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Permit Building Permit A lie tIlOII t g-a vog � -, ®: ® FICE:�USEOtiLYk���j,- ; �,A�'�, • 0 [� :' -1 e ��/� 3 Building A �/ - City of Tigard R tC I I L? . 1 � � y Permit No( - B Approval Other 13125 SW Hall Blvd. Date/By: Permit No.: : Case/No. / Tigard, Oregon 97223 an Review Other APR � ZOOS D Post-Re Permit No.: " ' r: yr + .'i1 , . Post- Revi Phone: 503 -639 -4171 Fax: 50 3-598-19_60 Internet: www.ci.tigard.or -us 24 -hour Inspection Request: Si CITY OF- IGA te,'_ ' f I�a></s Land Use m o Ift i t IV . - -Y ?3-6T9 �79 Con tact lur�is. ®$� page a for NamrJMethod: A l � Supplemental Information TYPE OF WORK tgr New construction REQUIRED DATA: lacement Demolition - 1 & 2 :FAMILY DWELLING ❑ Addition/alteration/re P ❑ Other: CATEGORY-OF CONSTRUCTION Not Permit fees* are based on the total value of the work performed. Indicate ❑ 1 & 2- Family dwelling 154 Comrnercial/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 (1 Master Builder ❑ Other: Valuation . :JOB.SITE INFORMATION:'aiid LOCATION - - No. of bedrooms: No. of baths: $ Job site address: j. Voe' ',( 6 /7 4....... 4. _ . Total number of floors - -Suite #: I Bldg. /Apt-#: New dwelling area (sq. ft) Project Name: ,yjjv /f- s/6-yy Garage/carport area (sq. i3 ) Cross street/Directions to job site: porch area (sq. t3.) ................... ---------- Deck area (sq. ft.) Other structure area (sq. ft.) . mo t f .S 6 -fir / Subdivision: ;w.,:: U CKLIST r. lYi 1VIER �= REQUIR DATA: : _ ? _ ..�::::- : .:, ... :': I Lot #: PYYif(rj y : �.:.: ,�. ,; CIAL =. SE CHE __..:.,,.: - Tax map /parcel #: VS / 6 lam, 4 d/ _ ;,.. 4)#) 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, tea" ST/}i1/d /�S/� �/j / overhead and profit for the work indicated on this application. O,'-y- Si6-.4r AE,• no-e¢,e , Valuation "ZAtn)ANGl6 /P. 7/0 • 490 Ce))( i) Existing building area (sq ft.) New building area (sq_ ft -) :FROPRTY:a. Number of stories WNER.'-;:. :. i :1J :TEN ::x',.;: � •-ri: • tion Name: � .;:: . Type of construction Addres �'�� � �,1 u� sr) Occupancy group(s): ? off 0 •fttl � � kJAS/f[�V6.1,17N Sr SrE' '3`e> New: City /State/Zip: i42r v,p Abe 97da- I .0 °ne�3Tnrs. ;c a Fax: -113 � /„ u 9 NOTICE: All contractors and subcontractors are required to be '� A1�IT , �'''� "�'` : - .':: �" �� ` on Constructi Co ntractors Board under co rrrACal�eERSOI� .. �:� = ;. = ";� licensed � Business Name: ,v-7e2,2",- " - - T �� provis with t he ons of ORS 70] and may be required to be licensed in the Contact Name: jurisdiction where work is being performed. If the applicant is exempt 4 n r ,n404- Wtizt 2-r from licensing, the following reason applies: Address: /5 1 3 /1 soco,4 j. sr City/State/Zip: , ia-r'1 C d u C,C w,0.. i „F66s Phone: ,...749- Y -0V2, I Fax: p E-mail: �-S g06 •o 5/5/....a_ „: W _.. -, : � i �Dof a • c b _ 'Vi'µ ? -::: 1 : "�BUnit - - _- __._ ::r<'' -�_ : w. ... _: ;y._,,,., '::"}C_:Y:�e ” _ ��'�`'.',,=,/�/�7�7�.,D� �� �r :. _ ^'*�. �:.. - - - '� ;L. -.: – - -•: at :' .o a : - - <v.:.' ._ - -1s .`F- -,�i.' :tricoli r'4yl�i�.�'C��•or'']] - ii �:Y,� . _ �a :' t- "- 'J ' I M L.- '" � , r i: 1 -. Y .-_;.• - _ - V3.V�'Y�ei -. - .et�? l:.Z�� � "l.. _ _ ���.RG. �1y ,,�,�,�7��,a G�•�',_: ..3 �....s. "4t � °Y�.__., .vF � ^f, r -. .....a fer�::L l/��.J{.11W �: �.::? ,'• . . --. ,?; - -.. -.- Business Name: : . s� � - - °:� .,: _ ale. =. _ _ Bus G7l'ie- GI-�..fzZ.4 c�-tr - ._.�_: z:,._..._,- Address: j Fees due upon application $ City /State/Zi.: - t..e_fra='�/e di e_ - ■ Amount received $ Phozie; j -1 / /_3`d,.j . '*3t Fax: „V/ - � e.0 .1 E Date received: CCB Lie. #: G)9. - Authorized Signature: �" Date: Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. (Please print name) *Fee methodology set by T r - County Building Industry Service Board. i :\osts\Permit For ms\BldgPermitApp -doe 01/03 I Exhibit 3 S Page /CO of /5-1.---Pages c , �¢ , . .11., , ;, I' - . •- -AI, Commercial Application Checklist pr' P P - A�o-�y;? I'� I 1- ,!!.. City of Tigard APR 2 2 20Q3 City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 Phone: (503) 639 -4171, Fax: (503) 598 -1960 CITY OF TIGAPD Internet address: www.ci.tigard.or.us BUILDING DIVISION PROJECT INFORMATION • Project name: Mai-rd.,. 1\„ 1 ' Date: / f a 1 ( 03 Address: , /g /t ' , J City: c �, ,e( State: ©R ZIP: c o a a 3 Scope of work: Free - S - �c•Ae "3 Y' = ` 0r\ e.�..4-el S cy. a-e•t�`i'barct trAkk+Avc i Code s-ec -i - tvIA_ 184-70,010(e)(4). Map and tax -lot no.: Reference no.: p 1s 1 3 c - -T3 v 00„), 0 Contact person name: _ IA 'p , }Z \MA tA,,r i c._ Company: I .A. G Phone: 0360 ct 06- Fax: (360') 7o6 - o�'-ta Cellular phone , 0- crq q_ 3 (1 E -mail: �5��'� -- Z ('� aO[ a , . cove . NOTES AND INSTRUCTIONS , • The purpose of this checklist is to help define a complete submittal package for the scope of work. Plan review will not take place until a complete package is submitted. • This checklist can be used for all commercial construction projects, including new construction, additions, alterations and tenant improvements. • For complex projects, applicants should use the "location" space to note the item's location and page number from the plans or the specification book. • It is not necessary to duplicate submittal information, even if it is asked for in multiple sections.. • In the checklist, "Required" means that the applicant must provide this information for plan review. • In the checklist, "P" means — • if checked by the applicant — the information is provided for the plan review. • if checked by the plans reviewer — this information is required for the plan review. • In the checklist, "NA" means that the information does not apply. • Choose only those sections of the checklist that apply to your scope of work. Section 1.0, "General Project Data," must be included with each .ro'ect submitted. . PRE SUBMITTAL PROCESS . - - An applicant may request a pre - submittal meeting with representatives of the jurisdiction in which the project will be built. The meeting may take place during the conceptual, schematic, or in- progress phase, or when the applicant has completed plans. INDEX OF CHECKLIST SECTIONS , 1.0 General project data Page 2 7.0 Mechanical data (Types I and II 2.0 Civil data Page 2 kitchen -hood permits) Page 6 3.0 Architectural data Page 3 8.0 Plumbing data Page 7 4.0 Structural data Page 4 9.0 Electrical data Page 8 5.0 Mechanical data (new construction, tenant 10.0 Fire - suppression data Page 9 improvement, gas- piping permits) Page 5 11.0 Fire - detection and fire -alarm data Page 9 6.0 Mechanical data (additional or replacement 12.0 Re -roof installation data Page 10 rooftop- equipment installation permits) Page 6 13.0 Jurisdictional requirements Page 10 This checklist is for building department jurisdictions in Clackamas, Multnomah, and Washington counties. 440 -2734 (8 /01/WEB /COM) i:\ Dsts\Forms \COM- AppChecklist.doc 05/29/02 Exhibit 33 . Page IS1 of ■ 5- .Pages •� . SECTION 1.0 GENERAL PROJECT DATA :. . . Construction documents Location (sheet number or spec section) 1.1 . Z Required No. of sets of plans: New: 1 TI: 2 1.2 ® Required Cover sheet title block 1.3 ® Required Cover sheet vicinity map 1.4 ® Required Cover sheet plan index 1.5 ❑ P ❑ NA Code summary 1.6 ❑ P ❑ NA Deferred submittal summary 1.7 ❑ P ❑ NA Professional stamp and signature 1.8 ❑ P ❑ NA Fire and life- safety plan 1.9 ❑ P ❑ NA Landscape plan 1.10 ❑ P ❑ NA Landscape specifications Supporting documents Notes 1.20 ❑ P ❑ NA Land -use or planning actions 1.21 ❑ P ❑ NA Required fire -flow calculations 1.22 ❑ P ❑ NA Fire - hydrant flow -test report 1.23 Cl P ❑ NA Fire department or fire district building survey report 1.24 ❑ P ❑ NA Material safety data sheets (MSDS) SECTION 2.0 — CIVIL DATA Construction documents Location (sheet number or spec section) 2.1 ® Required Site plan 2.2 ® Required Site utility plan 2.3 ® Required Grading plan 2.4 Z Required Erosion - control plan 2.5 ❑ P El NA Utility-vault location and details Supporting documents Notes 2.20 ❑ P ❑ NA Geotechnical/soil engineer report 2.21 ❑ P ❑ NA Storm -water calculations 2.22 ❑ P ❑ NA Site retaining -wall structural calculations 2.23 ❑ P El NA "Assurance of Compliance" with environmental rules .... • 440 -2734 (8 /01/WEB /COM) Tri- County Commercial Application Checklist 2 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i;\ Dsts\Forms \COM- AppChecklist.doc Exhibit 33 7 ge 1 S' of y Pages A - SECTION 3.0 - ARCHITECTURAL DATA • Construction documents Location (sheet number or spec section) 3.1 Z Required . Floor plan(s) 3.2 ® Required Transverse and longitudinal cross sections 3.3 ® Required OSSC Chapter 11 accessibility requirements 3.4 ❑ P ❑ NA Interior elevations 3.5 ❑ P ❑ NA Exterior elevations 3.6 ❑ P ❑ NA Roof plans 3.7 ❑ P ❑ NA Exterior wall sections and details 3.8 ❑ P ❑ NA Reflected ceiling plan(s) 3.9 ❑ P ❑ NA Fire -rated construction_ details 3.10 ❑ P ❑ NA Energy code compliant construction details and specifications 3.11 ❑ P ❑ NA Door schedule 3.12 ❑ P ❑ NA Glazing schedule 3.13 ❑ P ❑ NA Furniture plan Supporting documents Notes 3.20 ❑ P ❑ NA Energy code compliance forms /calculations 3.21 ❑ P ❑ NA Material safety data sheets (MSDS) 3.22 ❑ P ❑ NA Hazardous materials inventory statement (HMIS) 3.23 ❑ P ❑ NA Hazardous materials management plan (HMMP) 3.24 ❑ P ❑ NA Written fire and life- safety evacuation plan for area of rescue assistance 3.25 ❑ P ❑ NA Active and passive smoke - control information • 440 -2734 (8 /01/WEB /COM) Tri-County Commercial Application Checklist 3 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i: Dsts\Forms \COM AppChecklist.doc Exhibit 3 3 Page /S3' of hr).— Pages O � SECTION 4.0 STRUCTURAL DATA Construction documents Location (sheet number or spec section) 4.1 ►4 Required Structural cover sheet 4.2 ❑ P ❑ NA Foundation plan 4.3 ❑ P El NA Under -slab mechanical plan 4.4 ❑ P ❑ NA Under -slab electrical plan 4.5 ❑ P El NA Under -slab plumbing plan 4.6 ❑ P ❑ NA Floor framing plan 4.7 ❑ P ❑ NA Roof framing plan 4.8 ❑ P ❑ NA Structural elevations 4.9 ❑ P ❑ NA Structural details and cross sections 4.10 ❑ P ❑ NA Standpipe information 4.11 El P ❑ NA Special inspector /structural observation matrix Supporting documents Notes 4.20 El P ❑ NA Geotechnical /soil engineer report 4.21 ❑ P El NA Site - specific seismic hazard report 4.22 ❑ P ❑ NA Design narrative 4.23 ❑ P ❑ NA Structural calculations 440 - 2734 (8 /01/WEB /COM) Tri- County Commercial Application Checklist 4 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i:\ Dsts\Forms \COM- AppChecklist.doc Exhibit 33 Page Tof --,.. - RECEOVD ....._ __ _..... .,. . ?APR 22 2003 • - ,-:e.1.%.• CITY OF TIGARD . 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