Permit CITY OF TICAARD BUILDING PERMIT
PERMIT #: BUP2004 -00515
- a. 4 DEVELOPMENT SERVICES DATE ISSUED: 10/28/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102AD 01601
SITE ADDRESS: 09037 SW BURNHAM RD
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR 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:
Remarks: Change of occupancy inspection for expired BUP2002- 00169.
Owner: Contractor:
STEVE DEANGELO
13215 SW 124TH
TIGARD, OR 97223
Phone: 503 - 620 -9020
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 10/28/2004 $62.50
[TAX] 8% State Surcharl 10/28/2004 $5.00
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (50. 46 -66•• , 1- 800 - 332 -23
Issued :y. a/641A4241
Permittee
Signature: •��
Call 639 -4175 by 7 p.m. for an inspection the next business day
m •
P r Building Application FOR OFFICE USE ONLY
City of Tigard DateB // . 1I Permit No.: �..
' i .—.6657 .—.6657 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ill
Phone: 503.639.4171 Fax: 503.598.1960 Oe nra � Nl I y Date/B : Other Permit:
Inspection Line: 503.639.4175 _.... Date Ready/13y: Juris: 21 See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
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t'f;',?aa'.' .: 3fr: w". ` �`�� 3 h ` I - F : , . :.> ,. ' 272 .
a i v � y t ^ G ATEGO Y * il CONSTRUGTIOIY A t , ` E OVV' -: '' work indicated on this application.
. �_ ' tea. .x...:k Valuation: $
❑ 1- and 2- family dwelling Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
0 , 4* ,,,, 1 ; , °1 m7s,�p 0;44 , Ry >, :' , : % �g; ,
q "" JOB SITE tFORIVI�ITIOIY r D L.ti1 TI ' G ; „ WAWA Total number of floors:
t/Job site address: y0 j ? dW BJ (1401^ New dwelling area: square feet
I/City/State /ZIP: 7 Ott ( t 71-2- 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name D /3 14 ) 60:1 -Q ! e ito� Covered porch area: square feet
Cross street/directions to job site: ` Deck area: square feet
Other structure area: square feet
..- ;"3fie i� "' a''i�*?"`ti - "� 4.° !t"`�r;'i: „:;H.«5: ;�:'i:. ^.': ° _'C
IiiiKi J liMi `A" 1„ 1 CON IVIE0244)SE CI3E`CI. .. ...
Subdivision: 1 Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
:4.-- DiSCRI PT ION 0��1!ORK v t �, work indicated on this application.
a ipmpec ,41r pir_e i 0 -?0,0a -taI /4 9 Valuation: $ y
Existing building area: square feet
New building area: square feet
' 'PRPERTYO ` �. "i" °µ: b -
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s- 1__. >. l ;�v.- �.�-- `"'�",r��: ., ���'h: n..m'-, =:�a. .� '... NN:, � E., � . �'�� � ' Number of stories
• Name: 6 e D t714.1 Type of construction:
Address: /124 5 5-w (.4.- Occupancy groups:
✓ City/State /ZIP: T b Atenh 92. /72.t..3 Existing:
L.,--- Phone: ( ) 6j0 — %07,49 Fax: (503) 620 - 3f6v New:
r-e ,�'. , . s `t' �, - � .. sp �.� n;,;, �"3,�i '`" "` , .?m�ci?� "> �Y � "k»°�,e�.,�+'v�.a:.v:,r,s:My.
' V A "°` APPI . ,t CONTAC 'P - RSON:, a N : 4- 1.9 �, ' ,�. _._ : y ==
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Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax: : ( )
E -mail:
CON - N?
' a,�.:.er,J<.: '4�u.. N.• a+:�a `t� A.. �&. =�r,*...,�.».» t om: ;s"` u i .''. ux'.''. k
Business name:
107/(t•-• . , . •
�F °e':;�' `"='`'�'B �!ILDING���PERNIITrREES .
Address: .
Please refer to fee schedule.
City/State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
CCB lic.: Amount received
Date received:
Authorized signatur This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Pe AV64110 Date: /0/04 * Fee methodology set by Tri- County Building Industry
Service Board.
i \Permits \B[JP- PermitApp.doc 12/03 440- 4613T(I1/02 /COM/WEB)
•
Building Division
o 40 Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
r OType�o f�Subn><ttal s # o f Plans
(Includes new; additions andd alterations) Re 40147 2
ate
lareA
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
•
•
Site Work . • 2
(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 \COM- PlanSubReq.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 e/Y\
INSPECTION,DIVISION Bus Line: (503) 639 -4171 3 MST
BUP a2Q o 6 oSlS ---
Received Date Requested /6 ��� AM PM BUP
Location 1_411 Suite MEC
Contact Person • 4 Ph ( ) /793 _ Da0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain 8,6 l — 00 He?
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation iffirrAM ,�� 7 ' .%, Drywall Nailing � . �� _
Firewall /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: f \
PART FAIL C� 1
„ J I BING
Post & Beam
Under Slab
Water he
Water Service
)(
Sanitary Sewer C((
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 El 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 D (0 0
Approach/Sidewalk Inspect Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL