Permit BUILDING PERMIT
CITY OF T I GA R D
PERMIT #: BUP2003 -00696
i DEVELOPMENT SERVICES DATE ISSUED: 12/19/03
. .� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16060 SW 85TH AVE PARCEL: 2S113B0 -00600
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 256 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: 256 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 1 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: N PARKING:
VALUE: $ 4,500.00
Remarks: Demo wall a create office space w /suspended ceiling
Owner: Contractor:
UNIFIED SEWERAGE AGENCY CEDAR MILL CONSTRUCTION COMPAN
150 N 1ST AVE 19465 SW 89TH AVE
HILLSBORO, OR 97123 TUALATIN, OR 97062
Phone:
Phone: 503 - 620 -0552
Reg #: LIC 131345
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 12/19/03 $91.30 Electrical Permit Required
[TAX] 8% State Surchari 12/19/03 $7.30 Gyp Board Insp
BUPPLN Pln Rv 12/19/03 $59.35 Gyp Board Insp
[BUPPLN] Susp Ceilng Insp
[FLS] FLS Pln Rv 12/19/03 $36.52 Final Inspection
Total $194.47
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: 1-u JN
Pe rm ittee
Signature: �/ red/ e
Call 639 -4175 by 7 p.m. for an inspection the next business day
•
' 113il lding Perm Ap p li cat i on FOR OFFICE USE ONLY
Received 1 .� t Ct Building J 172003 ` L 6
Date /ByBy: L Permit No.:
City of Tigard Planning Approval Other
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review A Z ,.14, el Other
Tigard, Oregon 97223 Date /By: Of O Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 � �'"' v lill"I Post -R view IS a ) Q C n e Noe
Internet: www.ci.tigard.or.us s__..
24 -hour Inspection Request: 503- 639 -4175 Contact Juris.: Su See Page l Information
p Q Name /Method: Supplementalnformation
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition I & 2 FAMILY DWELLING
1EAddition /alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling tL Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: i 4p b (oO SW 8$ AVE 71(.141e0 Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: '(PS Garage /carport area (sq. ft.)
Project Name: T p.5 'gvlL,Uln)(,- Re-stellec Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
l7. UP-Mil IM. 20 % 8S 444 40E- Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
CZFWI,I;UE ga-, of tau afnP -1I-7r 1c/A
-.YTVJn l-1bur.., LAMA/ . .0304 von 4 /060 Valuation $ 4'bc0 1' "
f'! � g D 02 - — C v Wit/ ORoOiOV New building di building (sq. (sq. ft.) ,J n o0
T � New building area (sqq . ft.) 250
L( /Z Number of stories /
❑ PROPERTY OWNER I ❑ TENANT Type of construction V- N
Name: C LCrattp (,U A-TE2 .SEP-4Jt LvS Occupancy group(s): Existing tj �
Address: 1 to b( b 6J $ s o-u New:
City /State /Zip: ?J bvi 2 17 27-`f
Phone: Sp 3 68't wet Fax: NOTICE: All contractors and subcontractors are required to be
❑ APPLICANT ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip: •
Phone: Fax:
E -mail: BUILDING PERMIT FEES*
CONTRACTOR Please refer to fee schedule.
Business Name: CEbP2 / ttL LL) L. tr Fees due upon application $
Address: 141406 S w Stt +J - pv/
City /State /Zip: 1 • DP PR- Amount received $
Phone: 6i'3 8S � Fax: 03 SK 68 Date received:
CCB Lic. #: 4310 b2 /3/3g I
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: �' �^ Date: 12 l )/03
180 days after it has been accepted as complete.
I
/c- t 9A g 6- P &L. *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
•
Plan,Submittal Requirement Matrix
aaw
. Commercial & Multi - Family
City of Tigard _ New, Additions or Alterations
•
TYPE OF SUBMITTAL ' ' # of Plans
(Includes New, Additions or Alterations); Required at
�!. ..r : Submittal
Site Work
• (must include location of all accessible parking)
Plumbing - Site Utilities 2 0
Building 1*
•
Fire Protection System 3 **
Mechanical 2 . . v`
• Plumbing - Building Fixtures 2
•
z
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.
is \Building \Forms \PlanSubMatrix.doc 04/03 .
•
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 •
INSPECTION DIVISION Business Line: - (503) 639 -4171 MST
Received Date Requested I _....Q... AM ✓ PM MP 3 _ - D 0 ( 7(4
Location /4 O ev O gs -4.--k...- Suite MEC
Contact Person Ph ( ) 8 Rte- `) 3 7a PLM
_____seicA,../________ Con - Ph ( ))) SWR
UILDING
Tenant/Owner ELC• EL C
Footing
ELC
• n Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation ��
Drywall Nailing 6 ' S
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling L
Roof
•
(4)/f (i'rL
___ 4 PART FAIL
MBING
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 . ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line - C - _
ADA f 7
Approach/Sidewalk Date ® D y Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL -