Permit t:�=,', i
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00069
. DEVELOPMENT SERVICES DATE ISSUED: 2/23/2005
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL
SUBDIVISION: ZONING: MUE
BLOCK: LOT: 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: 3N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 1,082 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 60,000.00
Remarks: TI: Walls and rated door.
Owner: Contractor:
BENENSON 68TH PARKWAY IN LINE COMMERCIAL CONSTRUCTION
KEY LLC, THE PO BOX 5837
BY FIRST AMERICAN TAX VALUATIO ALOHA, OR 97006
\( MA 01615
Phone: 519- 3970(CEL)
642 -5117
FEES Reg #: LIC 51880
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 2/23/2005 $525.50
[TAX] 8% State Surcharl 2/23/2005 $42.04
[BUPPLN] Pln Rv 2/23/2005 $341.58
[FLS] FLS Pln Rv 2/23/2005 $210.20
Total $1,119.32
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:
A
i dl . ti J _)
Permittee C
Signature: ; _ 1, 0
CaII 639 -4175 by 7 p.m. for ail ins ection the next business day
1, E.�
R6 CE1 uild Permit Application , f'' FOR OFFICE USE ONLY
City of Tigard FEB n 3 005 Date/By: c2/7 6 T)0 g6
Pe rmit No.: ()op 6
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 y OF ��' Bl r Mij i� ' Date/By: Other Permit:
T� clT T._9 w 7ur s El See Attached Checklist for
Inspection Line: 503.639.4175 —IL
Internet: www.ci.tigard.or.us d '7 Date Ready/By: 7
Notified/Method: Supplemental Information
Li ,.1 r),N;
TYPE OF WORK . REQUIRED. DATA:. 1= AND 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 CONSTRUCTION ' work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling 1XCornmercial/industrial
❑ 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: 11 Ski 66' 1(21414/A-( New dwelling area: square feet.
City/State/ZIP: - 1 ' G m p 0 912 . Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: RDv l DEltt £ 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK' work indicated on this ap ligation-----
1 " 3 v Valuation: $ 0 �c
Existing building 39.2S square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT • „ Number of stories:
Name: Type of construction: -IV (7..20 Address: Occupancy groups:
City /State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
Ej, A1;PLICANT D CONTACT .PERSON NOTICE - .. -
Business name: Ay >i s &j NeSatrjor - /*l rti EL/191)E D &V 5k ( All contractors and subcontractors are required to be
Contact name: �L/} l�� me �-� licensed with the Oregon Construction Contractors Board
` 1m S under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: apply:
PP Y:
Phone: (S03 ) 23 9 `Ij 33 3 Fax: : ( )
E -mail:
.. CONTRACTOR
Business name: Ik, Li Mr Con4. b BUILDING PERMIT F EES' ,
Address: PO Reg 583 6 .
�q� P lease refer to fee schedule.
City/State/ZIP: AL�4 C12 9�� 6
Fees due upon application
Phone: („5 ) G 4 5ji7... Fax: ( ) Amount received
CCB lic.: 6 gge),
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: Aiv / (J4(- L_, Date: 21251 el 5 * Fee methodology set by Tri-County Building Industry
Service Board.
i:\Building \Permits \BUP- PermitApp.doe 12/03 440- 4613T(11 /02/COM/WEB)
Building Division
4 1F
"'� Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type -of Submittal # of Plalns
• (Includes new, additions and alteration's..) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(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 \COM- P1anSubReq.doc 12/24/03
r.- ,
CITY _ OF TIGARD
BUILDING DIVISION PERMIT #: BUP2005.00069
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/23/2005
Phone: (503)"639 -4171 ' "' '4P4,tdlli''t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/6/2005 TIME: 7.10AM PAGE: 80
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: TI: Walls and rated door.
OWNER: BENENSON 68TH PARKWAY, PHONE #:
CONTRACTOR: IN LINE COMMERCIAL CONSTRUCTION PHONE #: 519-3970(CEL)
Inspection Request Scheduled For: Date: 6/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 006244 -01 503 - 849.7891 Y
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Corrections /Comments /Instructions: " 1i&4,_ — GaZ—
As
(
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITION FEE ASSESSED -- VW Inspector: Date:(l/ Phone #: (503) 718-