Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2013 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2013
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 195
Project: Houston Insurance Agency Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Replace existing door with new door and side light.
Contractor: PACIFIC REALTY ASSOCIATES LP Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300 PHONE: 503 - 624 -6300
FAX: 503 - 624 -7755
Specifics: FEES
Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 05/13/2013 $164.96
Class of Work: ALT Type of Const: IIB Demolition
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Building 05/13/2013 $19.80
Dwelling Units: 0 Plan Review 05/13/2013 $107.22
Stories: 0 Height: 0 ft Plan Review - Fire Life Safety 05/13/2013 $65.98
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Lg $2.00 (over 05/13/2013 $2.00
Value: $6,000 11x17)
Info Process /Archiving - Sm $0.50 (up to 05/13/2013 $0.50
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $360.46
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 issu. • - , or i . •rk is suspended for more the 180
days. AT ION: • -!on law requires you to follow the rules adopted by the Oregon Utility Notif - • -nter. Tho e rules are set forth in OAR
952 -00 010 through OAR • •2 -00 -.190. You may obtain a copy of the rules or direct questions to OUNC by i 03.232. 987 or 1.800. ;32.2344.
Iss ed By: — i Permittee Signature: ,/�'�
Call 503.639.4175 by 7:00 a.m. for the next available ins , ecti date.
This permit card shall be kept in a conspicuous place on the job site unt co • let' • : •1ect.
Approved plans are required on the Job site at the time of each i pec ion.
Building Permit Applicati �_}},,.- r _ D
Commercial ' FOR OFFICE USE ONLY , t
City of Tigard MAY 0 2 2013 Da, S � �A -' Permit No. U PRO/5 -2;10/00 rir 13125 SW Hall Blvd., Tigard, OR 97223
Plan Revie �t� Other Permit:
Phone: 503.639.4171 Fax: 503 ®F TIGARD DateB : � rr��► � � �
TIGARD Inspection Line: 503.639 BUILDING DIVISION Date Read S�/2 / a Jun ®See Page 2 for
Internet: www.tigard- or.gov Notified/Method: r , .) . Supplemental Information
- i9 titt- WI Lo-rt
, - T YPE 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: $
❑ 1- and 2- family dwelling Commercial /industrial _
Number of bedrooms:
❑ Accessory building ❑ Multi- family
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION : Total number of floors:
Job site address: New dwelling area: square feet
P Ru F t. c C �, (4 44er 1 SWS ec�,x;,tz. PKwy
City /State /ZIP: 10,....1-‘atid ` bR criZ7-9- Garage/carport area: square feet
n
Suite/bId /a t. o qsi � B Project name: �S ,v 1... p'► .1.� lr. lt•�nCG A �— Covered porch area: square feet
g' P I
Cross street/directions to job site:' C men 1 ,r. u •_. 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 work indicated on this application.
Valuation: $ / Bt,
'Fe_ e. \Qc e7._ 4trlc c&c z r U.) 1 �' n � or ca A L b 00 '
S; 1 Existing building area:4g square feet
New building area: 1U/A, square feet
PROPERTY OWNER 0 TENANT Number of stories: 3
Name: PacTrust Type of construction: S i,
Address: 15315350 SW Sequoia Pkwy., Suite 300 Occupancy groups:
,City/State/ZIP: , Portland, OR 97224 Existing:
Phone: (503) 624 -6300 Fax: (503) 624 -7755 New: 'N.Vg • i'..: LE/ APPLICANT . ' --: ® NOTICE
CONTACT ;.:s
'_Business name: PacTrust // - ( All contractors and subcontractors are required to be
:Contact name: Pt D c le-ost k_� or or t h t C l-t L 1 t rt t licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe required to be licensed in the
:Address: 15350 SW Sequoia Pkwy jurisdiction in which work is being performed. If the
-.City/State /ZIP: Portland, OR 97224 ppicant is exempt from licensing, the following reasons •
apply:
Phone: (503) 624 -6300 I Fax: : (503) 624 -6300
E -mail: Q-r{cA r . co tr'1
. C .: 4`�„x '. - ; : _
. - , - '
' ^ .ars. *.. �J� ' �4's3 "$- .•: --
Business name: --Pc -k-- ,, " BUILDING PERMIT F'EES''T :t. ' t=
Address: 44 .. , ,,: ` ;' t'" (Please y ::% := '' ", ; a`�s_ ,A
(S 3 To S vJ Se f .. t �' Kw 1 Structural plan review fee (or deposit):
City/State/ZIP: 'FO l a __.., ,A i C) K 9122.4 — —
FLS plan review fee (if applicable):
Phone: ( 6,3) 6 I Fax: (03) 424-17 CS
CCB lic.: l 6 Q( , Total fees due upon application:
1 / Amount received:
A_ uthorized sign.' This permit application expires if a permit is not obtained
` within 180 days after it has been accepted as complete.
P,•rint name: ‘, 't IV Ghl t t 0 t Date: S. 0 Z - ` ■ Fee methodology set by Tri -County Building Industry
Service Board.
I :\Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02/COM/WEB)