Permit CITY OF TIGARD BUILDING PERMIT -00125
PERMIT #: BUP2002
a � , , DEVELOPMENT SERVICES DATE ISSUED: 4/9/02
. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S110CD 00105
SITE ADDRESS: 15900 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DE''1/1 11 '� FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0.00 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: IMP SURFACE: PRO CORR: PARKING:
VALUE: A - 61`"" , d
Remarks: Demo interior walls in preparation for tenant improvement permit to convert office space to restaurant.
Owner: Contractor:
UNITED STATES NATIONAL BANK CHAMPION HEATING & AIR COND.
REAL ESTATE MGMT DIV -T3 2655 SE 39TH LOOP #F
PO BOX 8837 HILLSBORO, OR 97123
PPnone ND, OR 97208 Phone: 503-648-4411
Reg #: LIC 122088
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Final Inspection
PRMT CTR 4/9/02 $62.50 27200200000
5PCT CTR 4/9/02 $5.00 27200200000
Total $67.50
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Pe mi it tee ' 4 y/,)
�/
Signature:
Issued By' „t.,,_1:_Cc�ZG,, fir., 1,6_,z.
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application
D ate received: i Permit no.:'E .D - CXJ I 5
,, °b City of Tigard
: ... Project/a no.: Expire date:
CiryofTigard Address.` 13125 SW Hall Blvd, Tigard, OR 97223 Y
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Commercial /industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addit ion /alteration/replacement .Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
t Job address: i i ory SAO // A- Bldg. no.: Suite no.: '
Lot: I Block: ISubdivision: I Tax map /tax lot/account no.:
Project name: ..)41 A S k. 4 --se, �.e, -,'
y Description and location of work on premises /special conditions:
l OM NER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: 3 oc m , 1 ,4 0 A_ (Floodplain, septic capacity, solar, etc.)
Mailing address: ? ,i qf- 5 .-1 ler ,•11 It 1 & 2 family dwelling:
City: AI (,,,,,_ State: p/l_.I 97 0-0 7 Valuation of work $
Phone: Cry 3 )157- 9}?,Pax:($ .'..e IE -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
'
City: ,
CONTRACTOR ,n Valuation of work $ S� ' an
Business name:
C /tf I /0/0 • 6077/JO, �` 4 /,Q. c. AJ7 Existing bldg. area (sq. ft.)
2 New bldg. area (sq. ft.)
Address: a SS S c. • N 9 ,,,p Number of stories
7 l &,e40 State:D' I ZIP: �: /�,3 Type of construction
Phone: 64 St -%d f!/ / I Fax: I E -mail:
CCB no.: /,9,,g4 /re' Occupancy group(s): Existing:
New:
City /metro lic. 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
Name: Contact person: Fees due upon application $ (o.2 • 57)
Address: Date received: !„ "l S'. UV
City: 'State: IZIP: Amount received $ ( ., 7. SV
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 cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with hether s cified herein or not Credit card number: / /
Expires
Authorized signature: / late: /7/O Name of cardholder as shown on credit card
Print name: «�i _ • 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 -4613 (6,00/cotrt)
6 7, s‘)
Commercial Plan Submittal
L � I 1. Requirement Matrix
City of Tigard
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:\dsts \forms \COM- matrix.doc 9/24/01
lhair KING CITY
15300 S.W. 116th Avenue. King City, Oregon 97224 -2693
Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project:
located at: - VS ( V55 ) ti1rp J
King City Representative' 3_as:- -d2
1 DSTS FCINST DOC
CITY -OF TIGARD 24- Hour
BUILDING Inspection Line: (503) 639 -4175
iii ` INSPECTION DIVISION Business Line: (503) 639 -4171 MST
4r, 2.0-Ve - oo // (
Date ;quested 7-5- AM � "11 / PM BUP _
Location /5 U° .5w // �Qv-e /1 Suite MEC
Contact Person Ph 7c')— S q 7 PLM
Contractor �n/1 Ph ( ) I SWR
UILD
B Tenant/Owner ' v ' �S 3/ 1 �W 1 (0. 1 vL ■ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear D / 'n C dr(„ „ _ ��� o
Framing 1T ' " ` ' C� O
Insulation 'VP 2- a 2-- 0-0 / Z `.
A, Drywall Nailing A cD 1.11--
Firewall "'''.PP '45c 6003 0 1 - Cre O �i�
Fire Sprinkler / ,/� _ `, 4<e__6()
Fire Alarm /I (� X i i e-C 2-(-)C2- - 0 0 / / ( l—,S'
'X R oof p'd Ceiling
Roof 1U�'/ //�� / / C T / 1
oo C.--,•7 > /��SS�d/ `� U 7 - J — d t---
er: t �
F ? /►'"l 1 - 6 / 4 3 ( 7 )
ASS PART Lc -:-/* •/
PLUMBING
Post & Beam (N' v , J i,� -24-42 , v v 1.q Tr
Under Slab J\ l�
Rough -In /4 C5 - �7/0 2 Cr‘;') j
Water Service
Sanitary Sewer A''� �g' j U 2 � Q Q / 7 s ( /. - d )
Rain Drains !w l '
Catch Basin / Manhole ' - ,4s £!//3/ Z 67 O
Storm Drain
Shower Pan n l a.,C�vs /`'a l �� -, c G.- 4
Other: (.•
Final I,
PASS PART FAIL (f
MECHANICAL !9 Lt -f S S .
Post & Beam �/L� /) A} i ■ S C I C1 e t
Rough -In ��
Gas Line A) ' 1� A 66 fr
Smoke Dampers �-
Final b.) a ‘
PASS PART FAIL f r t .
ELECTRICAL e.) f 1 c.. ro°v &Q.4' ' �f -- 4 0
Service �j
Rough -In `' , c_-_,-' e
Low olt Q.i` (
Low Voltage
Fire Alarm 1 ( 6 l h .._) S
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
Approach/Sidewalk Date (7 / S a .?--- Inspector 'i Ext Z
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL / ^
CITY OF TIGARD 24 -Hour ,
o BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received _ Date Requested AM PM BUP
Location Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
I nt Sheath/Shear 9 ,) W Q �,r• _ Q s; s (-�� 6 rte{ r L-t-
Framing .! Vv
Insulation 1.. /G 4- .
Drywall Nailing �/lJ
Firewall V!) re, Le. lP _-+ - r It ye
Fire Sprinkler
Fire Alarm te_S C 6-.,'"1 y /.
Susp'd Ceiling
Roof
Roof 01 / ' ` e ,.e1 .� IA- c -- ` s —Q
Other: c- /� �. �O �p
Final Z5' 1/4 5`� , .L , c.i �- (i1f 6L-4 l` 'r �nn "`_
PASS PART FAIL y,�,
PLUMBING
& Beam 0 �� I'ra' u+ / / �' 6 -
Post .- j � _ _ j _/' 5 Under Slab �1� Rough -In ‘ / 1 Water Service Sanitary Sewer Cr ` ! f
Rain Drains l V (�`.•� n
Catch Basin / Manhole � C 0 ,\ p ,e ,><-4-0--1- `` -N�
Storm Drain j '�
Shower Pan G.M Q ,ry�.� .�� e--y-`-
Other: r
Final
PASS PART FAIL 1
MECHANICAL a) �1�./\t s' ,,, ,:< ? `' Z � (A)
R o ou t & Beam Q —N 1
Rugh -In �./ a-- c--5L- -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 111 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: ❑ Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Inspector Ext ADA Date 7 /C
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
-a- q- 2--
CITY OF TIGA,RD 24 -Hour
BUILDI G Inspection Line: (503) 639 -4175
Ur:UP + � INSPECTION DIVISION Business Line: (503) 639 -4171 ST .
--61° i l l
Received Date Requested a& L6 AM PM BUP I . 5- 9 - 0 -0 Location � � Suite MEC
Contact Person Ph ( ) *7o .S 7 PLM
Contractor // ,Ph ( ) SWR
— 1 / 2
BUILDING Tenant/Owner 1 kc/ /- 4/'/ '1a c ELC
Footing
Foundation ELC
Ftg Drain ELR
Crawl Drain •
Slab Inspect) n No SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear j . /4/ j� . i x, 1' S-.A.„ +,V3
Insulation nj A e ? - d rte- v �.G
(tl'YL!�)
Drywall Nailing 079C -do,?- "`
Firewall O o / 3 / (ryPQ .� /kod1 4 4 -� a;r)
Fire Sprinkler ,
Fire Alarm /o�,cl �d / - c 0 J T 3 ( _ 4 - <1 , / - Low I cute_ ,
&- F// / - 41/H (- La. - 0
Susp'd Ceiling �// J D
Roof /-t (mot- < -e%-Q` S Le Y) - 0 I TT C /LJ j
Other: /— 0 Q O ' / /
Final ae rrv-,e_ i2,-; CE .S �i ki d C�,;. S -
PASS PART CD ,[� ! f /
PLUMBING ;) /q� / &1 .4_6A prr-jS . ,, TA 7 / - 5 Post & Beam /l ›� � ' 1_ ` - \ &<-4 3 C�Q r -✓L.
Under Slab J� l J
Rough -In 0/4..,1/4...4_ �` 90)- % l c C S S
Water Service (� Y
Sanitary Sewer '74D /` i � "C / 5'5 2-(...e O'
Rain Drains
Catch Basin / Manhole 3 1 NO 6 4 r � i � f '
Storm Drain /
Shower Pan fy eW / v 4 Ai A 7 h/l_S t
Other:
Final O/^ L �/7 C�
PASS PART FAIL a 5.12-1r52.-...4
MECHANICAL S•� ` � G Le /.t / c ? 'ef
Post & Beam ID / .1 � _ i ,C j -v S ,
Rough -In /
Gas Line Z.-4 (c_,-- ... � �h
Q i r2 6 72e--r -r2"
Smoke Dampers
- s - --• f �
Final
PASS PART FAIL V � �, ��C _ ` ELECTRICAL LZCK.tr'i/� ,- �
Service
Rough -In -c Z 1 c) S G�a- a,i' Gy (-�2-� (.4_2 ,
UG/Slab , .� a , J ,, aa �—� ,o
Low Voltage 9 i I4 3 7 ` -ri-C ki D 7`'� . �2 — ` c
Fire Alarm 9 4 vX-e S , ,c c��- 2-y /' <....-c_...---7 440i -fv
F PASS PART FAIL III Reinspection fee of $ required before next inspection. Pay at Giitfy Hall, 13125 SW Hall a` .
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line _
ADA i Approach /Sidewalk Date / ;/d T 2 . I nspec t or `� Ext /9
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OFTIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received Date Requested (� 1 AM PM .3-rd d — G 0
Location / Sqd o //‘ Suite MEC C J
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
Tenant/Owner ELC
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int S th/Shear
am in
InsuTation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
he .
F.
ZM II1 PART FAIL
u •! • =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
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
ADA
Approach/Sidewalk Date __6416 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD Inspection ction Line: (503) 639 -4175 \/ 7) f
'Q3UIL�iNG - "
INSPECTION DIVISION Business Line: (503) 639- 171
Received Date Requested AM PM //c DQ 4P-E
Location / _ ,� / Suite MEC
Contact Person JoV Ph ( ) 2d S-- S9 PLM
Contractor Ada, ( ) SWR
BUILDING Tenant/Owner %�1 S Avg a, / zri ELC
Footing ` ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear \ OTh∎
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final
PASS PART Al
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 ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA f eT1 (1�e41� \� � 2y2S4
Approach/Sidewalk Date Inspector � Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
' w
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By 4 Inspection Description Date, Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage _
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
4 Inspection Description Date Passed By
Drywall nailing
Post/beam mechanical
Suspended ceiling _ Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final _ Duct work
Bolting Lab Final Smoke detector
Structural observation Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm fmal Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By _ Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab -
Catch basin/Manhole SWR - Sewer Permit
Engineered soils ,f Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts \ forms \ InspRecordBUP.doc 04 /17/01
•
..
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00125
ho DEVELOPMENT SERVICES DATE ISSUED: 4/9/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CD - 00105
SITE ADDRESS: 15900 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0.00 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:
Remarks: Demo interior walls in preparation for tenant improvement permit to convert office space to restaurant.
Owner: Contractor:
UNITED STATES NATIONAL BANK CHAMPION HEATING & AIR COND.
REAL ESTATE MGMT DIV -T3 2655 SE 39TH LOOP #F
PO BOX 8837 HILLSBORO, OR 97123
PppTLAND, OR 97208 Phone: 503 - 648 -4411
one:
Reg #: LAC 122088
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Final Inspection
PRMT CTR 4/9/02 $62.50 27200200000 '
5PCT CTR 4/9/02 $5.00 27200200000 ,
Total $67.50
Illh
1
gi
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes i
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 c
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR O
952 - 001 -0010 through OAR 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
1
Pe rm ittee s�
Signature: yro., t f !v d_ _6/9 t
Issued By LA � S: 4iL
(11
Call 639 -4175 by 7 p.m. for an inspection the next business day