Permit . .
CITY O TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00440
r^ DEVELOPMENT SERVICES DATE ISSUED: 7/23/03
"III 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16562 SW 72ND AVE B -09 PARCEL: 2S113AA -01000
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOC 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: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 10 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: / la Soo • OD
Remarks: TI Demo existing walls, create accessible restrooms.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA BLVD
PORTLAND, OR 97224 STE 300
TIGARD, OR 97224
Phone:
Phone: 624 -7717
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 7/23/03 $168.10 Electrical Permit Required
TAX 8% Tax 7/ 23/03 $13.44 Plumbing Permit Required
[TAX] Framing lnsp
[BUPPLN] Pln Rv 7/23/03 $109.27 Gyp Board lnsp
[FLS] FLS Pln Rv 7/23/03 $67.24 Susp Ceilng Insp
Total $358.05
Final lnspection
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: ,
.,,,d,d4„,...,, Z,7 ,
Pe nn ittee ,
Signature: /� j/ J r , , ..., .. ■•■
/ Call 639 -4175 by 7 p.m. for an inspection the next business day
Rov •Z3 -0 135
• -
-- 7 Bi Permit Application
-.�
-� � City of Tigard Datertxeived: � -,�, :5 Permitno.:; S /,��L� - vo�t�i7
-s Project/appl.no.: Expiredate:
City o Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: BY
1 Receipt no.: •
Fax: (503) 598 -1960 , ' , , -/ Case file no.: Payment type:
Land use approval: - . 1&2 family: Simple Complex:
TYPE OF PERMIT
Q 1 & 2 family dwelling or accessory Q Cna tetgiail vlbetirlal 0 Multi-family 0 New construction 0 Demolition
0 Addition/alteration/replacement Q Tenant improvement 0 Fire sprinkledalarm 0 Other:
JOB SITE INFORMATIOiN
Job address: /le 5b , S 7 �' 1 �'r Bldg. no.: Suite no.:
Lot: 1 Block: s ubdivision: I Tax map/tax lot/account no.:
Project name: ?-'--- 5//9/32,6
x
Description and location of work on premises/special conditions: L c �' vr -71
r 1 4:f , _ ',
OWNER FOR SPECIAL INFORMATION. USE CI(ECKLIST
Name: PacT ru s t (Floodplain, septic capacity, solar, etc.)
Mailing address: 15350 SW Sequoia Pkwy. , #300 1 & Z family dwelling:
City: Portland . State: OR I ZIP: 97224 valuation of work $
503 Phone :5:624 -'6300 ?I Fax6 224 =-775 E -mail: No. of bedrooms/baths
Owner's representative: Den n i s P a g n i Total number of floors
• Phone: Same Fax: S . tie E-mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area(sq. ft.)
Name: P a c T r u s t Covered porch area (sq. ft.)
Mailing address:15 3 5 0 SW Se. u o i a Pkwy. , #300 Deck area (sq' ft)
City: Portland State: OR ZIP: 97224 Other structure area (sq. ft.)
503 Phoned 2 4 - 6 3 0 0 Fax6 2 4 - 7 7 5 'irMii Commercial industrial /multi- family: / t _ */
CONTRACTOR Valuation of work $ ^ / '
Existing bldg. area (sq. ft.) /2
Business name: H. L. Green
Address: 153 5 0 S W S e q u o i a Pkwy. , #300 New bldg. area (sq. ft .
City: Portland State: OR ZIP: 97224 Number of stories
Type of construction ACIr
. 503 ∎ Phones 24-7717 Fax: E -mail: tx�i u s: Existing: ''Y
CCB no.: 41328 Occupancy gro P() g I _
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Boaid under
Name: John R o m i s h provisions of ORS 701 and may be required to be licensed in the
Address: 1 5350 SW Sequoia Pkwy. #300 3 0 0 jurisdiction Where work is being performed. If the applicant is
City: Portland 1 State: OR I ZIP::9 7 2 24 exempt from licensing, the following reason applies:
Contact person: Plan no.:
. 5031 Phone:624 -6300 Fax$24 - 775 . E -mail: ' ohnr@ t act ust I t . com
ENGINEER
Name: Contact person: Fees due upon application $
Address: : Date received:
City: State: ZIP:. Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the ' Not all jurisdictions accept credit cads. please aril iuris& &ion for ante information.
attached checklist. AU provisions of laws and ordinances governing this °visa 0 MasterCard
work will be complied with, whether . ifi herein or, r, t. c eait crud number. / /
Expires
Authorized si f", , ./ / /■' , . % ,// /'Kr 7 7--/-.4P__ rD_ Name of cardholder as shown an aedit and
S
Print name: k./Q • Cardholder signature nmoam
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6A0l00M)
•
Z
CITY OF TIGARD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
a 3-00440
Received Date Requested O - d AM PM BUP
Location /40.5 -- 7 .2' /` �I we• Suite - g — MEC
Contact Person 7° nt Ph ( ) 307- D8'40 PLM
Contractor Ph ( s-t've ) . 3a0 - ' ' 0 ( SWR
Tenant/Owner ELC
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
E heats • : ar
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
• I er: O , ra.yi
�.�) PART FAIL
" : ING
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 \10
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 /D/4 D (Q3 o - - ''mil Ext
Approach/Sidewalk InBpeCtor
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL