Permit (2) CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00287
A I � DEVELOPMENT H O BMEN SERVICES 639 -4171 DATE ISSUED: 6/3/03
SITE ADDRESS: 11847 SW PACIFIC HWY PARCEL: 1S135DD -00800
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 022 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 6,000 sf N: S: E: W:
TYPE OF USE: COM SECOND: sf • PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: A3 TOTAL AREA: 6,000 sf ROOF CONST: FIRE RET?
OCCUPANCY. LOAD: 286 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: 2 IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 3,000.00
Remarks: Convert retail space to teen night club.
•
Owner: Contractor:
SANOKEE TENANT PER APPROVAL FROM OWNER
375 NW GILMAN BLVD STE C -203
ISSAQUAH, WA 98027
Phone: 425 - 391 -0570
Phone: 425- 391 -0570
Reg #: LIC 00013125
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 5/22/03 $72.10 Electrical Permit Required
[TAX] 8% State Tax 5/22/03 $5.77
Plumbing Permit Required
BUPPLN Pin Rv 5/22/03 $46.87 Framing Insp
[ ] Gyp Board Insp
[FLS] FLS Pin Rv 5/22/03 $28.84 Final Inspection
(additional fees not listed here)
Total $2,073.58
•
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 than 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 -01 • Tolig BAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling .13) 246 -6699 or 800 - 332 -2344.
Issu - • By: - •
S it
Signature: re:
Call 639 -4175 by 7 p.m. for an inspection the next business day
•
/ /9 5 4ki PAC �f w
4 u�� i n g Per 1� FOR O FFICE USE ONLY
Received / Building A P )-
LL���VI�L Date/By: ,J9 ?-2-1 �J Permit No.: b 00 .9 - CVO-0 /
Planning Approval Other j
City of Tigard
Date/By: Permit No.:
13125 SW Hall Blvd. MAY 22 2003 Plan Other
Tigard, Oregon 97223 CITY OFTIGARD / � Date/By:6 Permit No.:
�n, f it f\ Post - R Land Use u
Phone: 503 - 639 -4171 Fa sI�Qt�b l ISI_i� �d � .' l l I Date/By: Case No II" O a a2 o7
Internet: www.ci.tigard.or.us Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition I & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ® Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building LI Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 1%1541 S W h4,C. 4,,, rt arg OR Total number of floors
S New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: Xe, W CS4 Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Coyn U e.- o Q. Ar pito a Ir P,c.► C rt c. Awl OU e Other structure area (sq. ft.)
bLoc\ E. o Sr l�pt1� % 1�. • REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: I Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK . the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
A_Q- 1‘4 Irv.) n Me*" - loeArt1Nq uaal.,5
'DS 130,AV. Ante- Si. Ay- Valuation $ .3 O
J Existing building area (sq. ft.) _ (0 ftb0,{t
New building area (sq. ft.)
Number of stories /
IN PROPERTY OWNER I ❑ TENANT Type of construction
Name: Occupancy group(s): Existing:
San>'ok .ea: New: 4J
Address: 21 S Nto Gilinkt4 I1vL Sara C
City/State/Zip: MSSA4 j Lot; Lot; ettea.
Phone: 1 0.5 - .191 •4' L Fax: 4,5-4411-33,64 NOTICE: All contractors and subcontractors are required to be
® APPLICANT tt ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: Xectoe l4 Loest jurisdiction where work is being performed. If the applicant is exempt
Contact Name: G^etV G Gk,les from licensing, the following reason applies:
Address: li`Jy1 SW ThACtc-tC Att.0.01%tA
City /State /Zip: 1,410,4 3 6/k 511.3...
Phone: S03 CtI,W 06 603
5 BUILDING PERMIT FEES*
E -mail:
XGh701J 3t # Q ms h • C AM Please refer to fee schedule.
CONTRACTOR
Business Name: - Teo e.NA$- Fees due upon application $
Address: 13941 Sw 10 Q,vt
City /State /Zip: Tttgpra Oil- T1 5.9.3 Amount received $
Phone: 6703 Gibe 05 Fax: Date received:
CCB Lic. #:
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: C Al-o...3 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name) 7a . 10 5, , 7 - _ 8
\P
is \Dstsermit Forms\BldgPermitApp.doc 01/03 4 (� , g7 Ag • 6 ' ' l5 31
Commercial Plan Submittal
JP Requirement Matrix
City of Tigard
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2 f `
Building 1*
"'
i . . i i ;' 1 • . /- i
'' Fire Protection System n }-. +
f . '
f : Mechanical 2
1
4C.1:4,, ,.,
a�4 • � C. : tII. • • , R' 7
Plumbing - Building Fixtures ... f_ ,•�..- WV
Electrical .I. ,. • ?. ;
,". . it ;";
Plan review is dependent upon submittal of a completed applicatior fter
plan review approval, the Plans Examiner will con -t the applic�an }' requ
f t ; `
additional sets of plans for distribution purposes '(for Contractor, City o f tigard,, "
Washington County, and Tualatin Valley Fire & Rescue). „,,:i •.
I :.
*For over - the - counter commercial tenant improver nt ;submit 2.sets° pf plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engirteer, AIICET level ' 3" technicians
is \dsts \forms \COM- matrix.doc 9/24/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION ' Business Line: (503) 63E04171 MST
BUP _7) _�aa87
Received / / Date Requested 7--/t AM PM BUP
Location /1 0 i � -i Suite MEC 3 -0° 3 77
Contact Person Ph ( ) `f (13 3b 3c. PLM
Cow Ph ( ) SWR
IILDI Tenant/Owner ELC
, o
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other
na
r S PART FAIL
PL MBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P• :T FAIL
s a: eam
Rough -In
Gas Line
Smoke Dampers
ii"'
PART FAIL
7 RI CAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay - C• :II, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: , e to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7 / ///0 3 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL