This permit application expires if a permit is not obtained
�' within 180 days after it has been accepted as complete.
Print name: T
, t) /2/J 0- ea GiJv/ a gli e " Fee methodology set by Tri-County Building Industry
Service Board.
1:\ Building \Permits \BUP- PermitApp.doc 03/21/06 440-4613T( I 1/02/COM/WEB)
P h B uilding Division
Over - The - Counter (OTC) Building Permit
TIGARD
Check List
Description of Project:
GENERAL INFORMATION
Class of Work:* (� Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* tit First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: e S`L Third floor: Openings Protected Y /N ?:
Occupancy Load: 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 Il'EMS
Fire sprinkler: Handicap access:
Smoke detector: Protected corridors: W)
Fire alarm: l t..4-) Parking spaces ( #):
Notes:
Total Valuation: $ C 4, e�
INSPECTIONS FEES DUE
Footing /foundation Firewall $ 4 3.? 5 Permit Fee
Post /beam structural Smoke detector $ , A-7 State Surcharge
Shear wall Misc. inspection $ Z ,C71 Plan Review Fee
Masonry Approach /sidewalk $ I F , i 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:
$ -I,- V7 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.
I: \Building \Forms \OTC- BUP.doc 08/19/08