Permit CITY OF TIGARD BUILDING PERMIT
1111 — COMMUNITY DEVELOPMENT Permit#: BUP2015-00223
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/23/2015
Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 165
Project: American Lung Association Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: TI-Add(4)offices,(1)storage room&(1)coffee bar.
Contractor: PACIFIC CREST STRUCTURES INC Owner: OREGON STATE BAR,THE
17750 SW UPPER BOONES FERRY RD SUITE 16037 SW UPPER BOONES FERRY RD
190 TIGARD, OR 97224
DURHAM, OR 97224
PHONE: 503-968-8949 PHONE:
FAX: 503-598-6658
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: I IB Permit Fee-Additions,Alterations, 07/23/2015 $652.31
Demolition
Occupancy Grp: B Occupancy Load: 21 12%State Surcharge-Building 07/23/2015 $78.28
Dwelling Units: 0 Plan Review 07/23/2015 $424.00
Stories: 3 Height: 0 ft Plan Review-Fire Life Safety 07/23/2015 $260.92
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Lg$2.00(over 07/23/2015 $4.00
Value: $42,350 11x17)
DC Provision Review,COM TI-Ping 07/23/2015 $88.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,507.51
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done . •-. e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day •TTENTION: Ore.• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth"in OAR
9• -001-0010 through OAR 9 •-001-s••0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234
•sued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-- Utldin2 Permit Application
Commercial RECEIVED FOR OFFICE ESE ONLY
City of Tigard Received ,A is Min Penult No.-C. 0,,,, —i.,at
13125 SW Hall Blvd.,Tigard,OR 97 3 Plan Review "Ili I
a Phone: 503.639.4171 Fax: 503.59$ 2 3 2015 Date/By:
I other Permit:
T I c.n I;[) Inspection Line: 503.639.4175 Date Ready/By: rod': 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TICARD Notified/Method: Supplemental Information
BUILDINn flVLSION
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
ID
construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
>TAddition/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 X Commercial/industrial Valuation: S
❑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: /0p3 7 54, v �y#, �j ites /Iew dwelling area: square feet
City/State/ZIP: 777,‘,1, 0,/e. t ,?22 3 Garage/carport area: square feet
Suite/bldg./apt.no.: ,9 Project name: norenk-on itefij Covered porch area: square feet
Cross street/directions to job site: eiSt G . 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.
4 ./J 6/) / t r . /*- I A i Valuation: S v2/
old ah� /! GD _ / _ _ _ Existing building area: �3 !� square feet
s!� ( �-(/� New building area: RD,htiore feet
X PROPERTY OWNER
L ❑ TENANT Number of stories: h� 1/�
Name: /j e1 GL s1 C .13A-b- Type of construction: 1/8 5��iht-e
Address: V/b e 3 7 S Gv g� ARoQ�,( i Ci 1/G eJ Occupancy groups:
City/State/ZIP: 77fez, d "/� �J Existing:
Phone:(03)/17.0 O Z 2:2_, Fax:( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: T/ sty/ Iiii G rfjv All contractors and subcontractors are required to be
Contact name: ,,/� licensed with the Oregon Construction Contractors Board
��u"`� „....60/14.7 under ORS 701 and may be required to be licensed in the
Address:/O0 BD k {p jurisdiction in which work is being performed.If the
City/State/ZIP: �A' l D/e I ?jr� applicant is exempt from licensing,the following reasons
..R Iry apply:
Phone:(53) 78/ &;, 77'G / I Fax::( )
E-mail: issi/n, e 7 Wets/fa/FDA, , Ga” 7
CONTRACT ,�( -
Business name: / ,'/G Comas�• S%l7,fGT/ ��ryC/ BUILDING PERMIT FEES*
Address: /7 7.5- ) 5 ,/ ,80,71e k".- �/(TO
(Please reef'w fee deposit):
mrle)
`/ Structural plan review fee(or deposit):
City/State/ZIP: iulih?v d27 ,p,7Z2 y - -
u FLS plan review fee(if applicable):
Phone:(5-23,3 !zr� � 7 Q s Fax:( )
ZIle �'.5--• Total fees due upon application:
CCB lic.: L�
Authorized signature: f ao Amount received:
!� This permit application expires if a permit is not obtained
. within 180 days after it has been accepted as complete.
Print name: Lis, dic S ,J/ Date: 7, L3 . ! s- * Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP-COM PermitApp.doc 2/23/07 440-4613T(11/02/COM/WEB)
1111 ' Building Division
Over-The-Counter (OTC) Building Permit
T I G A R D Check List
Project Description: . (
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: Group: Type of Construction:
Type of Use**: Occupancy Load: Oregon Specialty Code: `2){2E.
SPECIFICS
Number of Stories: S 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: vE3 Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
'Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: Battery Calcs Provided:
Density: Cut Sheets Provided:
Design Area:
K Factor:
Total Project Valuation: $ fa 13'50—
$ DC Prov Rvw,COM TI-Ping
$ 4;62-:31 Permit Fee-Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2015) $ z-4 5.Z 12%State Surcharge
Project Valuation Planning $ .Q0 Plan Review,Structural
Up to$4,999 $0.00 $ Zrob,'9 u'lan Review,Fire Life Safety
$5,000-$74,999 $88.00 $ 4, Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $220.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $351.00 $ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
$ Other:
Building Staff: $ Other:
Date/Time: $ ! O7 5( TOTAL FEES DUE
*TYPE OF USE: COM=commercial;CMS=commerciaranufactured structure.
**CLASS OF WORK ACS=accessory;ADD=addition;ADU=accessory dwelling unit;ALT=alteration;DEM=demo;NEW=new;
OTR=other(use for fences,decks,retainlls,signs,awnings or canopies).
I:\Building\Fortes\OTC_BUP_070115.docx
71 City of Tigard
■
COMMUNITY DEVELOPMENT DEPARTMENT
TI G n K D Building Permit Review — Commercial - No Land Use
Building Permit #: ------Fa-Lt 1' j 3 c 9'2-
Site Address: k ',0 37 S v i u9Per Boone s Ce(vSuite/Bldg#: 1 oS
Project Name: D1'r_000n S4i{- 6etr
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: r Z G cl cA. 1 0 kt w S
Existing Business Activity: CA yr( trc i7t.&, / 0 FGi LL.
Proposed Business Activity: ]m, uq!, / Q ((Gill?,
/Z Verify site address/suite# exists and active in permit system.
-e-River Terrace Neighborhood: ❑ Yes g No
0 Zoning: I P
Permitted Use: A Yes ❑ No ❑ Spec Space
Confirm no land use required.
Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: M 0✓1 i)- ( I L Date: 7/ / I S
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 7/P3("5-
Site Plans: # f)
Building Plans: # -
Building Permit#: "$-Enter building permit#above.
Workflow Routing: u-Planning Dt--Pe . ator iding
Workflow Sign-off: ! Sign-off for Planning include notes from planning review)
Route Application Documents: [a-Building original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: t�
i
By Permit Technician: Date: 7/W-5
I:\Building\Forms\BldgPermitRvw_COM_NolandUse_070915.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT ' - ea- -d: Date:
Notes:
Revisions (after uilding Submittal on
Revision Notice Date Sent to s plica• :
Revision Notice 2: Date Sent to Ap: ' ant:
Revision Notice 3: Date Sent to :.lic, •t:
❑ SDC Fees Entered: Wash Co ' .ns Dev Tax: - ❑ N/A
Tigard rans SDC: ❑ Yes ❑ N/A
Par . SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_070915.docx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16037 SW UPPER BOONES FERRY RD 165,
TIGARD, OR, 97224
Commercial - Building
275 Framing
PASS
BUP2015-00223
Jeff Grove
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16037 SW UPPER BOONES FERRY RD 165,
TIGARD, OR, 97224
Commercial - Building
299 Final inspection
PASS - C of O
BUP2015-00223
Jeff Grove
Violation Summary:
Inspector Contractor