Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00446
� q DEVELOPMENT SERVICES DATE ISSUED: 9/21/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
SITE ADDRESS: 10313 SW 69TH AVE PARCEL: 1 S136AA -01500
SUBDIVISION: FUR VALLEY ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
REISSUE: �99 FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: SR3.2 TOTAL AREA: &010 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: $ 50,000.00
Remarks: Addition to exising care facility.
(bU 5 .7. .+ / Y2_ &..i
Owner: Contractor:
LUKE -DORF PLUMB CONSTRUCTION LLC
10313 SW 69TH 1015 15TH STREET
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: 503- 624 -0866
Phone: 503 - 705 -2176
Reg #: LIC 146357
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require Final Inspection
[BUILD] Permit Fee 9/21/2004 $470.80 Electrical Permit Required
TAX 8% State Surchar 9/21/2004 $37.66 Sprinkler Permit Permit Require(
[TAX] � Fire Alarm Permit Requirr
es
[BUPPLN] Pln Rv 9/21/2004 $306.02 Plumbing Permit Required
[FLS] FLS Pln Rv 9/21/2004 $188.32 Foot/Found Insp
Framing Insp
Total
$1,002.80 Insulation Insp
Shear Wall Insp
Gyp Board Insp
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: ,, Z,e....tZ67..z..2
Permittee
Signature: ,✓
Call 639 -4175 by 7 p.m. for an inspection the next business day
t
Building Permit Application FOR OFFICE USE ONLY
Received ,, � �l
City of Tigard
Date/8 : "J� ! Permit No.:0. ,00 '9�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie • ` \ �
Phone: 503.639.4171 Fax: 503.598.1960 / / im iFi•. � � D ate / B : �� 0 ` Other Permit:
S
Inspection Line: 503.639.4175 � r.7I 1 Date Ready/By: kris: 65 See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. • . 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
R I Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION ' work indicated on this application.
• ❑ 1- and 2- family dwelling ❑ Commercial/industrial
Valuation: $ CG oo 0
❑ Accessory building ❑ Multi- family Number of bedrooms: Z
❑ Master builder ❑ Other: Number of bathrooms: V
. JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10313 5 L (A Av€ , New dwelling area: bo 0 square feet
City/ State/ZIP: lir QR `1721a3 Garage/carport area: -19- square feet
I
Suite/bldg. /apt. no.: Project name: 51, VII' Covered porch area: ...8— square feet
Cross street/directions to job site: ( Deck area: 42)-- 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 application.
600 seer. REN Z — 2 „ 'RcIStZW
aSrl t � Za + Valuation: $ ,c
5 l�l�l -- Existing building area: square feet
tir_ New building area: IOW square feet
IV PROPERTY, OWNER - ❑ TENANT ' , Number of stories: f•
Name: LfKE---Dap Type of construction:
Address: fcJ313 S ) t e L 1vc , Occupancy groups:
City/ State/ZIP: 41'R(b I OR_ off 722..:S Existing:
Phone: (503) (,2-4 — 0$16G Fax: ( 93) New:
❑ APPLICANT I � CONTACT PERSON NOTICE
Business name: PWN6 coism a ZTA, Lit_ All contractors and subcontractors are required to be
Contact name: TscN licensed with the Oregon Construction Contractors Board
,I under ORS 701 and may be required to be licensed in the
Address: 6 SE gvut._ i - jurisdiction in which work is being performed. If the
City/ State/ZIP: Hl.�.K/m)KIE t U1 9726+7 applicant is exempt from licensing, the following reasons
apply:
Phone: ( 503) 6S 7 -731 Fax: : (S (,SZ- - 2397
E - mail: 1 F IP f ,U►18 CCOS R1JQ ZUJ IL. Ner
CONTRACTOR
Business name: l7Ly1-16 GA) c , L L C., - .
BUI LDING PERMIT`FEES*
Address: cZ1 U SE m E Please refer to fee schedule.
City/State/ZIP: firt.wpwiat 0.1Z- q 7 2 6
/ Fees due upon application
Phone: (S)3) 6SZ Z3 9y Fax: (Sv3) & _ Z3y
/46 3S'7 ` Amount received
CCB lic.:
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: JGFF AVOW") Date: eV, �� * Fee methodology set by Tri- County Building Industry
/ Service Board.
i:\Building\Permits \BUP- PermitApp.doc 12/03 440-4613T(1 1 /02/COM/WEB)
%
, 4
Building Division
' '" wr '��iAtii ,,\ P lan Submittal Requirement Matrix
�'' `--� Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(Includes new, additions and alterations.) . 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- PlanSubReq.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUl .DING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP -6)6a2 -
Received Date Requested AM PM BUP . 2004 - eo
Location 1 0 3 ] 3 Suite MEC
Contact Person Ph ( ) • LM
Contractor Ph ( ) SW -
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire, -
1Pi
Fire Alarm �� di
Susp'd Ceiling n Roof r L � I� � ArA Other: pegt
PART FAIL
• ING
Post & Beam
Under Slab
Rou -In �E1
Water Service � -
Sanitary Sewer MIL
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 I for reins ction RE: _ Unable to inspect – no access
F
Fire Supply Line 613-- �'ri'
Approach/Sidewalk Date Inspector 1 Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL •