Permit CITY OF TIGARD BUILDING PERMIT
8.: COMMUNITY DEVELOPMENT Permit#: BUP2012 -00164
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 115
Project: Builder Services Group, Inc Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: (1) barrier -free toilet room
Contractor: PACIFIC CREST STRUCTURES INC Owner: JDS LLC
17750 SW UPPER BOONES FERRY RD SUITE CRITERION CREEKVIEW LLC
190 ATTN JAMES A MEYER
DURHAM, OR 97224 PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 968 -8949 PHONE:
FAX: 503 - 598 -6658
Specifics: FEES
Description Date Amount
Type of Use:
Class of Work: Type of Const: DC Provision Review, COM TI - Ping 08/16/2012 $67.00
Occupancy Grp: Occupancy Load: DC Provision Review, COM TI - LRP 08/16/2012 $10.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 08/16/2012 $210.59
Demolition
Stories: 0 Height: 0 ft 12% State Surcharge - Building 08/16/2012 $25.27
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 08/16/2012 $84.24
Value: $8,200 Info Process /Archiving - Lg $2.00 (over 08/16/2012 $2.00
11x17)
Plan Review 08/16/2012 $136.88
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $535.98
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: 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 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calli , .232.1987 1.800.332.2344.
Issued By: 4 Perrnittee Signature: I S
Call 503.639.4175 by 7:00 a.m. for the next available Inspection d. te.
This permit card shall be kept In a conspicuous place on the Job site until completion of
Approved plans are required on the Job site at the Urns of each Inspection.
Building Permit Application
Commercial . RECEIVED FOR OFFICE USE ONLY
City of Tigard Permit No.: �IDI�,.q� ,
Date/
Pr
B a 1 SW Hall Blvd., Tigard, OR 97223 � ,� I � j 16 2 01 P Review ;� `�����
Phone: : 503.718.2439 Fax: 503.598.1960 Re ceive d •
60 r�a� d Date/13 : `1//` � Other Permit:
TIGARD Inspection Line: 503.639.4175 CraOF 1111.1['�RD Date Ready luris:I (7. El See Page 2 for
Internet: www.tigard - or.gov BUILDING DMVISlO Notified/Method: �` r Supplemental Information
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
Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ I- and 2- family dwelling 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: (5 ` F is.144. New dwelling area: square feet
City /State /ZIP: 14 ) o'& Garage /carport area: square feet
Suite/bldg. /apt. no.: 11S Project name: gj iL— )�. Covered porch area square feet
Cross street/directions to job site: lAIG 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.
D 5 • P1z*�' -rt) )i T Valuation: S ZOO �-
Existing building area square feet
/ New building area: square feet
E
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 3' e:1;7- - ,1N wigs Type of construction:
Address: l`2�J .may, �v% sr ) l'�'�1 Occupancy groups:
City /State /ZIP: p 0 ( eig. or/1M Existing:
Phone:., s--71.13 Fax: ( 024 — C':I!L�'j New:
irtiPPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee
name: ��, �� gg�� e
P'1"L'�TO reetthLe.
. Structural plan review fee (or deposit):
Contact name: c 'j®atia,
Address: s FLS plan review fee (if applicable):
Total fees due upon application:
City /State /ZIP:
QD I C))2. 2460 Amount received:
Phone: (503 2.2.4.- r1 An Fax: : (503 22,6 • 572.1
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: OgiAlpie, o iler / r T V_ S Submit two (2) sets of roof plan with connection details
v, v �1 r j.�"`r and fire department access, along with the 2010 Oregon
� tiJ ' '^i
Address: 17� r6 Solar Installation Specialty Code checklist.
Op 11 � Permit fee ( includes plan review
City /State /ZIP:
�� l 1� 1 � and administrative fees): $180.00
Phone: (n 1� - LJIQ Fax: ( gldg. r6os1i State surcharge (12% of permit fee): $21.60
CCB lie.: f 6
i !! Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: . 3A )��1/� Date: ico qz,
* Fee methodology set by Tri- County Building Industry
1 Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I I/02 /COM/WEB)
1 ° Building Division
Over - The - Counter (OTC) Building Permit
T l c n k Check List
Project Description: T( 81,9° (O - U` 0a(o tf
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: AT Occupancy Group: 5- I Type of Construction:
*Type of Use: Occupancy Load: Oregon Specialty Code: ZQ(C)
SPECIFICS
Number of Stories: I 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: Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ c 2CO, CC FEES DUE
$ (7, OD DC Prov Rvw, COM TI — Ping
$ 10, Cf3 DC ProvRvw, COMTI —LRP
DC Provision Review Fee for COM TI $ '2(0 . Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 25.2- 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 4 Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ frilM Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ Z, 4'6 Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $268.00 $39.00 $ 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: $ _.5 ' 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.docx 07/01/2012
o ° Building Division
Development Code Provision Review
T i c n - Commercial Projects - No Associated Land Use Case
Building Permit No: Cwt! 1-' / T ❑ Expedited Review
Plan Submittal Date: l �(P
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 4 at 503 -718- Z�y or @ tigard- or.gov)
Zoning - P Permitted Use Yes .2 No ❑
p --Y.and Use Required: Yes ❑ No (explain below)
Notes: �w
Al, N i le �cl TJ
Approved 0 Not Approved Date: 5i— 6 t 2 —
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert@tigard - or.gov)
Notes:
Routed back to Building Division Date:
I: \CURPLN