Permit C ITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2006 -00403
1��� , DEVELOPMENT SERVICES DATE ISSUED: 9/14/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S102BD -01900
SITE ADDRESS: 12920 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: HUDSON PLAZA LOT: OOD JURISDICTION: TIG
Project Description: Restroom, equipment room.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: NEW FIRST: 426 sf N: NR S: NR E: NR W: NR
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: N S: N E: N W: N
OCCUPANCY GRP: F2 TOTAL AREA: 426 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 1 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: 13 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 100 psf LEFT: 20 ft RGHT: 20 ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: 20 ft REAR: 20 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: 1 IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 16,017.60
Owner: Contractor:
HENDERSON, MARILYN DOROTHEA MARLAND HENDERSON CONST.
JENSEN HUDSON TRUSTEE 12950 SW PACIFIC HWY #225
11795 SW KATHERINE ST TIGARD, OR 97223
TIGARD, OR 97224
Phone: Contact #:
Reg #: LIC 70266
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
Refund - [BUPPLN] Pln 9/13/2006 - $74.29
Refund - [FLS] FLS Pln 1 9/13/2006 - $45.72
[BUPPLN] Pln Rv 8/24/2006 $208.52
[FLS] FLS Pln Rv 8/24/2006 $128.32
(additional fees not listed here)
Total $804.75
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 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
CITY TIGARD BUILDING PERMIT
PERMIT #: BUP2006 -00403
-�,� l DEVELOPMENT SERVICES DATE ISSUED: 9/14/2006
+r -- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102B D - 01900
SITE ADDRESS: 12920 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: HUDSON PLAZA LOT: OOD JURISDICTION: TIG
Project Description: Restroom, equipment room.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: NEW FIRST: 426 sf N: NR S: NR E: NR W: NR
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: N S: N E: N W: N
OCCUPANCY GRP: F2 TOTAL AREA: 426 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 1 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: 13 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 100 psf LEFT: 20 ft RGHT: 20 ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: 20 ft REAR: 20 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: 1 IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 16,017.60
Owner: Contractor:
HENDERSON, MARILYN DOROTHEA MARLAND HENDERSON CONST.
JENSEN HUDSON TRUSTEE 12950 SW PACIFIC HWY #225
11795 SW KATHERINE ST TIGARD, OR 97223
TIGARD, OR 97224
Phone: Contact #:
Reg #: LIC 70266
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
Refund - [BUPPLN] Pin 9/13/2006 - $74.29 - -
Refund - [FLS] FLS Pin : 9/13/2006 - $45.72
[BUPPLN] Pin Rv 8/24/2006 $208.52 ' b -�
[FLS] FLS Pin Rv 8/24/2006 $128.32
(additional fees not listed here) 1
Total $804.75 f
C /Y1-0 (2.m. ,,
- c -4o-'4 aJ )
This permit is issued subject to the regulations contained in the Tigard Municq ,
applicable law. All work will be done in accordance with approved plans. Thi; � 's of
issuance, or if work is suspended for more than 180 days. ATTENTION: Ore ' .- i
Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 copy
of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1 -800J
Issued By: LT=LISLI Permittee Signature: f
wr
Call 503 - 639 -4175 by 7:00 a.m. n ins. • ction that business day.
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.
Buildine Permit Applicatiol i* '-"` ''':
hc11i r11- vsa: oN1.N
City of Tigard Receiv.- DateBY - �'" Permit No..
13125 SW Hall Blvd., Tigard, OR 97223 r( � ;, i . . 2006 Plan Revi = �� � � J �� ,/ l
: .. Phone: 503.639.4171 Fax: 503.598.196NU G D . - • 3•Q4 /P V Other Permit:
T l G AR D Inspection Line: 503.639.4175 Date Ready/By. • _ ' See Attached Checldist for
Internet: www.tigard- or.gov i^-- Notified/Method / /6 1 Supplemental Information
� F 1 <-N;,,,; �t 0(�) c2.� 1\e53e)A
TYPE Oi 'WORK REQUIRED DATA I- 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 CON CTION work indicated on this application.
❑ 1- and 2- family dwelling Commercial /industrial
Valuation: S
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATIOY t Total number of floors:
Job site address 12 920 <Iu.D 1 t .f c l ti, (.4 New dwelling area: square feet
.
City /State/ZIP: A A-Q. '. 01 - 2 ,C /—C>1 eN4 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: { I vc-D D PL..et -z \ l. Covered porch area: square feet
Cross street /directions to job site: VL9 kt ��� Deck area: square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL -USE CHECICLLST
Subdivision: Lot no.: Permit fees' are based on the value of the work performed.
Tax snap /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
Valuation: /d * DNA S t
� p 641, (_ ( ( 601 0- Existing building area: square feet
/ `E.p%s -ak Ak. / y / d� 4- -P. R New building area: ,V square feet
❑ PROPERTY OWNER I ❑E / T Number of stories: (
Name: V - Q.c.4.m. (p t1/2 ( Type of construction:
Address: ( l . . 5 G � (. ! CC, Occupancy groups:
City / State/ZIP: CZ 440 C Q 91 Z.S. Existing:
Phone: () - ��^� S Fax: (6 .46 , 3 ?` � 6,3, (� 3 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
& NTV
Business name: (' j \ All contractors and subcontractors are required to be
Contact name: 1 ki )?..„ licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: l I S 5 (J3. -k-- { S jurisdiction in which work is being performed. If the
City /State/ZIP: it-- I C1 �0 0 p c applicant is exempt from licensing, the following reasons
l apply:
Phone: ( g) D .... f / g 7 Fax: : (S 6" --31
E -mail: �c- (7 (kc ® 14_ . D • t CDaivt
CONTRACTOR
Business name: NAkiA )J0 Draw &C 4: d I BUILDING PERMIT FEES*
Address: 12 u3 — - 3 - (Please refermjees:heduk)
` v Structural plan review fee (or deposit): � N Y'
City /State/ZIP: Ti. C )>�D 0 e c J� �22'5 J
qq�.,, ' FLS plan review fee (if applicable):
Phone: �� - yy : 3 ' - � ) S - ` J .. Fax: (S ) .,, 3 — 0346,6
CCB tic.:
Total fees due upon application:
i
�/ / /'� Amount received: ��?,(
Au orized signature' This permit application expires if a permit is not obtained
......411 within 180 days after it has been accepted as complete.
Ni■ Print name: iI "/j CIIM Date: ; _ IMO ' Fee methodology set by Tri- County Building Industry
Service Board.
■ I \Building \Permits \BUP- PermitApp.doc 0321/06 440 -4613T(I I /ObCOM/WEB)
. . .
....,....": 7 111 a " ' Building Division
System Development Charges
T I G n R D 1/1/2006
Type of Submittal ' # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished) ... r. •
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
• . • Building 1*
Fire Protection System 2 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington
County, and Tualatin Valley Fire & Rescue)
* For over -the- counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
I:\ Building \Forms \COM- PlanSubRcgMatrix.doc 06 /29/06
I
CITY OF TIGARD 9/13/2006
Il IN 13125 SW Hall Blvd.
Fees Associated With 10:36:11AM
C .
Tigard, OR 97223 (503) 639 -4171 Case #: BUP2006 -00403
TIGARD
Fee Start End Revenue Created
Type Date Date Description Account Number By Date Amount Due
PLCK 1/1/1990 12/31/2020 [BUPPLN] Pln Rv 245- 0000 - 433000 BLD 8/24/2006 208.52 0.00
FIRE 1/1/1990 12/31/2020 [FLS] FLS Pln Rv 245- 0000 - 433020 BLD 8/24/2006 128.32 0.00
PRMT 1/1/1990 12/31/2020 [BUILD] Permit Fee 245- 0000 - 432000 BSB 9/12/2006 a 206.50 86.49
5PCT 1/1/1990 12/31/2020 [TAX] 8% State Surcharge 100- 0000 - 207020 BSB 9/12/2006 16.52 16.52
CDCB 12/28/2004 12/31/2020 [CDCBLD] CDC Bld Rev 245- 0000 - 433060 BSB 9/12/2006 140.50 140.50
CDCP 12/28/2004 12/31/2020 [CDCPLN] CDC Pln Rev 100 - 0000 - 433060 BSB 9/12/2006 140.50 140.50
LRP1 12/28/2004 12/31/2020 [LRPF] LR Planning Surcharge 100- 0000 - 438050 BSB 9/12/2006 41.00 41.00
EROS 1/1/1990 12/31/2020 [ERPRMT] Erosion Control 100 - 0000 - 207307 BSB 9/12/2006 26.00 26.00
ERPC 1/1/1990 12/31/2020 [ERPLN] Erosn Pln Rv CWS 100 - 0000 - 207308 BSB 9/12/2006 8.45 8.45
ERP2 1/1/1990 12/31/2020 [EROSN] Erosn Pln Rv COT 245- 0000 - 433010 BSB 9/12/2006 8.45 8.45
PLCK 1/1/1990 12/31/2020 Refund - [BUPPLN] Pln Rv 245- 0000 - 433000 CTR 9/13/2006 7 0.00
FIRE 1/1/1990 12/31/2020 Refund - [FLS] FLS Pln Rv 245- 0000 - 433020 CTR 9/13/2006 5.72 0.00
Total Due: $467.91
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Page 1 of 1 CaseFees..rpt
CITY - OF TIGARD P N
BUILDING DIVISION PERMIT #: r31lI?ttt6 (l0€P
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/14/2006
Phone: (503) 639 -4171 - NiilOilly
Inspection Requests (24 Hrs.): (503) 639-4175 , ` __..
I NSPECTION WORKSHEET FOR DATE: 12114/2006 TIME: 7 :p2AM PAGE: 41
SITE ADDRESS: 12920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: OOT.? TYPE OF USE:
PROJECT NAME: HUDSON PLAZA,
DESCRIPTION: ''
Re� equipment ros�t�,.
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: /2/1412006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 041087 -01 503-639-5537 N
Corrections /Comments/ Instructions:
/i�1
I
►_ AT
PASS 1 1 PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL I CALL FOR INSPECTION ❑ ADDITIO AL F ES ASSESSED
\\\ i
Inspector: /'r Date: 0/ Phone #: (503) 718 - CZ
, aili
C O - TIGARD
BUILDING DIVISION t
PERMIT #: E UP2006.00403
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1412006
Phone: (503) 639 -4171 n (
Inspection Requests (24 Hrs.): (503) 639 -4175 l J
INSPECTION WORKSHEET FOR DATE: 10/30/2006 TIME: 7:05AIVI PAGE: 62
SITE ADDRESS: 12920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: Restroom, equipment room.
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
250 Roof nailing 038984 -01 503-639-5537 N
Corrections /Comments /Instructions:
r \ Ad 1 /
Wirialiffl .
, ,..4 , .
PASS n PARTIAL APPROVAL n CANCEL 1 1 NO ACCESS
n FAIL i CALL 'jsR INSPECTION 1 1 ADDITIO AL FE S ASSESSED
Agi Ipi
Inspector: 1 . ' Date: 6 5d (Phone #: (503) 718 - til e3
p wr )
CITY OPTIGARD
BUILDING DIVISION PERMIT #: BUP 006 t�0d103
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/2006
Phone: (503) 639 -4171 , a4 'q� , y p �Il
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 10/17/2006 TIME: 7 :O4AM PAGE: 77
SITE ADDRESS: 12920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: OOD TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: Reslroorn, equipment room.
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/17/2006 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 038303-01 503 - 639-5637 N
Corrections /Comments / Instructions:
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....:- m----m pp. IF 1 %■""
mew&
A ________,
NiNP . Fr
....-- ...,..,,mm r.� / - -rdi 1 , PASS PARTIAL APPROVAL 1 I CANCEL I I NO ACCESS
❑ FAIL C CALL FOR SPECTION 1 1 ADDITI•NAL FEES ASSESSED \ Inspector: 4 Date: 1� 0 • Phone #: (503) 718- Egr--
mor
CITY` OTI`GARD
BUILDING DIVISION PERMIT #: 13UP200G 00403
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9!14/200;
Phone: (503) 639- 4171p „ �iiI�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ��_
INSPECTION WORKSHEET FOR DATE: 10/17/2006 TIME: 7 :0.AM PAGE: 78
SITE ADDRESS: 12920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: Restroom, equipment room.
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/17/2006 Pour Time: 11 : 00
Code # Inspection Description Confirm # Contact # Message
266 Masonry 038302 -01 503-639-5537 N
Corrections /Comments /Instructions:
1
I II` wir
PASS n PARTIAL APPROVAL 1 1 CANCEL NO ACCESS
n FAIL CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: ilk _ ' Date: le al, Phone #: (503) 718 - 2._40
.w
CIT 'TIGARD
BUILDING DIVISION PERMIT #: Do1P00003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/2006
Phone: (503) 639 -4171 !
In Requests (24 Hrs.): (503) 639 -4175 !� - fi__..
INSPECTION WORKSHEET FOR DATE: 10//3/2006 TIME: 7 : 00AM PAGE: 61
SITE ADDRESS: 12920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: (10D TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: R€stroom, equipment room.
OWNER: HFNDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10113/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
215 Footing drain 038115 -01 503.639.5537 N
Corrections /Comments /Instructions:
Ara
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PASS I ° PARTIAL APPROVAL ❑ CANCEL 1 l NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
N ON I
n Inspector: �' ; Date: Phone #: (503) 718- ����
CITY'`OFTIGARD
BUILDING DIVISION PERMIT #: BUP2008.00403
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/3006
Phone: (503) 639 -4171 pdpf�l
Inspection Requests (24 Hrs.): (503) 639 -4175
i INSPECTION WORKSHEET FOR DATE: 101/0/2005 TIME: 7:05AI PAGE: 25
SITE ADDRESS: 12920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: OOD TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: Restoom, equipment room.
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/10/2006 Pour Time: g:ftf3
Code # Inspection Description Confirm # Contact # , Messag-
265 Masonry 037934-01 503-639-5 Y
Corrections /Comments/ Instructions:
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(1U6- ks 6-- ) c A JE-- (s S U (LJS( ' - f
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I PASS ARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
1►.d
Inspector: d r 1 Date: 0 (e)(6) Phone #: (503) 718 -2 A 7 !3
1
CITY OFTIGARD
BUILDING' DIVISION PERMIT #: C3UP i 06-004 �3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/14/2006
Phone: (503) 639 -4171 i "l
Inspection Requests (24 Hrs.): (503) 639 -4175 A IL.
INSPECTION WORKSHEET FOR DATE: 9/20/ 2006 TIME: 7 02AM PAGE: 35
SITE ADDRESS: 12920 SW PACIFIC FIWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: Restroom, equipment room,
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 912412005 Pour Time: 2
Code # Inspection Description Confirm # Contact # Message
205 Footing 037300-01 503 -639 -5537 N
Corrections /Comments /Instructions: , ,,, ,
5 e- - c- - To . 0--0-62(1.6,0__s -- -cA.(
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as ii ,,,, -1 el C .... " y
•
4.e' talIMI
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PASS PARTIAL APPROVAL CANCEL 1 I NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITI• AL FEE. ASSESSED
�i
�, Da te: ' ��C.J Phone #: (503) 718 -
Inspector: /` ( )