Permit `CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00498
141 DEVELOPMENT SERVICES DATE ISSUED: 9/9/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S109AB 10000
SITE ADDRESS: 13165 SW HOODVISTA LN
SUBDIVISION: RAVEN RIDGE ZONING: R -
BLOCK: LOT: 029 'JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 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: $ 3,000.00
Remarks: Stand - alone fire sprinkler system.
Owner: Contractor:
PEVZNER CONSTRUCTION WYATT FIRE PROTECTION INC.
13470 SW TAPADERA ST 9095 SW BURNHAM
BEAVERTON, OR 97223 TIGARD, OR 97223
Phone: 503 - 888 -6405
Phone: 684 - 2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -
[BUILD] Permit Fee 9/9/03 $72.10 Sprinkler Final
[TAX] 8% State Tax 9/9/03 $5.77
[FLS] FLS Pln Rv 9/9/03 $28.84
Total $106.71
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 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
caking (503) 246 -6699 or 1 -800 -332 -2 • , .
Issued By: k , • %. lieu, � ' AIL JA
it e _ lO
Signature:
r Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System
6 s sw H ;90 V/ s r� 1 L
I / 1. bon FOR C FFICE USE ONLY
i Building Per Received Building Q
• ; Date/By: f 1 c � 6 ' " 1 Permit No.: &1400.5— ��A3' 00 `C !` 9
• (
City of Tigard AUG 1 $ 2003 " ''X� Planning Approva Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: 3 7/t Permit No.:
�
Phone: 503 639 - 4171 I
f1 '� I Date/By: Case N o. V
Post - Review Land Use
Internet: www.ci.ti a rdor. 1 ING DIVISION e.
g ' Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 _ Name /Method: Supplemental Information
H 5 i o5 -oo
. TYPE OF WORK.:. "'' 'IRE`^.iIIRED:DATAc
®.New construction ❑ Demolition -1 &2tFAMIIYDWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION +:, Note: Permit fees* are based on the total value of the work performed. Indicate
1 & 2- Family dwelling ❑ Commercial/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
❑ Master Builder ❑ Other: Valuation $ .3 Cr c�
'._JOB SITE INFORMATIONand LOCATION . , -i No. of bedrooms: No. of baths:
' Total number of floors
Job site address: 31 5.w. 1 il1It A L!'Q■l�= New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: r?../N 2i3 t S1(1 —G_ Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.) C
,:,r p: va - , 'rte ,x '_.'."�'., ' . =4' ,,� ; ; .i;':
°' - `�"�'- „^',_i��. ,Q -DATA =:�; `' �:;�: � =t �?.; -:: .;
t �. N p CHE ICLIST _
" ; —�
Subdivision:
Lot #: .,::.,� ....n u:gitt�.�a,n'a"•ni ��. ± ..,: ���.�.- r-- .hh�.a: �.,r+�• =:,+r.... -. K .•.:: �.
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate C
DESCRIPTION OF WORK . the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Valuation $
Existing building area (sq. ft.) .
New building area (sq. ft.)
Number of stories
': -••-, ; Type of construction
.. PROP T .- . >••'� TEN .....:. - .... .::...... YP
ante: e JAO rC (Q Q1)/0 U N Occupancy group(s): Existing:
New:
Address: I?a4.1 Stk.) 1P1Pt-)E2ia--. -r
City /State /Zip: f _0 _, ;2-r6 (5 (L Q 7 "3
NOTICE: All contractors and subcontractors are required to be
Phone:3- igg- 1 i F ax' licensed with the Oregon Construction Contractors Board under
0 APPLICANT 0 CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: • jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Fax: ���. ,:�,.� : ;. .�,• >tia
Phone: � + g+►t' ° r ;;: �� ,� ':. _,.1'
-: _.: .�,.�,il, . >s���'L' " Nr .. - .. _ t.
. . : i ; .v.
E - mail: .� �� � ; ,�, f lease"`"iefecto' fee schedul ' -_ �t'- _ *" •
CONTRACTOR : .... ` :,,... .:•1< ... , �... rr.., .
Business Name: (,() y/kT Fl pi2v - CE C - tl()I' Fees due upon application S
Address: c 'O 1 5 . t. 3 . Gl t(L.IJ 4I- N\
City/State /Zip: Tl (,(•(2 piZ Amount received $
Phone: (,v - z,5-=(7_6 Fax: t E 4 - cu 7 5 5 7 Date received:
CCB Lic. #: 64 0
Authorized , Notice: This permit application expires if a permit is not obtained within
�� �
Signature: " - ---........., Date: // fit& 3 180 days after it has been accepted as complete.
R i Ci. (k(2_l) RLj ∎i12 .Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Perm,t Forms \BldgPcrmitApp.doc 01/03
•
CITY C7F TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 fib G — 00 3 7 .0
INSPECTION DIVISION Business Line: (503) 639 -4171 .
, -GO ,
Received Da e Requested ® PM BUP
Location 1 ' \ QS a LP Suite MEC
Contact Person Ph ( ) 9 —' 1 (L PLM
Contractor Ph ( ) • SWR \I
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
Fi rewall
l y a S. nkle
'fir- •-
Susp'd f eiling
Roof
Othe.
\, in.,,!
it PART FAIL }
4,,
,
i
P '? f BING t
Post & Beam
Under Slab
A
Rough -In
Water Service . /
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS P RT FAIL
M :A C L
,e'
a
Post a Beam .
Rough -In
Gas Line
S • _- ! ampers
PART FAIL
' TRICAL
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: 0 Unable to inspect — no access
Fire Supply Line 4( 7(o Date I actor (`" t�v
Approach /Sidewalk P Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL