Permit CITY OF TIGARD BUILDING PERMIT
INI I: COMMUNITY DEVELOPMENT Permit #: BUP2013 -00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2013
Parcel: 2S101AD00800
Jurisdiction: Tigard
Site address: 12550 SW 68TH AVE
Project: Heintberger Payne Subdivision: WEST PORTLAND HEIGHTS Lot: 26
Project Description: Interior demolition prior to tenant improvement
Contractor: OWNER Owner: BHKZ LLC
HEINTZBERGER PAYNE & CO LLC 12600 SW 68TH PKWY
12511 SW 68TH AVE PORTLAND, OR 97223
TIGARD, OR 97223
PHONE: 503 - 597 -1621 PHONE: 503 - 546 -4151
FAX: 503 -597 -1649
Specifics: FEES
Description Date Amount
•
Type of Use: COM
Class of Work: ALT Type of Const: �/g Permit Fee - Additions, Alterations, 06/13/2013 $271.43
Demolition
Occupancy Grp: B Occupancy Load: 39 12% State Surcharge - Building 06/13/2013 $32.57
Dwelling Units: 0 Plan Review 06/13/2013 $176.43
Stories: 1 Height: 0 ft Info Process /Archiving - Lg $2.00 (over 06/13/2013 $4.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $12,600
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0 '
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $484.43
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes 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. ATT N: •r- r •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 through OAR • 0090. You may obtain a copy of the rules or direct questions to OUNC by ca n, 503.232.1987 or 1.800.332.2344.
Issued y: , 6 1/' i 1 . Permittee Signature: ' AIM. 1� 4
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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
Commercial RECEIVED FOR OFFICE USE ONLY
ece
Ilq City of Tigard R DateB ived : 4 Perm No. ■ roi 3-.00/ 5
q 13125 SW Hall Blvd., Tigard, OR 97223 I 11 1 3 2013 Plan Revie • ► . Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : �M
��
I . I G D Inspection Line: 503.639.4175 CI OI��Gt71[ Date Ready/By: funs ® See Page 2 for
Internet: www.tigard or.gov t71[lJ Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
``'' ,�(ncae e vaue (rouned to e nearest doar) o a I.Uat:{�l i .= p-0V eq materials , labor overhead , and t ll pr ofit f ll
❑ Addition/alteration/replacement ❑ Other: Te. for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- 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: I2_S5 54k1 6S'- AVE' New dwelling area: square feet
City /State /ZIP: fl GA.. P.— t Q r-,p}J S) 1'2 -3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Arc..1 IJYfZI (�Q4,GP_PA 1 [ Covered porch area: square feet
Cross street/directions to job site: /- ` � I' i Deck area: square feet
5W L'S`- ® l9t�Z��. Sr Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: I Lot no.: 800 Permit fees' are based on the value of the work performed.
Tax map /parcel no.: TJ (�'D 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. y
1) E Nl0(� n (v� = ��us 4 _ (N -eo0 -- Valuation: $ 2 t (p oo , °� /
(S 1 Wp tt)(7 1 — ` t� :'p . f Existing building area: II f ( o t -I'l square feet
Let ) • TL a-1 New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories: '
Name: 13114( ■ 1--L—C Type of construction:
Address: I2,(0010 5 W (o p,• ' Occupancy groups: .- e: 0 0S( >`Je5I &mop 5
City /State /ZIP: - c D t O Z 91 2'Z 3 Existing:
Phone: ( 503 54L, ^1)Sf Fax: 603 S4 4 vi. l New:
❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
Business name: ` oDrcQa3 , �es(('}� (Pleaserejerro(eesclredr•le)
' rl� ^ 5 C J Q PET? Structural plan review fee (or deposit):
cw
Contact name: t -—1
Address: I IL O N< (� - 5T12 - 1" L— FLS plan review fee (if applicable):
City/State /ZIP: -p p Q Z 91 Zp9 Total fees due upon application: / /
� 01 Amount received: f9'9 • y3
Phone: (503) 5 3Cl -(,,,1 ( P I Fax:: ( ) !—
E -mail: C hy4S 0 Vl55C ¢_le 'p [�yY1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted ' •otoVoltaic Solar Panel Syste •
Business name: E, ? �CD/ _ _ FAII NE, S L.L.L. Submit two (2) sets o •of plan with conne ••n details
` WW�� ' and fire department access, ' ong wi • e 2010 Oregon
Address: 1 2 _st ( StU tags ' Solar Installation Specialty Cs • c ecklist.
City /State /ZIP: Permit fee (incl • plan re w
����� �� Z?'3 a • : iministrative fees): $180.00
Phone: ( 50is £ 7 / Fax: (SQ)� S9'� t (o p
7 State c arge (12% of permit fee): $21.60
CCB tic.: ` 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.
/ , t n t o \ r-fN Q r•(1 / L I 1 I �13I '' Fee methodology set by Tri -County Building Industry
Print name: £_4r; � S s 1J rGF� F7Cr`-�3 _ Date: ` 1 .�I
Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(1 I /02/COM/WEB)
1,1 Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: - AT CLT —1&T(C &) IcEM )
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: lT Occupancy Group: Type of Construction:
*Type of Use: - - Occupancy Load: 41 Oregon Specialty Code: 20(0
SPECIFICS
Number of Stories: ' 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: t ? Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 2 -760C ) I FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 2: ,4-j Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ , 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 1 76 Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ 4,c-r, 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: $ 4414:3 TOTAL FEES DUE
•
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; CND = foundation; DEM = demo;
l ND = 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 07/01/2012