Permit , .i.
CITY OF T BUILDING PERMIT
PERMIT #: BUP2003 -00493
*���; DEVELOPMENT SERVICES DATE ISSUED: 8/14/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AB -00600
SITE ADDRESS: 16195 SW 72ND AVE BLD.D
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 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: $ 38,500.00
Remarks: Re -roof
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PACIFIC ROOFING COMPANY INC
15350 SW SEQUOIA PKWY #300 -WMI PO BX 1728
PORTLAND, OR 97224 BEAVERTON, OR 97075
Phone:
Phone: 640 -3163
Reg #: LIC 41571
FEES REQUIRED INSPECTIONS
d.
Description Date Amount M t sc . Fo&. P2oQeES5 '
[BUILD] Permit Fee 8/14/03 $388.30 Final Inspection
[TAX] 8% State Tax 8/14/03 $31.06
Total $419.36
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: _ZCue2�.eiC__
Pe rm ittee
Signature: a 3 6 Q -IC—
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application OFFICE USE ONLY
t ��Ji' City of Tigard C l e �D Date receive /o3� Permit no.:/ �J� �9j
��`� " Projectlappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd Tigar 97223 C
Phone: (503) 639 -4171 Date issued: BYZIg Receipt no.:
Fax: (503) 598 -1960 'AUG 14 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGARD 1 &2 family: Simple Complex:
..
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory ($,Commercial /industrial 0 Multi - family 0 New construction 0 Demolition
0 Addition/alteration /replacement O Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address:
1 NA — 5 w 7) rd 4,,e.- Bldg. no.: 1 Suite no.:
Lot: I • Block: 'Subdivision: 'Tax map /tax lot/account no.:
Project name: V O r
Description and location of work on premises /special conditions: w c-re. / G -ccr e- CCSC�t- c rv
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: i � ;c_ \ \,-,' 4`�i ctcok.1 L p (Floodplain, septic capacity, solar, etc.)
Mailing address: 15 35-0 sc.,), 5 I e v o Ic4 a ' . w ,. $.�. . 306 1 & 2 family dwelling:
City: Qarka,,,.1 a/ l State:0 r ZIP: ' j ,.) 4 Valuation of work $
Phone: I,yy - &got IFax: 6a9- 17Z1E -mail: No. of bedrooms/baths
Owner's representative: ,off,,, U jj.i. y Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
Name: PI�.z.n,z. ,,,I Covered porch area (sq. ft.)
Mailing address: p c„,. 1-7a4 Deck area (sq. ft.)
City: g r%. I State: Q r I ZIP: 91015 Other structure area (sq. ft.)
Phone: (,y,ct- 1 t Fax:(Jt - • E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $ 31s,
ctc.• - gcyc Existing bldg. area (sq. ft.) as(, p0
Business name: T
" ,f New bldg. area (sq. ft.) @-
Address: QA ( 1-1).% Number of stories 1
City: 6 rla lcr A 'State: 0 r I ZIP: 9101 S Type of construction TA 1r-- 0 4
Phone: yis3 -o.w. t1 11 316 I Fax f,• - 31 E -mail:
CCB no.: 1-11 s-i Occupancy group(s): Existing: X
New:
City/metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER 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: I State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER _. OFFICE USE ONLY
Name: Contact person: Fees due upon application $
Address: Date received:
City: IState: `ZIP: Amount received $
Phone: 1 Fax: E -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 of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with whether spec ed herein or not. Credit card number: / /
D Expires
Authorized signature: B Date: V)3/65 Name of cardholder as shown on credit card
Print name: (fit, 3 g e l
s
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 -46l3 (6 /OO /COM)
?
t c-//c>.?-1. -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received . /lam/ 95 , Date Requested -- / L i AM ✓ PM BUP
Location's / '' r %: -= Suite MEC
Contact Person Ph ( )' ` / i PLM
Contractor Ph ( ) - 0 ° i - ` - % ' L SWR
BUILDING • Tenant/Owner ELC
Footing
Foundation .� ��. }.�;, .�� �...: ELC
Ftg Drain ELR
.'`°_, �k: ; ,�, � Y, ;': t a ,oJ �'
'� t � 1 ► � : ,.• i•/
Crawl Drain "= _`� - -�J� ^1 P : ° �� ?,,�..r- t.s•h.n.c•- 'z�� ?ct �:�; r _ �� :, }�.f
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
Otheri t' -
Final 6
PASS. ART FAIL
. ` Prown3ING
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 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line `� / +,
ADA Approach/Sidewalk Date f ! 7 1 C) Inspect Ext
• Other: /
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/61 c7,5— BUP 6 O ce9)
Received Date Requested ? AM PM BUP
Location Suite MEC
Contact Person .1.1- Ph ( ) Co tie - 3163 PLM
Contractor Ph ( ) SWR
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 ,,...---- ti _...
Insulation
Drywall Nailing
Firewall gi,k
Fire Sprinkler
Fire Alarm ,
S� Ceiling ! S / 17 0 0, S c Gt/ i r `
1__ PART FAIL
PL 1 '' BING -
Post & Beam P o e t {J r- 6 w 1-- -7 fi. 72
Under Slab >
Water /� -P4c/ m C/? - 4 i.c.:1 s-!' ' k
Water Service
Sanitary Sewer i
Rain Drains (.../ e-- � 0 /2� 4f S ��h e.�
Catch Basin / Manhole /
Storm Drain / 4 t- / U , , µ [ / f w / //
Shower Pan G� q c/-C ( ,, / Cc c 7' , / G �T
Other:
Final S T72 / / 6- L4�' o`
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: 0 Unable to inspect — no access
Fire Supply Line C� / /
ADA Date ! �y/ v 3 Inspector ( Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL