Permit 1CO 0 � 5(A) $5 ' 11
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Build Permit Application Received n Building
Date/By: ' /(9 I r D3 97)'( t DD Permit Nc uf, FOR OFFICE USE ONLY . 2 �' 2
City f Ti and Planning Approva Other / y3
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Revieyi / Other o
Tigard, Oregon 97223 Date /By: S `o� /�S !1 Permit No,: V\
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 4 '' 4j1lt� Post Review land Use
e_ Date/By: Case No.
Internet: www.ci.tigard.or.us Contact Juris.: ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 Name/Method: Supplemental Information
•
• TYPE OF WORK REQUIRED DATA
• .
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING C
10 Addition/alteration /replacement ❑ Other: ,
'' CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling g] Commercialandustrial 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: /go c 0 5 kag400149.4 8 5 fit` Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: nn Garage /carport area (sq. ft.)
Pj N
roect ame: Du t e Lit,••►• . O t p5 f . - cA S k CJc 2 C Covered porch area (sq. ft.)
Cross street/Directions to job sit : Deck area (sq. ft.)
s s S + Lt 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.
S CA,22 ft 1,3 0—Q—05 el L'OLA (,,e1 a iipoe v
e v / o �vr Valuation $ 9 06
/A-,., Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
- _,®.:PROPERTY OWNER • .'1 0. TENANT Type of construction V N
Name: G) eo-i -' I) V t%V C QS' Occupancy group(s): Existing: If Z
New:
Address: j 6.cc Q o S 0 S '
City /State /Zip: fl / O 1 7 2. Z `'
NOTICE: All contractors and subcontractors are required to be
Phone:�y(, ZO Fax: 5D3 8y6- y(,2 licensed with the Oregon Construction Contractors Board under
lin APPLICANT . , _ ❑ CONTACT. PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: M f} SS,-, Ch u Ni k+.Q....M. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: Gv cq Ma tk&J S from licensing, the following reason applies:
Address: / 2 3 3 S 0 C� ►vo,..
City /State /Zip: -r, Gerd OK-- q 7 Z Z 3
Phone:5D3- 968y93o Fax: 5D3 -q68 -73
BUILDING PERMIT FEES*
E-mail: el�i'e�/ • �L" t Please refer to fee schedule.
' - CON .
Business Name: Sr/A/-4_ Fees due upon application $
Address: •
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB Lic. #: / Si-/ oL
Authorized
re: • . Date: 7 /2.1/0.3 Notice: This permit application expires if a permit is not obtained within
Signna I A 180 days after it has been accepted as complete.
l?117 07 A. r� `a7� &5 � *Fee methodology set by Tri-County Building Industry Service Board.
(Please print name) nn / -
i: \Dsts\Permit Forms\BldgPermitApp.doc 01/03 'L I Y g s -
r�5 113 s l?
dr ' e ,
b„ l Plan Submittal Requirement Matrix
�,� Commercial & Multi- Family
City of Tigard New, Additions or Alterations
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:\ Building \Forms \PlanSubMatrix.doc 04/03