Permit ice'
CITYOFTIGARD BUILDING PERMIT
P ERMIT #: BUP2003 -00702
,, DEVELOPMENT SERVICES DATE ISSUED: 12/24/03
III!
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12323 SW 66TH AVE PARCEL: 2S101AA -06400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: C -G
BLOCK: LOT: 024 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 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: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 78 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N SMOK DET:N
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 10,000.00
Remarks: Enlarge Break Room
Owner: Contractor:
DICK SOUTHARD JOSEPH HUGHES CONSTRUCTION
20400 NE 122ND ST 7035 SW HAMPTON
BRUSH PRAIRIE, WA 98606 TIGARD, OR 97223
Phone: 360- 256 -5764
Phone: 503 - 624 -7100
Reg #: MET 44 00 g 0 gq 011914
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 12/24/03 $139.30 Electrical Permit Required
[TAX] 8% State Surcharl 12/24/03 $11.14 Framing lnsp
FLS FLS Pln Rv 1 2/24/03 $55.72 Gyp Board
nsp tion
[FLS] Final Inspection
[BUPPLN] Pln Rv 12/24/03 $90.55
Total $296.71
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: `f" / %
Pe rm ittee T/
Signature: 'I. 4 � Ai
Call 639 -4175 by 7 p.m. for an inspection the next business day
c
Building Permit Application FOR OFFICE USE ONLY
Received ' Building / I
Date /By: i a- �a ' i/05 6 ) L v Permit No.: �O 7 -07O
City g
CIt of Tl and Planning Approval r((r 2� Other
Date /By: IJ Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.: "'
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 �tl " , 4 j�i Post-Review
Case d Use
Internet: www.ci.tigard.or.us
24 -hour Inspection Request: 503- 639 -4175
Contact Juris.: Su See Pen for
P 9 NameiMethod: Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
ig 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 N Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
❑ overhead and profit for the work indicated on this application.
111 Accessory Building Multi- Family
❑ Master Builder ❑ Other: Valuation s
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: / A. 3,1 3 5 W 4,411 Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /1t. #: Garage /carport area (sq. ft.)
Project Name: Va. /k M. c.-13 -1 "3 v us -C C Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: 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,
4 I re w h" is
overhead and profit for the work indicated on this application.
1.0 e /'57� 5, 4.-C G • Valuation $ rU/ 00 0
/ Existing building area (sq. ft.) u-i 4
New building area (sq. ft.) /AV
Number of stories ikr
m PROPERTY OWNER < 1 TENANT Type of construction J NI
Name: *D i GK 0" Occupancy group(s): Existing: it - 3
Address: 02 a 1 10 A/E ?. " - I S ' New: h ,
City /State /Zip: !1 rKsi( t'r4)l C A.0- f $ 06
Phone:340 12 Fax: no c -3 Kr / f 9 X NOTICE: All contractors and subcontractors are required to be
APPLICANT CONTA T PERSON licensed with the Oregon Construction Contractors Board under
,/ provisions of ORS 701 and may be required to be licensed in the
Business Name: J'p S 50 it 4 eS Co t/ • jurisdiction where work is being performed. If the applicant is exempt
tat" Contact Name: 37 t". /(� p or from licensing, the following reason applies:
Address: 7033" S w G )�0 Si-,
`
City /State /Zip: 1 a-'-- , D 17,2 A3
Phon40.3 - bd r- 7 00 Fax:503 - 6i :S'. YS
*
E -mail: d tv,,U6act• *-r e oe4.4.A, - Lo w BUILDING PERMIT FEE
CONTRACTOR / Please refer to fee schedule.
Business Name: 5 o -� 8 1 4 a 0" C_ Fees due upon application s
Address:
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB L / s (v y
Signature: � y�
,? Notice: This permit application expires if a permit is not obtained within
Si nature: ��/ J�/y� Date: 180 days after it has been accepted as complete.
ea- ✓ 1/ de"'"" C - *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01 /03
illf Plan Submittal Requirement Matrix
Commercial & Multi- Family
City of Tigard New, Additions or Alterations
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
Building 1*
Fire Protection System 3 **
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.
is \Building \Forms \PlanSubMatrix.doc 04/03
CITY OF TIGA.BDL 24 -Hour
BUILDING - 411011rispection Li 503) 639 -4175 MST
INSPECTION DIVISION . Business Li (503) 639 -4171
Received 4_ -2 i ( I �` Date Requested / 2 .69 PM BUP
Location / Z 3 Z 3 �� Suite MEC
Contact Person G Ph ( S a■ 2 O / - SQ 3 7PLM
Contractor iNALliA Ph ( nn ) SWR
BUILDING Tenant/Owner - cRJL1A/'J -A --- _. • ELC
Footing
Foundation ELC
Access:
Ftg Drain 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 � J
Roof - 1
_ / _
i fi rm m. •
. PART FAIL 111111,111S; �� -�I_
•
P = ING
Post & Beam ®
Under Slab
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
-
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In •
UG/Slab
Low Voltage
Fire Alarm
Final 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 111 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
\ \ A_pproach/Sidewalk Date / lP 0 L/ Inspector Ext
`Other:
anal DO NOT REMOVE this Inspection record from the Job site.
\ SS PART FAIL