Permit A,,,,,,i • 'CITY OF TIG BUILDING PERMIT
PERMIT #: BUP2002 -00504
..�1�, DEVELOPMENT SERVICES DATE ISSUED: 11/20/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 � PARCEL: 2S113AB-01400
SITE ADDRESS: 73�fo SrAJ 0,,, 1Q1
SUBDIVISION: FANNO CREEK ACRE TRACTS p LP& 14 ZONING: I -P
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: 0.00 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 30,000.00
Remarks: Minor modification and expansion in existing tenant space.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA BLVD
PORTLAND, OR 97224 STE 300
TIGARD, OR 97224
Phone: 624 -7717
Phone: 624 -7717 .
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 11/20/02 $320.80 Electrical Permit Required
Plumbing Permit Required
[TAX] 8% State Tax 11/20/02 $25.66 Framing Insp
[BUPPLN] Pln Rv 11/20/02 $208.52 Gyp Board Insp
[FLS] FLS Pln Rv 11/20/02 $128.32 Susp Ceiing Insp
Final Inspection
Total $683.30
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 o� 1t- 800 - 332 -23441
lied By: k s ,s ' / 4p i _/
Pe ittee . , / .
Signa i re._.— ) ../i/� Alr A / 'Iq'Z���.A
/
Call 639 -4175 by 7 p.m. for an inspection the next business day
A •
., Building Permit Application.
Date received: If 2 0 , 4 9 i Permit no.: Y a-.00
., 4 j; ;llil City of T
City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Project/appl.no.: Expire date:
Phone: (503) 639 -4171 Date issued: Br- l Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type: •
Land use approval: 1&2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 New construction 0 Demolition
0. Addition /alteration/replacement b`. enant improvement 0 Fire sprinkler/alarm 0 Other.
JOB SITE INFORMATION .
Job address: 73 0 s % "ffe? t ' Jr) Bldg. no.: Suite no.:
Lot: 'I Block: Subdivision: I Tax map /tax lot/account no.:
Project name: __,c4)///„ 5 f/ ,S . .
•
Des ption and location of work on pre special conditions: 7/1/4,00A ��, / / � ,7 / � /
• OWNER FOR SPECIAL INFORMATION, USE CHECKLIST -
Name: PacTruSt (Floodplain, septic capacity, solar, etc.)
Mailing address: 15350 SW Sequoia Pkwy. , #300 1' & 2 family dwelling:
City: Port] and • 'State: OR I ZIP: 97224 Valuation of work $
503 Phone:562 =44:6300 GIFax6.24'- 773 -mail: No. of bedrooms/baths
Owner's representative: Dennis P a g n i Total number of floors
- ' Phone: Same • Fax: Same E -mail: New dwelling area (sq. ft.)
Garage/carport area (sq. ft.) -
Name: PacTruSt Covered porch area (sq. ft.) •
• Mailing address:15 3 50 SW Sequoia Pkwy ., #300 Deck area (sq- ft.)
City: Port] and State: OR I ZIP: 97224 Other structure area (sq. ft.)
503 1 Phone:6 2 4 - 6300 Fax6 2 4 - 775 ' E-mail: Commerciall ndustriallmulti- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.) . ‘f
Business name: H . L . Green New bldg. area (sq. ft.) Address: 1 SW Sequoia Pkwy. , # 3 0 0
City: Portland I State: O R I ZIP: 9 7 2 2 4 Number of stories y 5 0 3 Phones 2 4- 7 717 I Fax: I E -mail: Type of construction
LS f�
- CCB no.: 41328 Occupancy group(s): Existing:
New: .
City/metro lic. no.:
Notice: All contractors and subcontractors are required o be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: J O h n R 0 m 1 sh provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed. If the applicant is
Address: l5 3 5 0 SW Sequoia Pkwy. 7 #30 0 exempt from licensing, the following reason applies:
City: Portl and [State: OR 1ZIP:97224
Contact person: I Plan no.:
,503) phone: 624-6300 Fax{24- 7755E -mail: - ohnr@ l actrust i r . com
ENGINEER
Name: Contact person: Fees due upon application $ -
Address: - : • Date received:
City: (State: IZIP:. Amount received $
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 0 Visa 0 MasterCard
work will be complied with, wheth= s , feed here•n , not. Credit card number: I
/ � Expires
Authorized signatll / /�� /' ��
. �Y, / .• :: l/ "- 1 "14 Name of cardholder as shown on credit card
Print name: ,1 MFA .. d%/ $
C ardholder 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 (6A3/COM)