Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00492
i � DEVELOPMENT SERVICES DATE ISSUED: 8/14/03
Ail 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16364 SW 72ND AVE B -04 PARCEL: 2S113AA -00100
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOA 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: $ 34,500.00
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
Description Date Amount Dfyrot ater- tear -o# (1tsue. "")sio ie- -P060-2:
[BUILD] Permit Fee 8/14/03 $358.30 Final Inspection
[TAX] 8% State Tax 8/14/03 $28.66
Total $386.96
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: / - _- %'�l/j
P `' ��
U Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit ' "� OFFICE USE ONLY . Date received /'/ —O'j Permit no.: pp'��/ 1------ r X1,7 City of Tigard �v�'aoos
�y r n Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, 1 �1�7124 2003
Phone: (503) 639 -4171 Date issued: By`:/Qj Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
BUILDING DIVISION
Land use approval: I &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory til Commercial /industrial ❑ Multi- family ❑ New construction ❑ Demolition
Cl Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE E INFORMATION
Job address: 1 ,. 411 L., . " a iPjMIIIMMIMIMIMM Bldg. no.: g Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name:
Description and location of work on premises /special conditions: b...30.4 a I N , -):1c / O {kc e Re- ‘
AP9 7 -oPG
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: t 4uSi.c. Q-cAX\ Ix . • , (Floodplain, septic capacity, solar, etc.)
Mailing address: �' (..+..i 'c Vs iA • , 4 •• 1 & 2 family dwelling:
EMIIMMIIMIIIIM State: p f ZIP: 9 , a4 Valuation of work $
Phone: Z., -(, , { Oo IESEMEZZa E -mail: No. of bedrooms/baths
Owner's representative: 451 , f t , , , ` L- .1... c . Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
Name: A& Covered porch area (sq. ft.)
Mailing address: Qd 11)- , Deck area (sq. ft.)
State: 0 ZIP: • 1 c ? Other structure area (sq. ft.)
Phone: sp; -1,Ltu -3163 IMEEMI E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $ 311 ,---,..
Existing bldg. area (sq. ft.) 401'106
Business name: e :. Q_,, ,6 New bld s ft. B
Address: • o ; - 7, , g area (q )
Zo -
State r ZIP: 9 Number of stories
Phone: . 3 `tip_ t` Type of construction -� -�i0
E -mail:
CCB no.: Occupancy group(s): Existing: K
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: State: 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: State: ZIP: Amount received $
Phone: 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 specified herein or not. Credit card number: / /
�/ 2/ Expires
�
Authorized signature: e e.L 9 Date: �/ ! Name of cardholder as shown on credit card
Print name: vu J y1e Cardholder signature s
Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/OOICOM)
• Parr ? •
11 3$(/.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Pjquested g— 14 AM PM s' _ 0136P
Location % " 1634 q 72• Suite MEC
Contact Person Ph ( ) 6 L b " 3 1 L? PLM
Contractor Ph ( ) '5 5° 3 0 . 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:2
Fi r
FART 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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date fi yfo3 Inspecitor `�✓ "� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL