Permit n CITY OF F TIGARD I GA BUILDING PERMIT
., ► PERMIT #: BUP2007 -00306
COMMUNITY DEVELOPMENT DATE ISSUED: 6/29/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-04100
SITE ADDRESS: 11850 SW 67TH AVE 200 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: Fire alarm
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 3N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 7,400.00
Owner: Contractor:
LEISER, ANNE TRUSTEE CAPITOL ELECTRIC CO, INC.
6009 SW PENDLETON CT 11401 NE MARX STREET
PORTLAND, OR 97221 PORTLAND, OR 97220
Contact #: PRI 503 - 255 - 9488
Phone: FAX 503 - 255 -1966
Reg #: LIC 48748
FEES
REQUIRED ITEMS AND REPORTS
Description Date Amount
[BUILD] Permit Fee 6/29/2007 $120.10
[TAX] 8% State Surcha 6/29/2007 $9.61
[FLS] FLS Pln Rv 6/29/2007 $48.04
Total $177.75
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.
By: : Permittee Signature: y 41 . - r!��G
Issued y �\
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.
Building Permit Au 'c ion g ,y ° ' yoR,oFFICEIUSE oNP • ` // c'ii „ eax. .w-. * rc Nw.NhffrlAwiF.. r+fa -wc ?c '. 'G , -•• k "_ f s ..
City of Tigard } 13.3,1a Re eiv t Y 07 r / Permit No.: 13125 SW Hall Blvd., Tigard, OR Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 j �� Date /By: Other Permit:
p JUN 08 2007
Inspection Line: 503.639.4175 l � ( :, Date Ready/By: luri ' ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified /Method: 7"( a Supplemental Information
CM( OF 1T1 iA
c r t REQUIRED DATA: 1- AND 2- FAMILY DWELLING
New construction Demolition &A IM L r Permit fees* are based on the value of the work performed.
/.1
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 CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ® CommerciaUindustrial
❑ 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: 11850 SW 67 AVE New dwelling area: square feet
City/State /ZIP: TIGARD, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. notSUIT°E'2001 Project name: AMERICAN FAMILY INS., T.I. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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.
INSTALL TENANT FIRE ALARM DEVICES PER PLANS Valuation: $7,400.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New: B
APPLICANT ❑ CONTACT PERSON NOTICE •
Business name: CAPITOL ELECTRIC COMPANY, INC. All contractors and subcontractors are required to be
Contact name: DAN WILSON licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11401 NE MARX STREET jurisdiction in which work is being performed. If the
City /State /ZIP: PORTLAND, OR 97220 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 255 -9488 Fax: : (503) 255-1966
E -mail: dan @cepdx.com
CONTRACTOR
Business name: Capitol Electric Company, Inc.
p BUILDING PERMIT FEES* •
Address: 11401 NE Marx Street
Please refer to fee schedule.
City/State /ZIP: Portland, OR 97220
Fees due upon application
Phone: (503) 255 -9488 Fax: (503) 255 -1966
Amount received
CCB lic.: 48748
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: DAN W. WILSON Date: 6/6/07 * Fee methodology set by Tri- County Building Industry
Service Board.
is\ Building \Permits\BUP- PemritApp.doc 12/03 440-461 3T( 1 I /02 /COM /WEB)
CITY OF TIGARD. ,
--BUILDING DIVISION , PERMIT #: IBUP2007 -00306
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6129/ 2007
Phone: (503) 639 -4171 ,
Inspection Requests (24 Hrs.): (503) 639 -4175 .411P
INSPECTION WORKSHEET FOR DATE: 8/23/2007 TIME: 7:OOAM ' PAGE: 43
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Fire alarm
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO, INC. PHONE #: 503.255 -9488
Inspection Request Scheduled For: Date: 8/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 054504 -03 971-506-3072 N
Corrections /Co/
v i : PASS is /Instructions:
#-------
' "A RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL Ir /", ' LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: rill.. Date:/. Phone #: (503) 718- ZCV