Permit .-5 .1
CITY OF TIGARD
PERMIT #: BUP2003 -00176
DATE ISSUED: BUILDING PERMIT
DEVELOPMENT SERVICES SSUED: 4/17/03
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY ��, V ))
SUBDIVISION: TRIANGLE CORPORATE PARK IY ZONING: MUE
BLOCK: LOT: 002 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: 2FR . sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: 5 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: $ 85,000.00
Remarks: Tenant improvement, work will take place on 2nd & 3rd floors and in the basement.
Owner: Contractor:
TIGARD TRIANGLE I LLC R & H CONSTRUCTION
4650 SW MACADAM AVE STE 220 1530 SW TAYLOR
PORTLAND, OR 97201 PORTLAND, OR 97219
Phone:
Phone: 503 - 228 -7177
Reg #: 283-9570 38304
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 4/17/03 $662.25 Electrical Permit Required
[TAX] 8% State Tax 4/17/03 $52.98 Sprinkler Permit Required
Plumbing Permit Required
[BUPPLN] Pln Rv 4/17/03 $430.46 Framing Insp
[FLS] FLS Pln Rv 4/17/03 $264.90 Gyp Board Insp
Susp Ceilng Insp
Total
$1,410.59 Final Inspection
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 10 through AR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 503) 246 -6699 or - 800 - 332 -2344.
1 Ka4,0iudidi
Issue y: , `
Perm ittee /
Signature: r 7 ___.--...
CaII 639 -417 7 by 7 p. • . for an inspection the next business day
Building Permit Application
• of Tigard OFFICE USE ONLY
City g Permit no.: ,, 6 2-003 - 0011
11
13125 SW Hall Blvd. Date Received: y 16, o3 EC: Y / N
Tigard, OR 97223 Date Issued TP : Y / N
Phone 503 639 -4171, Fax 503 598 -1960
TYPE OF PERMIT
• 1 & 2 family dwelling or accessory • Commercial /industrial • Multi - family • New construction • Demo
DAddition /alteration/replacement D Tenant improvement 0 Fire sprinkler 0 Other
.IO13 SITE INFORMATION
J• . • • - . 13221 SW 68 Parkwa Bldg no.: Suite no.: MI
Lot: Block: Subdivision: Tax ma. /tax lot: 2S 101 DA00102 R2064147
Pro'ect name: HealthNet TI
Description and location of work on premises /special conditions: Interior only Tenant Improvement with
demo and add new walls.
OWNER (REQUIRED) FOR SPECIAL INFROi\'IATION. USE CHECKLIST
Name: L &B c/o Pacific Real Estate Management (Floodplain. septic capacitv. solar. etc.)
Mailin: address: 1120 NW Couch St., #610 1 & 2 family dwelling:
Cit : Portland State: OR Zi.: 97209 Valuation of work. $
Phone: 503- 224 -1460 Fax: 503- 299 -6748 No. of bedrooms/baths
Owner's re • resentative: Total number of floors
Phone: Fax: Existing dwelling area (sq. ft.)
APPLICANT New dwelling area (sq. ft.)
Name: Cadence Design Systems Garage /carport (sq. ft.)
Covered porch area (sq. ft.)
Mailing address: 2655 Seely Ave. Deck area (sq. ft.)
City: San Jose State: CA Zip: 95134 Other structure area (sq. ft.)
Phone: 408 - 428 -5296 Fax: 408 - 428 -5519 Commercial/Industrial/Multi Family:
CONTRACTOR Valuation of work: $ $85,000
Business name: R &H Construction Existing bldg. area (sq. ft.)
Address: 1530 SW Ta for Street New bldg. area (sq. ft.)
Ci : Portland State: OR Zi.: 97205 Number of stories .. 5
Phone: 503- 228 -7177 Fax: 503- 224 -3638 Type of Construction II -FR
CCB no.: 38304 Occupancy Type Existing: B
Ci /metro lic. no.: New: B
ARCHITECT/DESIGNER Notice: All contractors and subcontractors are required to be
Name: Grou • Mackenzie licensed with the Oregon Construction Contractors Board under
Address: PO Box 69039 provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed. If the applicant is
City: Portland State: OR Zip: 97201 exempt from licensing, the following reason applies:
Contact .erson: Bill Bezio, AIA
Phone: 503- 224 -9560 Fax: 503- 228 -1285
ENGINEER OFFICE USE ONLY
Name: N/ A Contact .erson:
Address: Plan Check Fee:
State: 12111 Date Paid:
Phone: Fax:
1 hereby certify I have read and examined this applicati; an e attached work checklist. All provisions of laws and ordinances governing this work will
be complied with, whether specified herein or not
Authorized signature:
Print name: 6, Allbo _ j�' Date: 4 /
Notice: This permit application expires if a permit • i t obtained within 180 days fter it has been accepted as complete.
3/2001
CITY OF TIGARD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST 2 7 BUP 3 - od t
Received Date Requested , 4 AM PM BUP
Location /30 O - �F-4� Suite MEC
Contact Person e Ph ( ) '6 3 - /` 3' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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
Roof
Other:
rna
PASS PART FAIL -
PLUMBING
Post & Beam
Under 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 Date l0 L ( 0 3 Inspector Ext
Approach/Sidewalk (
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL