Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00416
I DEVELOPMENT SERVICES DATE ISSUED: 8/31/2004
il 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10763 SW GREENBURG RD 110 PARCEL: 1S135BC -00201
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: AL"( 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: $ 2,500.00
Remarks: Remove 9x8 roll -up door, frame add new 4x7 man door, side to match existing and paint.
Owner: Contractor:
BELANICH, ROGER M JOSEPH HUGHES CONSTRUCTION, INC
BY SOUTHLAND CORP 7035 SW HAMPTON ST
PO BOX 711 TIGARD, OR 97223
D.iLL TX 75221
Phone: 503 - 624 -7100
Reg #: LIC 45645
FEES REQUIRED INSPECTIONS
Description Date Amount Framing Insp
[BUPPLN] Pln Rv 8/27/2004 $46.87
Insulation Insp
Gyp Board Insp
[BUILD] Permit Fee 8/31/2004 $72.10 Final Inspection
[TAX] 8% State Surcharl 8/31/2004 $5.77
Total $124.74
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 expi 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 or 1- 800 - 332 -2344.
Issued By: �/11 /
Permittee
Signature: r,"
Call 639 -4175 by 7 p.m. for an inspection the next business day
/
� �
Building Permit Application e FOR OFFICE :USE ONLY - . .
City of Tigard ON DateB d , V Perm t N..: ' d al e � � 13125 SW Hall Blvd., Ti a rd, OR 97223 C T VV
Tigard, Plan B , w 0
Ar ✓v I
Phone: 503.639.4171 Fax: 503.598.196 ' c, ` r� .yi; E a\ Other Permit:
,:; � ∎ 1 Date/B :
Inspection Line: 503.639.4175 �_!_, t $ •
Date ReadyBy: Juris• H See Attached Checklist for
Internet: www.ci.tigard.or.us 0 10 Notified/Method: 1 (7 Supplemental Information
, ; Ypi p 4 ? . • r= b. REQI7IRED�DATA , ,, ANDs20 D ,W,EL I I-, -
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❑ New construction h molition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
+ qzs ,.,� ^.. i pe, =.,,rv' x'x :3t° .`:w :,5ri,s °-:cad¢< "'��,.. �s w
`� �� �"��,a � ��'CA`FEC�.OIi�'�OF C NS��TiCTTON � � �' r � � work indicated on this application.
El � 1- and 2- family dwelling CCommercial /industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
a air SIDE INFO TIT A.NI T:OCA'I I ttNit )�� Total number of floors:
Job site address: 1 0 `7 (O 3 S W 6- e co iwr, 1Q New dwelling area: square feet
City/State /ZIP: f ` ay 6/12- 97 .'-.' Garage /carport area: square feet
Suite/bldg. /apt. no.: / / (2 f Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
f, REQUIRE A: ; ., CIIEC_KGI ,
Subdivision: 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
.. r. 4` „ . pV,. ,: ��s«”' `* ',v . 1 ' .s�zr „sx: z . : .ES +ts. "a•J a .: R � . '`. , �ez...*av: »3t^ t �: 1 . "e .
_; t,, GRTP, work indicated on this application.
Valuation: $ d tS O G —
Ke q " Ro��-u�, door a id/
a y 7 ° wit. Svc f 5 tit f e At Existing building "area: square feet
e lc S A' � avv Pet , ' �/ New building area: square feet
�a� 'v«` 9' 1'a,€�^�. "" m " % ` '.- «: > n w � y .�F^ -y ' : ,* + ' " ;' ' „'�;. a ... � ...r n ,
.w ''ER O R` . ; . „ :' TEN , ' , Number of stories:
= Y . . . ,?; A )1/4 ,.. ` ./:: ;'t'- s ��,,. . , , s,'• , '�,r,E ;:i DFw x ._.. .. :v. i .
Name: g i t n e SS Pr d ea ,P e Y` C I? 4 -`n- f Type of construction:
Address: d_ p p,._ Q / 7 Occupancy groups:
City/State/ZIP: ac .I eft / (,,/ / 4 7 � 8 Q ,- Existing:
I 7g
Phone: V � ! . f�f / Fax: 9 n t/85--- 5 ! ! 6 New:
., ,a. ; : =j i4 -I) ekk ` : z,' ig & CON;T�ACT PE .:' , . �;r: r a . ,. ��
�.� a q - r �s�.. 4, - , z 41,. 4 .4 : -, ` `e,•a� r� , > . , i t N `; .: OT IC - `'n , v . , r
T A . � « � � » �._ � � -�.,a. -gay � .... . . �
Business name: J O S e® 4 / -i _ 4.„.." c c' .-S f. All contractors and subcontractors are required to be
Contact name: ea (Ala l 2lz a e•y licensed with the Oregon Construction Contractors Board
/ under ORS 701 and may be required to be licensed in the
Address: / 1 / S 5 (/U e a/' 6 fit. r $ IV' e jurisdiction in which work is being performed. If the
City/State/ZIP: p t - f -A o to 1 7 2— / y applicant is exempt from licensing, the following reasons
apply:
Phone:,(S4)3) (p,7.' Y– 7/oa Fax: :45'e 3) to. g 4 /-5d7 ,_.s
E-mail: diAia, /08•60..1[ o f e D e 414,1 eS C G
Business name: a i- „ A ,.» ., ,-. »T -
:a.- :- �,:r��., .
S e,42 'f , -v . :l.m)3,ZJT PAIV
Address: •
Please refer to fee schedule.
City/State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.:
J' / Date received:
Authorized signature: ' - / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ` � ea,„ Wad'' L/e�'�` �- Date: /�> G L/ * Fee methodology set by Tri -County Building Industry
�� ✓"`��� Service Board.
i:\ Building \Permits \BUP- PertnitApp.doc 12/03 440- 4613T(11 /02 /COM/WEB)
A Building Division
4 /4 6114 Plan Submittal Requirement Matrix
AIAL "- � Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
(� Q ,0 Type of Subm = % , , # f l !' l
{ nc tides new; a ditaan a T t '
erat><o t
)� Requ a t'
.� '� - Y"a, 1 X1' t y *«i o ^s ° ,
l.. ,„ , ; , ,,;17:1311, , . tt,.1t:.: �. fat -f t d Submftt4
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
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP . 4 /l ‘e,
Received Date Requested AM PM BUP
Location /o 7 Cea 3 -0-.) j1 uAr— Suite Ye) MEC
Contact Person / Ph ( ) o/ _6 3 g? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:.
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ""
Fire Alarm �---- �,
Susp'd Ceiling 4/1
Roof \� le ► ��k :�■
Other: �zu -'(C_ �� 1
'ASS / PART FAIL _Ie Ar
•"r7BING
Post & Beam � -
Under Slab
Rough -In 1
-�I N
Water Service
Sanitary Sewer ague
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 ❑ 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 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL