Permit BU iidi>m i '
_ �C�t10I1 ' ' , �.�=Ny �� �: '..':� FOR OFFICE .USE OtiL'Y�� 1Mi V� k ,„„�
rte' t� !� �_ ived Building
Ci, of Tigard z a v • ; :T Permit No.:/3.662/3 -410 /7�
� TA i P,' ' g Approval
Other
13125 SW Hall Blvd. D �f A I ` may: Permit No.:
Tigard, Oregon 97223 �"` 2 2�3 �is� Date. view Other
Phone: 503-639-4171 ham. '.� Ti a /„ ,:. I Da �L Permit No.:
ax 503 :5 r 40196 � �.. .'.. 1 '' Pmt- Review Ri i nn :fr�? t > v ove``' .,' P Case No
Use
Internet: www.ci.tl
gard.or:us�. �.. t�t�l..i.�,v c! ; '• Date/By: Case
24 -hour Inspection Request: 503 -639 -4175 - _i.
Contact Juris.: ® See Page 2 for
Name/Method: Supplemental Information
TYPE OF WORK ..
0 New construction ❑ Demolition REQUIRED DATA:
❑ Addition/alteration/re . lacement ❑ Other: - ' 1 & 2:FAMILY DWELLING
CATEGORY OF CONSTRUCTION ' ' . ' Note Permit fees* are based on the total value of the work performed. Indicate
0 1 & 2- Family dwelling j Commercial/Industnal 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
,, - :JOB.SITE INFORIIMATION.and LOCATION •z.::`, . . : . • No. of bedrooms : No. of baths: $
Job site address:AZ two w r „ aL Total number of floors
Project Bldg. /Apb #:
Garage/carport dwelling area (sq. ft.)
Name: yyl, j j". »r S CwN Covered oh area (sq. ft)
- Cross street/Directions to job site: Deck area
/4)7 64.'1:641,
(sq. ft.)
f f p9.-' $ C -) AO Other stru area (sq. ft.)
hveAT`e� £fl cp �p , =,. r :: QUIRED
Subdivision: ( r-: ' R
Lot #: /4/06 "•` O I ► MER CIAL :::1&, CHECICI;IS1
Tax map /parcel # :42.6 /6 /C3,a :: - "
Note: Permit fees* are based on the total value of the work performed. Indicate
+ 'DE;SCRIPTION.`OF:WORK ' the value (rounded to the nearest dollar) of all
overhead and ) equipment, lica on. / materials, labor,
/�/ZcE' .ST/�}y1/{a/ /�/�- F ir����/ profit for the work indicated on this application.
® 5/6-otv /e rl6 -, e. , Valuation $
a�titi/S�AJGt6 /d�. 7F Q q C �� / t Existing building area (sq. ft.) i
4 J New building area (sq. f}.) /
(':i'ROPIZTY:iDWNER. ti ' .. . A�:: :TENANT- Number of stories
���� A1v� ::4•.�': "::' ^: Type of construction
Name:
CFa c cote -.rr) Occupancy group(s): Existing:
Address: 7a D Sul wASH•y veriztAe sr Sr e 630 ., - ` • . New:
City /State/Zip: #42T ,p ` MC. 97.145
P hone;5 7 . 1 3vit - -53 . Fax: �3 i =
n. //.9 NOTICE: All contractors and subcontractors are required to be
I'D :Ar i c NT:.' " x_67 -' : licensed with the
Oregon Construction Contractors Board under
Business Name: �; . ��`�— SN provisions of ORS 701 and may be required to be licensed in the
Contact Name: ' Jurisdiction where work is being pa If the applicant is exempt
'411 ri7`z,m.,4_ Kl�2,e.„ from licensing, the following reason applies:
Address: f .73 /S, ,gp1,4gY sr
Ci /State/Zi • : cot( t.,C - O . -- 0
Phone :3 �i� - Fax: p
E 4 - e, 50 �.� - ;,-- w:_:.- _w- : - - _ ._ _
C y _ _ .� . tTrr 77�r i �..._, _-' �ti iL-�= ;:i.i . .
7 �,�� �Q/ Ct9V'{� r= .;,,- �'':< ?!� - ��cJiii?Dil't�ir�d_ :.._ . ._ *Zi-c:. .... _; r-:!i' i'.'.
- .�._•,�- :�:T� :.�.M- t'of'ehsth - -�. :ti• -
B usiness Name: 40/2/ �.r. .:.. , . _._ _, _ . ..._ .:'.,a,=,-:=.;-::
Address: j ^ �� Gc/ � Fees due upon application $
City /State/Zi.: C--- o c- d Amount received $
Phones. / -39.- a9,3‘ Fax: SW
-2 . - 4� Date received:
CCB Lie. #: e)
Authorized
Signature - . - - Y� Date: Notice: This permit application
expires if a permit is not obtained within
180 days after it has been accepted as complete.
(Please print Warne) *Fee methodology set by Tri- County Building industry Service Board.
f:;
is lDsts \PemvtForms\BldgPemtitApp.doc 01103 f a (/IS -
Exhibit
Page t_ of
/ Pa es
Commercial Application Checklist RE C Th
APR 2 2 2003
��1! City of Tigard
City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGAaD
Phone: (503) 639 -4171, Fax: (503) 598 -1960 BUILDING DIVISION
Internet address: www.ci.tigard.or.us
PROJECT INFORMATION
Project name: Mt , S � .S Date: ya i(03
Address: iy,O po / / Cit cy r I State: O R ZIP: 9-
Scope of work: Free --- S-k-cw at Irnee v .� v t .. 1 S; W\kvvc -Sal Code s , ec +ty v�
Reference no.: Map and tax -lot no.: _SS `/ 3 S -'[3 -- 00a 0
Contact person name: J atA c Company: .{.V JA
Phone: (3 (00) q06- tj`toZ`� Fax: (360) c106-09
Cellular phone • . O 'T q _ 3 (1 y E -mail: j S 1-, -- 30 0 [ (S . , •L , --
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 /O1/WEB /COM)
is \Dsts\Fornu \COM- AppChecklist.doc 05/29/02 Exhibit
Page s-5' of
fir›.-Pages
SECTION 1.0 GENERAL PROJECT DATA
•
Construction documents Location (sheet number or spec section)
1.1 ® 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 ❑ 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 ® Required Erosion - control plan
2.5 ❑ P ❑ 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 ❑ 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:lDsts \Forms \COM- AppCheckl ist.doc
Exhibit l
Pa e Ss of
/f,,?- Pages
•
SECTION 3.0 ARCHITECTURAL DATA
Construction documents Location (sheet number or spec section)
3.1 ® 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 a 1
Page g-7 of
fir;.)- Pages
SECTION 4.0 - STRUCTURAL DATA
Construction documents Location (sheet number or spec section)
4.1 ® Required Structural cover sheet
4.2 ❑ P ❑ NA Foundation plan -
4.3 ❑ P ❑ NA Under -slab mechanical plan
4.4 ❑ P ❑ NA Under -slab electrical plan
4.5 ❑ P ❑ 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 ❑ P ❑ NA Special inspector /structural observation matrix
Supporting documents Notes
4.20 ❑ P ❑ NA Geotechnical /soil engineer report
4.21 ❑ P ❑ 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\Fomis \COM- AppChecklist.doc
Exhibit a
Page _ 2 of
/�y Pages