Permit i.
BUILDING PERMIT
CITY TIGARD PERMIT #: BU P2003 - 00691
- 13125 �
DEVELOPMENT r SERVICES 639 -4171 DATE ISSUED: 1/15/04
SITE ADDRESS: 10225 SW HALL BLVD 103 PARCEL: 1 S135AA 01901
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT: 037 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 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 15 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: $ 23,520.00
Remarks: Tenant improvement, new chiropractic clinic existing shell building.
Owner: Contractor:
WAYNE L GERIG OD OWNER
10225 SW HALL BLVD
TIGARD, OR 97223
Phone: 503 - 244 -1004
Phone:
Reg #:
FEES REQUIRED INSPECTIONS ,
Description Date Amount Mechanical Permit Require
[BUPPLN] Pln Rv 12/16/03 $177.91 Electrical Permit Required
FLS FLS Pln Rv 1 2/16/03 $109.48 Plumbing Permit Required
[FLS] Framing lnsp
[BUILD] Permit Fee 1/15/04 $273.70 Gyp Board lnsp
[TAX] 8% State Surcharl 1/15/04 $21.90 Final Inspection
(additional fees not listed here)
Total $975.99
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 -4! I arough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
call g (503) 246-6.•• or 1 - 800 - 332 - 2344.
- Is ed By: ' $�i , 0,60 441
Pe rm ittee
Signature: , } D/� ! 4----
1 Call 639 -4175 7 p.m. for an inspection the next business day
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` :.. - --- Received Building 1
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AePCtiOOD ttrar- DateB / /
u Permit 'o.: I 'O - Od 69
City City D �C of Tigard 1 6 200 Planning Apr 'val.
I Dute/c�y: Permit No.:
13125 SW Hall Blvd. rr .�. � Plan Review (fiber �.
Tigard, Oregon 9 rY Q
G� DaterBy: X6 Permit No.:
Phone: 503 639 - 4171 F^ ; , r w, , 1 > t , p Post-Rm.-few Land Use
y DateB : Case No,
in ters; www.ci.tigard.or Y ' .-4 _ . 4 Contact 1 Jo - Q Sse Page 2 for
24-hour lnspectaQtt, Request: 503 3 Name /Method: - -�_ 4 1 Supplemental Information J
'.,1 , I 'I 1 .. :. E • 1j f. P i 1, .- i ���
., I ', �, . � I : � 'I"YIk�A�+ 1.�9;E�'f��1 I'� � I , �' I .. I I � �
:.. - I 1' I R.EQL'IRED lbA' � i y A I ..-• I p
I I fl � New Construction 1 Demolition ' I 1, & 2 ' ..' : LY L : . 4i.T i.,' I 1 1f 1 1
value o2 the work performed. i Addition /alteration/replacexnent Other: I
' I ' I, :.. I `��,,���'�. ['It �' — N�' j : I , �f ! •Note: Permit fees* are based on the total va indicate
1 L.J 1 & 2- Family dwelling Comtmrcialllndustt•i "al the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
1 - In Accessory Building _ ulti- Family
{ fl Master Builder 1 fi Other: valuation S ____
r..: : . tio, As t. iPrI00104M1i tI idIE,rdIA. i'! Id .; ; No of bedrooms:_ No, of baths:
,r. 1.1\ P Lk �j . . 11J` �� Total number of floors
oh site address: 0 :Ll. �S� '
1• New dwelling Arcs (sq. ft,) _
L Li1tC (1� . Bldg, /Apt _r : Garage /carport area (sq_ ft-) _ —
Pro e ct Name: Covered porcli area (sq, ft.)
I Cross street/Directions to job site: — ! Deck arc (sq. ft.)
. S Other structure area (sq. ft. )
� { I
I ' I I
i I I' I QUIRED
Subdivision: Mt ee A c� s 1 Lot #: C �b1 - '
Tax map /parcel #: 31' ,J\' 01 Note: Permit fees'" are based on the total value of the work perfbrmed. Indicate
T 11) - '" I ove head and to
work indicated on this application, materials, labor
V� \ _
Valuation $ )—S �) L�
— 1 Existing building area (sq. ft.) 1 d2
--- I New building area (sq. it) Lb$ •
Number of stories
_
1' OP ICEY. OWN ,' '''':!:7...1... - _ ..: : .
�� ►� 'TENAI�'T'? � � Type of cansttucran
Name; T f - - V ar \K\s 0 ' , C - i Occupancy group(s): Existing:
Address: I)a� J cJ, IN, A. 5 ,* la . _1 1 .,_ _ , -- l
�f O. 13 _
City/State/Zip: O �I �- -- _ — __-- --� I
Ph : 9% '. Fax NOTICE: All contractors and subcontractors are required to be
AL'EI ICAl�
licensed with the Oregon Construction, Contractors Board under
-e ^ I : O I C'�' Illa� (Ply' p rov isio ns o ORS 701 and may be required to be licensed in the
L!usiness Nagle: 7D t...„ . ] jurisdibtion where work is being performed. If the applicant is exempt
C ontact Name: ` ,i E, * ., ! from licensing, the following reason applies:
"s - ddressi 0- 3t;-) 7 i1 VZ p - -- - -
n _ F -i
Phone Sbl taNk ' AS 1 \ I'ot� -T. .
'f A : ,I D � 'k34r,NI'I co- I �. '
E-mail: : , a II I' I'! i PI e I
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li- lllClll. .. .- _ 1I II1 I I . I .I I ' f ... ' � ge targe
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..'.= ' -'', ' .` '! !.. _ : ,� CONTR ( ACTOR' . - . . : - I 39 •
Business Name: O C,L JAJ (2 Fee due upon application $ Al g -7'
Address:
Amount received 5 ,..___.
City /State /Zip:cl13 7.. 4 oby cb3 1-44 i pa
l ~ ` "T Date received:
Phone• -•,�� ----- - �; = :� =: , Fax: •
CCB LI c. I A '.�= '
1 Authoriz• ' �, i ,, _ Notice: This permit application expires if a permit is not obtained within
180 Signature 1 / Date :�� �� �� Not days after it has been accepted complete.
P I Pj \ �' vL (,1 r �' 'J `Fee methodology set by Tri- County Building Industry Service Board.
('lease print name) 71 q
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 (0q , q g
,
col ,� Plan Submittal Requirement Matrix
�� 1I Commercial & Multi- Family
City of Tigard New, Additions or Alterations
T -
YPEIOF S UBMITTAL # of Pla ns_.
(lb cl udesNew, Additions )or Alterations) Required, at
,� �.,. �.... Subm "ittal
Site Work 4
(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\PlanSubMatrix.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received /Z- /te Reque ted a 25 V A sP�M BUP
Location /at Z S (AA, Suite /03 MEC
Contact Person c ■i, d Ph (.,fib -; ) g / — :S7 £ / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing - ELC
Foundation Access:
Ftg Drain �ti 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
Roof
FAIL
' _- I N G
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
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 2 J S/® I Inspector C ( Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL