Permit /
f{ / CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00568
Mtk �DEVELOPMENT SERVICES DATE ISSUED: 9/30/03
` '' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10215 SW HALL BLVD PARCEL: 1S135AA 01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -
BLOCK: LOT: 037 JURISDICTION: TIG
•
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS 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: 48 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: $ 18,000.00
Remarks: fire protection.
Owner: Contractor:
INTEGUMEND LLC BY SCOTT COLLINS MD DELTA FIRE INC
& MARIA ROSS MD 14795 SW 72ND AVE
9495 SW LOCUST STREET PORTLAND, OR 97224
PORTLAND, OR 97223
Phone:
Phone: 620 -4020
Reg #: MET 00001934
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 9/18/03 $216.10 Sprinkler Rough In
[TAX] 8% State Tax 9/18/03 $17.29 Sprinkler Final
[FLS] FLS Pin Rv 9/18/03 $86.44
Total $319.83
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
952-001-0040 0A. R 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 503) 246 -6699 or 1 :00- 332 -2344.
i
Issue By: , , � � 1 � ! d il
Pe nn ittee - --
Signature: A__ � , /i /z ( / •
Call 639 -4175 by 7 p.m. for an inspection the next business day
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" • Fire Protection System P�Rov�o 9 ;�9 -03 B5.0 it . l5 Sou HAt_ - — i& TE w-,e ro 1
Build Permit App '
Date received , 7 9 Permit no V ?..9( -) D .6
t,. ,y City of Tigard
= Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW taNtD 97223
Phone: (503) 639 - Date issued: By Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: SEP 18 2003 1 &2 family: Simple Complex:
TYPE OF PERMIT '
•
❑ 1 & 2 family dwelling or accessory ❑ Com al ' } inaustr i al ❑ Multi- family P construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other.
• JOB SITE INFORMATION -
Job address: /� .5N la a Bldg. no.: Suite no.:
Lot: Block: Subdivision: I Tax map /tax lot/account no.:
Project name: igommigrei
Description and location of work on premises/special conditions:
• OWNER. FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (Flood plain, septic capacity;solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: State: ZIP: Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
. APPLICANT Garage/carport area (sq. ft.)
Name: it- t ,f� he . Covered porch area (sq. ft.)
Mailing address: I _ , 7Z -¢\-.p_ • Deck area (sq. ft.)
EMIllenWIREIMMIIII State: g. ZIP: cj a Other structure area (sq. ft.)
Phone: 57,3 _ Fax: Commercial/industriallmulti- family: e
3 -x(02 D �� ° E -mail:
CONTRACTOR Valuation of work $ f d , 0d6
Existing bldg. area (sq. ft.)
Business name:
• .. to r ' k • New bldg. area (sq. ft.)
Address: y. . fr. , "]Z /t-• . e
ZIP: • 7
City: ke,,,..Z State: De 2z Number of stories
Phone: Fax: E -mail: Type of construction
� `� Occupancy group(s): Existing:
CCB no.: New:
City /metro lic. no.: cj 3 , , - . Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER •
Name: Contact person: Fees due upon application $
Address: . Date received:
City: State: ZIP: Amount received $
Phone: Fax: 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 jusisdtction for more information'
attached checklist. All previsions of laws and ordinances governing this 0 Visa 0 MasterCard
work will be complied ,/ , whether se i fl card ed herein or not. Credit ca number: / 1
� Expires Authorized si ature: �, , _ ' ate: 0 Name of cardholder as shown on credit card
Print name: nth'4'/ 1f- nu. /1 $
6 C ardholder signature Amount , i
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line:' (503) 639 -4171 / MST
Received /2-- zZ -�' i Date Req l Z —03 AM
Location /0 2.7S (- �k P 2 ! Suite MEC
Contact Person G C. e..P Ph (S 24 6 &O' cz02_,OpLM
l
Contractor P.� - � � Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ( SIT
Post & Beam C- 114.444
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation / / 5
Drywall Nailing
Fire
t grapp
Susp'd Ceiling
Roof
Ot ac
•ASS PART FAIL
-NG
-
Pos : -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 / 1. Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL