Permit CI
TY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00356
Or, DEVELOPMENT SERVICES DATE ISSUED: 7/18/03
'- I " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12965'SW 68TH AVE PARCEL: 2S101AA 08700
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: a...57/ LOT: 029 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 3,665 sf N: S: E: W:
TYPE OF USE: COM SECOND: 3,665 sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 7,330 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 29 BASEMENT: sf AREA SEP. RATED:
STOR: 2 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: $ 100,000.00
Remarks: TI, INTERIOR BUILD OUT OF SHELL BUILDING.
Owner: Contractor:
EDWARD HEINTZBERGER JT ROTH CONSTRUCTION INC
1600 SW 4TH AVE., STE 960 12600 SW 72ND AVE STE 200
PORTLAND, OR 97201 TIGARD, OR 97223
Phone: 503 - 228 -6390
Phone: 639 -2639
Reg #: LIC 31700
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUPPLN] Pin Rv 6/12/03 $483.80 Electrical Permit Required
[FLS] FLS Pln Rv 6/12/03 $297.72 Framing lnsp
In
BUILD P ermit Fee 7 /18/03 $744.30 Gyp Board Insp
[BUILD] Susp Ceilng Insp
[TAX] 8% State Tax 7/18/03 $59.54 Final Inspection
Total $1,585.36
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 -001-0 hrough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling ( 3) 246- 6699'or 1- 800 - 332 -2344.
Issued y : k 4 4 / 4 I /
Perm ittee
Signature: y ii . : � ,,�
Call 9-4175 by 7 p.m. for an inspection the next business day
. /LSos s w 4 TH Ay .
2 _ /y�
Building Permit Application FOR OFFICE USE ONLY
Received Building
1 c 5 ,\/ Date/B : & '/,1 03 66 Permit No.: 0< ?,a9 -003
City of Tigard Planning '_ Approval Other
Date/By J
13125 SW Hall Blvd. 7 ` Plan Rev* f
Date/By: 6 � � (/5
Other -
Tigard, Oregon 97223 h '" Permit No.:
Phone: 503- 639 -4171 Fax: 503- 598A969 OF / "•""'`�� ' ' I'l` Post - Review Land Use
,v ,° o
A 1 Date/By: Case No. 03
Internet: www.ci.tigard.or.us - =',' ;'C - - - • ° Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 - 639 - Name /Method: T IC-t Supplemental Information
_ — g
TYPE OF WORK REQUIRED DATA:
New construction ❑Demolition 1 & 2 FAMILY DWELLING
Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: c ,rmit fees* are based on the total value of the work performed. Indicate
_❑ 1 & 2- Family dwelling ,Commercial/Industrial the vak (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building J Phtlti- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: ��
Job site address: aso5 6P I/6 Total number of floors
A New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: fa7 ' eir — Pf.-0G Covered porch area (sq. ft.) --_'
Cross street/Directions to job site: Deck area (sq. ft.) I
Other structure area (sq. fl.)
ea_416f. OF Sw 4.8-61- 'K g °c.R -h4E REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: 1 Lot #: vct2
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.
Isl > t�l.[ TGltit r[E T
Valuation $ AVALICC)4>
Existing building area (sq. ft.) 7631
New building area (sq. ft.) PA
Number of stories
Ppi PROPERTY OWNER 1 ❑ TENANT Type of construction T .r.
ame: Occupancy group(s): Existing: j
a1eQ ` its ! New: x
Address: Zq 00L
City /State /Zip:
Phone: Fax: NOTICE: All contractors and subcontractors are required to be
❑ APPLICANT . ❑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: 5~45 e m jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: I Fax:
BUILDING PERMIT FEES*
E -mail: Please refer to fee schedule.
CONTRACTOR ..1 R--
Business Name: 3. j gyr7t (b LS7 CC Fees due upon application $
Address: /2,606. Se v '14VE auto .ZO'
City /State /Zip: 776440 t9 , e_ .972.2s Amount received $
Phone: 4 if ,,Z a �
y 'Fax: . ..-0i2S / C � Date received:
CCB Lic. #: J/ "OCR
Authorized
Notice: This permit application expires if a permit is not obtained within
Signature: ; , % Dater 180 days after it has been accepted as complete.
k c#4,4.) i y *Fee methodology set by Tri -County Building Industry Service Board.
' ' lease print name) �.�p�� ' i k �
i:\Dsts\Permit Fotms\BldgPermitApp.doc 01/03 Y `. - Cv O
lg-
Ni •
�� I ,i�
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.
i:\ Building \Forms \PlanSubMatrix.doc 04/03
CITY OF TIGARD 24- Hour
-BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP — 62 7 3S - 67
Received Date Requested AM PM BUP ,
Location / 2-511 �� Suite MEC a °CJ®5y�y
'�
Contact Person J44 - Ph ( ) ,'" 06 d2-'' PLM
Contractor Ph ( ) SWR
(713 Tenant/Owner ELC
Footing
ELC
Foundation
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
Roof
Other:
( PART FAIL
`-PCOMBING `
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final -
PASS PART FAIL
I IECHANaL
osreTeam
Rough -In
Gas Line
- moke Dam •
S PART FAIL
■RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line /
ADA Date r7- / Z Z /0 Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site. -
PASS PART FAIL