Permit • �- + . BUILDING PERMIT
C ITY OF T PERMIT #: BUP2002 -00372
M, DEVELOPMENT SERVICES DATE ISSUED: 9/3/02
.A.44-. - 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12909 SW 68TH PKWY 400 PARCEL: 2S101AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING 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: 2 -1HR : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 53 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: $ 35,000.00
Remarks: 4th fl. TI: Create serveral private offices.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300-WMI 15350 SW SEQUOIA BLVD
PORTLAND, OR 97224 STE 300 BB 2
Phone: 503 -452 -8003 TI Phone: (Z4 9 f • qZ � 4
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required
PRMT CTR 9/3/02 $433.30 27200200000 Framing Insp
Gyp Board Insp
5PCT CTR 9/3/02 $34.66 27200200000 Susp Ceilng Insp
PLCK CTR 9/3/02 $281.65 27200200000 Final Inspection
FIRE CTR 9/3/02 $173.32 27200200000
Total $922.93
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
PemtRtee �/
Signature: ��5,(/� J 7 / `��� _....._
Issue By: / 4 ,i , _ / 1 ! � ��
__a._
Call 639 -4175 by 7 p.m. for an inspection the next business day
BuildingFermitApplication --
• .
, .....,
•
. Datereceived: ,.1_9 -02- Permitno.: kg a..eh03
City of and
.. - 1 j ' I I! Project/appl.no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ° `g°"d Phone: (503) 639 -4171 Date issued: By: p I Receiptno.: o
Fax: (503) 598 -1960 Case file no.: Payment type: O
VI
Land use approval: 1&2 family: Simple Complex:
..g
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory 0 Commercial/mdustrial 0 Multi - family 0 New construction 0 Demolition
0 Addition/alteration/replacement Tenant improvement 0 Fue sprinkler/alarm 0 Other.
• JOB SITE INFORMATION
Job address: 1 d o r, 4�i . K r f iViiiii Bldg. no.: Suite no.:
Lot B1( lc Subdivision: Tax map/tax lot/account no.: ()(j ,-_
!� W Project name: A ,Gl J7J#
Description and location of work on premises/s , - ial conditib .: _ .
'.' . v _ .r
•l
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: PacTrust (Floodplain, septic capacity, solar, etc.)
Mailing address: 15350 SW Sequoia Pkwy., #300 I• & Zfamily dwelling:
City: Portland • I state: O R I ZIP: 97224 Valuation of work $
;5031 Phone:5624 56300 OjFax622C- 7.73=. -mail: No. of bedrooms/baths .
Owner's representative: Donn i s P a g n i Total number of floors
Phone: Same Fax: Same E -mail: New dwelling area (sq. ft.) .......
. APPLICANT Garage/carport area (sq. ft.)
Name: P a c T r u s t Coveted porch area (sq. ft.)
Mailing address:1 5350 SW S e t u o i a Pkwy., #300 Deck area (sq. fl• ••-
city: Portland State: OR ZIP; 97224 Other structure area (sq. n.) !1o"
503 Phone 6 24- 6 3 00 Fax6 24 - 7 7 5 ' Commercial lindash3al /multi- farnlly: i ' ' so
CONTRACTOR Valuation of work i/�
Business name: H L Green Existing bldg. area (sq. ft) :�.�J� : r
Address: l 5 3 5 0 S W S e u o i a Pkwy., #300
New bldg. area (sq. ft.) .' %l ...:00.-":" i. = _z -_.
City: Portland state: t R ZIP: 9 7 2 2 4 Number of stories
5031 Phone6 2 4-7717 Fax: E-mail; Type of construction < J, J
CCB no.: 41328 2 8 Occupanc group(s): Existing: lb
New: v
City/metro lic. no.:
Notice: All contractors and subcontractors are required to be
- :, ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: John R o m i s h provisions of ORS 701 and may be required to be licensed in the
Address• 15 3 5 0 SW Sequoia Pkwy. #300 jurisdiction where work is being performed. If the applicant is
City: Portland State: 012121P:97224 exempt from licensing, the following reason applies:
I
Contact person: Plan no.:
. 503 f Phone: 6 24-6300 Fax:624 - 775 ' E-mail: - ohnr@' act . ust i , . com
ENGINEER
Name: . Contact person: Fees due upon application $
Address: - - : • Date received:
City: State: IZIP:. • Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the ' Not to jurisdictions apt aedit cards. please au jurisdiction for mote ia[acmuioo.
attached checklist. All provisions of laws and ordinance governing this 0 Visa 0 MastaCatd
work will be complied • w • er s if - erein or no wait and numb«: Expires
Authorized signature•,,/ /! /' • `_ // i'.. - - s" %2 Name or cardholder as heron oo credit aid
$
Print name: s lr ✓. i . car bolder signature Amo®t
Notice: This permit application expires ifs permit is not obtained within 180 days after it has been accepted as complete. 4404613 (6103P00M)
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171 BUP
Received • Date Requested // `, ;- — 7 AM PM v BUP Z-- 6 3 9 7
Location I ? G f C) 811-"' ,kg Suite is � MEC
Contact Person �Y�.L2 Ph ( ( / ) 3 PLM
Contractor ' Ph ( ) SWR
BUILDING Tenant/Owner w � ELC
Footing
Foundation ELC
AoCesS.
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
P I BING
Post Beam \
Undnder r Slab
Rough -In
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 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / 2 / b Inspector C Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL