Permit BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2000 -00427
ln' DEVELOPMENT SERVICES DATE ISSUED: 11/6/00
- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09225 SW HALL BLVD E PARCEL: 1S126C0 00100
SUBDIVISION: ZONING:
BLOCK: LOT: 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:. 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 12 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:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 25,000.00
Remarks: Commercial TI
Owner: Contractor:
MENASHE, R BARRY TENANT
621 SW ALDER, STE 605
PORTLAND, OR 97205
Phone: Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Mechanical Permit Require
PRMT CTR 11/6/00 $283.30 27200000000 Electrical Permit Required
Plumbing Permit Required
5PCT CTR 11/6/00 $22.66 27200000000 Framing Insp
PLCK CTR 11/6/00 $184.15 27200000000 Gyp Board Insp
FIRE CTR 11/6/00 $113.32 27200000000 Susp Ceilng Insp
Final Inspection
Total $603.43
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 -0010 through OAR 952 - 001 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987. '
Permitee , 1
Signature: , / d `
Issued By: `
Call 639 -4175 by 7 p.m. for an inspection the next business day
. Building Permit A cation
Date received: l0 O40-00 Permitno.: c1a;
Iti^ �riyl City of Tigard
:_.. Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: B c y Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
• . TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ ommercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
CI Addition/alteration/replacement T enant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: j ( k /--/ /--/ (/ e(')I 4: • 4 1 7 Bldg. no.: Suite no.:
Lot: I BS Block: ,Subdivision: Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: / f 4 kJ / t' '6 Li /- r
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
•
Name: r r / S� � • ( Floodplain, septic capacity, solar, etc.)
Mailing address: � 6 a / S 1.cj . »/u e� _ 1 & 2 family dwelling:
City: AS, / t_ State:, ZIP: aOs Valuation of work
Phone: Fax: E -mail: , No. of bedrooms/baths
is
Owner's representative: . - r t. 1 y '� e 11 C? .S Total number of floors
• Phone: Fax: E New dwelling area (sq. ft.)
• APPLICANT Garage/carport area (sq. ft.)
Name: ,5 2 A / Y7 i'• as /../ Covered porch area (sq. ft.)
Mailing address: 1 S',6,). 1q f 'hid_ 77 / Deck area (sq. ft.)
City: �'C State: 6.74 ZIP: / 3 Other structure area (sq. ft.) •
Phone: _ . Fax: C ,.:6f I. E -mail: Commercial /industrial/multi - family: ,-../
CONTRACTOR Valuation of work $0r�Og
Existing bldg. area (sq. ft.)
• Business name: K y,'a ,j;( 64-17-- �7 j ilij /
Address: _TL New bldg. area (sq. ft.) �...`�c:f
g�� 6• (,J . 6G << C�SIC.i V1 e•c� Number of stories
City: 18pC l,�(• {-Kj ] State:v I ZIP: a l l cX2 Type of construction if t"
Phone: `— ^ `r "Fax: I E -mail:
Occupancy group(s): 6 Existing:
CCB no.: O w n Q. !--- ' i New:
City /metro lic. no.: Notice: All and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 77 / � -m aY . ,A0/4;) a y .. • 2.,/iii provisions of ORS 701 and may be required to be licensed in the
Address: 9 Dw. . 6 0, 6 kiqe/(/ f-er,- jurisdiction where work is being performed. If the applicant is
City: r s / , ,� State: IP: OA from licensing, the following reason applies:
' Contact person: fk yang Lt'-2_ Plan no.: _
Phone: " 7 _ e/7� Fax: E -mail:
ENGINEER
Name: Fafi' 2 ✓_, 12, 1 4 / 2 / /e . Contact person: FGt /l�llf !/ Fees due upon application $
Address: fr /v ( 5) 4 4_). , a6k,s CiJ7 f - e (r — Date received:
City: 6 ,24,r V , lc) \ IState:ar_. ZIP: ' -iczy Amount received $
Phones 7y 4141 ' I Fax: I 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 jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa (] MasterCard
work will be complied ,4th he r - r spe /led erin or not. Credit card number: Expires
- Authorized signature: - A_ / J / Date: Name of cardholder as shown on credit card
Print name: ' Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 - 4613 (&W /COM)
REGARDING: .Shahin Rashidi General Dentistry
Misc. Items for plan check review:
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