Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2001 -00447
- �,L A DEVELOPMENT SERVICES DATE ISSUED: 1/28/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136AA -01500
SITE ADDRESS: 10313 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT: 006 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: 5N : sf N: S: E: W:
OCCUPANCY GRP: SR3.2 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 16 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: $ 3,500.00
Remarks: Interior remodeling to create two new bedrooms with -in an existing 16 resident care facility
Owner: Contractor:
LUKE -DORF OWNER
10313 SW 69TH
TIGARD, OR 97223
Phone: 503 - 292 -5570 Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required
PLCK CTR 12/5/01 $40.63 27200100000 Sprinkler Permit Required
Framing Insp
PRMT CTR 1/28/02 $81.70 27200200000 Gyp Board Insp
5PCT CTR 1/28/02 $6.54 27200200000 Smoke detector insp
FIRE CTR 1/28/02 $32.68 27200200000 Final Inspection
(additional fees not listed here)
Total $174.03
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 -80 32 -2344.
Permittee ''
Signature: ( _-
Issued By: �iL1,(..,(A... i
Call 639 -4175 by 7 p.m. for an inspection the next business day
I iel ki 1 r e 1 .1 6
Building Permit Application
A Date received: /a 5 el Permit no.: u gt2C/ X 5`/7
�
��y City of Tigard
Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By: I Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: ! Oa 13• • L:) err TVA , or._ - `3 u3 _ Bldg. no.: Suite no.: '
Lot: ( P I Block: Subdivision: ,� �C, ?tie I Tax map /tax lot/account no.: (j 13(CAA —b 114
Project name:
Description and location of work on premises/special conditions: 26O1i- - D I V 1 S J a tJ — / Emb DF j<kti k
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: j,u,,lr_, _)00J L , ( Floodplain , septic capacity, solar, etc.)
Mailing address: , V, O0 .) 4 J rat 1 & 2 family dwelling:
City: T1 q 12� I O Q_I ZIP: 4g ;,S- Valuation of work $
Phone: 54)E, 11 Q, b IFax: 6'1e &,321,E-mail: No. of bedrooms/baths
Owner's representative: E 7 c , 13 t4i2 4 Total number of floors
Phone: Sft / C6 Fax:5 6 , ■ -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: r.UIL.i • -1?A2F , Z.N) C
Covered porch area (sq. ft.)
Mailing address: jLy ` /5 .Sw 140 t Deck area (sq. ft.)
City: 71(a A 12.) St ! l e) I ZIP: q Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustriallmulti- family: /�
CONTRACT OR Valuation of work $ • /� �-/
Existing bldg. area (sq. ft.) .a
Business name: -1 l t• g i b ('D i N - /..J /') New bldg. area (sq. ft.)
Address: AA A Number of stories
City: 1 State: ZIP: Type of construction
n r Rhone:isS 64-41 Fax: 1E-mail: Occupancy group(s): Existing:
CCB no.: New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /RESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: 171P: exempt from licensing, the following reason applies:
Contact person: I Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ 1 • ' 3
Address: Date received:
City: 'State: ZIP: Amount received $
Phone: I Fax: 1E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions o and ordinances governing is 0 Visa U MasterCard
work will be co ^ r , r - ified herein or not. Credit card number: Expir�
Authorized signature: Ma it.- e: /2- Name of cardholder as shown on credit card
Print name: -- 7 - 75114 x/66 Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440.4613 (6N0/COM)
4,A dug'i
Commercial Plan Submittal
,L Requirement Matrix
City of Tigard
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:\dsts \forms \COM- matrix.doc 9/24/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 _ MST
BUP ge e)O 7
Received Date Reque0ed 2 "3 AM PM BUP
Location /6 3/ 3 (Q v Suite MEC
Contact Person -1-0NeVI Ph ( ) G l 575 7q
Con Ph ( SWR
•. = Tenant/Owner — ELC
noting (16 - 3 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear lQ a I J
Framing !
Insulation 0 0 '? it a _
Drywall Nailing `T
Firewall LC. 6 Z - 000
Fire Sprinkler �t (I -
Fire Alarm ( 1 S�� a- i � 0 0 1 - 00 4 4 1 Q �'eiV �s+�- u`l tnl •JIM
Susp'd Ceiling l
Roof L6 C o >— 6 c o S 2— C i— -a I >
Other:
2i
ART FAIL ' v�
- : ING
Post & Beam cS ��
Under Slab J
Rough -In 4 ��
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final C 11'5 &
PASS PART FAIL
.f w� s� = = =�
Rough -In
Gas Line
Smoke Dampers O C�
PART FAIL �� 9 g A ` o
EL 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: Unable to inspect - no access
Fire Supply Line '1
ADA
Approach/Sidewalk Date \ 1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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