Permit -CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00320
�J4i DEVELOPMENT SERVICES DATE ISSUED: 6/4/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133AD 02200
SITE ADDRESS: 10820 SW 130TH AVE
SUBDIVISION: ZONING: R -
BLOCK: LOT: 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: 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: $ 4,500.00
Remarks: Tenant improvement, new walls & exterior door.
Owner: Contractor:
WESTGATE BAPTIST CHURCH BRIAN DUTTON
12930 SW SCHOLLS FERRY RD 16775 SW LAKE FOREST BLVD
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
Phone:
Phone: 503 - 407 -1627
Reg #: LIC 111999
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 6/4/03 $91.30 Framing lnsp
Insp
[TAX] 8% State Tax 6/4/03 $7.30 Gyp Bn Final Insspp d ecttion ion
[BUPPLN] Pln Rv 6/4/03 $59.35
[FLS] FLS Pln Rv 6/4/03 $36.52
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 i ) 246 -6.'9 or 1- 800 - 332 -2344.
t
Issue. � ' %� 4c6o- � :y: � ����Gf
Permittee 1
Signature: , L ` - j 0 � 1
Call 639 -4175 by 7 p.m. for an inspection the next business day
1p
Building Permit Application , FOR OFFICE USE ONLY .
Received // 2ll Building fj, D 3- 7 n
Date/By: tP dl d Permit No.: Ott d /`CJ
City f Tigard , Planning Approval Other
Y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other -
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 /ai�,addlpr41 Post - Review Land Use
Internet: www.ci.tigard.or.us 6 ' - Date/Bct y: Case No.
® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method:a/ . Supplemental Information
- Mw_ s TYPE. "OF' WORK: ° ..., , . R., w a `aREQUIRED DATA. 3
111 New construction El Demolition " Y r, ` . 3 0 4 R "x , a N,n
v.IA : ., , ... & 2 M IL, DWE A ?tt6. g%y=
[ Addition/alteration/replacement ❑ Other:
kt :' , ' 1 , CATEGORY 'OF CONSTRUGuHJ KMI Note: Permit fees* are based on the total value of the work performed. Indicate
111 I. & 2-Family dwelling 0 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 $
Ytb `e atOBiSITE, INFO RIYIA ° TIONfand LOCATION"; ,af No of bedrooms: No of baths:
Job site address: 1082.0 so. Car N Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: . Garage /carport area (sq. ft.)
Project Name: .fA6a; � s b 0 , s - 1 s, l'ro�P -c e4 Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
k, j CO R � IAL CT C HECKLIST,
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
. r' ` ; v _ �``'r`' �ES , TION OF °WORK°,°"" "a Z`' the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
tthb A eivit VLTIOrt O t- i 1,3AsKOT- a Bo et/
n_4,-46 i 4 0 v i0 t c t Valuation $ l� .
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
�, . ti N- H ' 4 T
�� � <., .: ,ROPERT�XO.WNER� �, �; TENANT �'' � '� ��� Type of construction
Occupancy group(s): Existing:
Name: 134 l- c , km, 6 TtSi C<tt)ac
New:
Address: czn 3 a 5;,s 5 c t';i:x..LS `L-.Fre.a y
City /State /Zip: g i 6,? €
Phone: S zq - go Fax: sa3 $z'-1 -4S‘o
NOTICE• All contractors and subcontractors are required to be
_.. _ � _.. , licensed with the Oregon Construction Contractors Board under
APPI rtCANTO` w �., _. ;�;.g 9 CONTCTi
APER SON „ a` provisions of ORS 701 and may be required to be licensed in the
Business Name: ' O T -t- c . S - t Abp IS7 i tJ v jurisdiction where work is being performed. If the applicant is exempt
Contact Name: R ifYt u T�06 from licensing, the following reason applies:
Address: i ,i'7S - 5t, LftKe F oa 1 Z,t.vb
City /State /Zip: (.AKE Of,;,Nat -c5 I 0,26 97 63S
Phone: 5'o3 SIa ?3i Z Fax: 503 OS oZL( x 'c PERM v e r 1 `
E -mail:
. WP . Nf c hQE E
,y s 3` .; k„ q a , ,4. - ' li , r ,. please re to ee ss d e , 1
, e r g f ul ,�
- - s . s.w s o-t _- . . Asp_:, ..nitW -4.. ` � A.
�.���. �:_ - �:�;'��'���� ,��.:;CONTRACTiQI?�n:_° �.,: �, � #.,t . � ��
Business Name: 1) -tooS rP. em6i 03-1 tom' Fees due upon application $ _
Address: tree ,o<j ,ftgatJgr
City /State /Zip Amount received $
Phone: Fax: Date received:
CCB Lic. #: l tc t i
Authorized / JJ Notice: This permit application expires if a permit is not obtained within
Signature: , a - -d 180 days after it has been accepted as complete.
13 le tt■ ft L 'b 0 crd NI *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\B1dgPermitApp.doc 01/03
Plan Submittal Requirement Matrix -
A\
t) ) Commercial & Multi- Family
City of Tigard New, Additions or Alterations
;, TYPE `OF SUBMITTAL o fPla ° ns
(Thcludes New, dd tl®�ns or Al ns) Re�g at
t,. A Sub
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.
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 22
/O Fa20 o /00 p -7 BUP J '
Received Data Requetted O ' °�' / AM PM BUP
Location - ! / / " 1, - e MEC
Contact Person Ph ( / ) S7? ' 73 PLM
Contractor Ph ( ) SWR
UILDING) Tenant/Owner ELC
0o ing ELC
Foun ation Access:
Ftg Drain TCztur T ELR
Crawl Drain 0 J C w` C4".4. T
Slab Inspection Notes: SIT
Post & Beam vY Cc (/ F r "be, ,.J
Shear Anchors c,t
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
t _ PART FAIL
P u :ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final SAtis
PASS PART FAIL e r e
MECHANICAL
Post & Beam
Rough -In �Z
Gas Line I a ,,, 45,_,/4-tJ'e--
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
Approach/Sidewalk Date 972- 7(o 3 Inspector ! Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL