Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00347
� I�, DEVELOPMENT SERVICES DATE ISSUED: 6/11/03
F — 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12325 SW KATHERINE ST PARCEL: 1S134CC 01700
SUBDIVISION: MARY WOODARD SCHOOL ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REISSUE: oft_ FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ben 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: El 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: $ 170,000.00
Remarks: Siding replaced by stucco.
Owner: . Contractor:
SCHOOL DISTRICT #23 JT BROCKAMP & JAEGER, INC.
13137 SW PACIFIC HWY 15796 S BOARDWALK
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone:
Phone: 655 - 9151
Reg #: LIC 00030
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 6/11/03 $1,017.30 Misc. Inspection
[TAX] 8% State Tax 6/11/03 $81.38 Final Inspection
[BUPPLN] Pln Rv 6/11/03 $661.25
[FLS] FLS Pln Rv 6/11/03 $406.92
Total $2,166.85
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 - 01 1 i 0 OAR 952- 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calli' g (503) 246- 6699.sor 1 -800- 332 -2344.
I. I
Issue.. By:
!, ,1 . ,- • CAilty
Perm ittee
Signature: - -
Call 639 -4175 by 7 p.m. for an inspection the next business day
B uildi n g Permit Application '' " , , • USE ONLYi '''':
R ece i ved i , Building n
Date /By: w /J /e3 Permit No.: 4 l f — 3!J
,
City f Tigard Planning Approval ' Other
y b Date /By: Permit No.:
' SW Hall Blvd. Plan Revie Other
ard, Oregon 97223 Date /By: (j "l e113 fi. Permit No.:
_ _.one: 503- 639 -4171 Fax: 503 -598 -1960 tu diM l Post- Review Land Use
• ' I Date /By: Case No.
Internet: www.ci.tigard.or.us `" -.a Contact Juris.:
® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: _ Supplemental Information
_, , TYPE OF.WORK> ` : : REQ DATA: '
❑ New construction ❑ Demolition 1 & 2 FAMILY °DWELLING
i Addition/alteration/replacement ❑ Other:
'.' S 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 $
_ ` : JOBrSITEJNF.ORIS TION_and-T tATIG !:: ;
:y , No. of bedrooms: No. of baths:_
Job site address: 123 Z5 IA ri ' 4e LN E. ST. Total number of floors
Suite #: PA. Bld /A t. #: A
New dwelling area (( f
f )
g• p N Garage /carport area (sq. ft.)
Project Name: LJOOr,W peyZ Q ES KlEIADVEL Covered porch area (sq. ft.) .
Cross street/Directions to job site: ') 124 t Deck area (sq. ft.)
Other structure area (sq. ft.)
(SW SC titOiLJe ` regO( - tb 547 tzta" 4,
, REQUIRED DATA s
f COMMERCIAL USE CHECKLI ,
Subdivision:
Tax map /parcel #: 1 Gj 03 4 cc Note: Permit fees* are based on the total value of the work performed. Indicate
? "' "�'_' a `;��DESCRIPTIQNi'OFlWORK�a` `=�`Q ", <'s� the value (rounded to the nearest dollar) of all equipment, materials, labor,
profit for the work indicated on this a licati . n
•`�aA.14! -E c4,44441:. ' V G'�1 mil JO�VE !"hW�{AI`�C�OL overhead and P PP � � � 7 ---
' CANIleaas w0YI4 • (gGa+AGt EN12116. Valuation $
W00 h %VI N G• G v, 4'[VU.D • W - r 1.1 Existin building area (sq. ft.) NA
tii� IN/4trt Alf Sov'T Iot.A.Y Alma ( )
New bu area (sq. ft.) UNGNkN(1C17
1
tY� a^i�'t. Number of stories 1
°� it `_-_' Type of construction V -)-I
PROPERTY OWNERF;, ' . °,,:��r ' TENAN,T��,N:`'�`:.,�, �� �� '� �; T
Name: " C j ( j412x? - To igtl,A I N (.L Ik0oL nI Occupancy group(s): Existing: E•
New: C -
Address: ( a S4N1716/rl... sr,
City /State /Zip: "C't• C.14it.tr , I b 4Z
Phone: . 51).-.4951, - 4bbb Fax �I'r3l - 4047 NOTICE: All contractors and subcontractors are required to be
Y „ licensed with the Oregon Construction Contractors Board under
,APPLIC`A�iT n -r � e _ }`a ,y -x .� ,_ F,£ o- ,CONTACT PERSION :_ provisions of ORS 701 and may be required to be licensed in the
Business Name: 2uU, bL.s bit W f E.l (S Aft*. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 19E4W 19E4 Ull.ImSo/J from licensing, the following reason applies:
Address: '50 510.1 kAtt4104 tbU Cr-. OZDD
City /State /Zip: 1Q.T1 t 0g, • 4? Z0
Phone: S�b 2 b r �Fax: 273 it T. ; :.�_: -. ;Y, r ; .. = .:F, 7r : ; {. :.-
f,' ill BUILDING PPE RMIT4FEES.:.x , H;.,a ; a. ,, '; s'� ".
E -mail: rtj'A ,i 3 . ctL a . .CDL„ , } , , x pleas refer to�fee s chedule �s r
��'`�"`,',`�:� -�'�� � ._.. � �' . ,� _ � _ x�. _ t. -h g ._ -:s. �..: _ iti:FQ;qt3 .,__.,
Business Name: 76 0., 2.ce.4��/F jcs ac r Fees due upon application $
Address: - 74t s. 844- ,t•ne.•4 14! '
City /State /Zip: aer,ao,. C, 7y O.� 97 S Amount received $
Phone:,3 -6Ss- 9 _ Fax. / ,ro3 - 6 Se- S3W. Date received:
CCB Lic. #: Gcja3C
`horized - - -- - - -- - - Notice: This - permit - application expires -if a- permit is not - obtained within
eture. - :M -`.* Date: 06 - //- ate 180 days after it has been accepted as complete.
L __ GEer....t// *Fee methodology set by Tri- County Building Industry Service Board.
(P1 . se print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour.
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP 3
Received Date Requested �� a� AM PM BUP
Location l D- 3 ac Suite MEC
Contact Person Ph ( ) 7C( ' ` 7 PLM
•
Contractor Ph ( ) SWR
UILDI j ~e 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 ' earvie reQ
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
1
:1-a PART FAIL
POI - ING
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
Anal 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 Z
Date / . Inspector Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL