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Permit CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2001 -00265 fl DEVELOPMENT SERVICES DATE ISSUED: 7/25/01 .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S126DC -04800 SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C - BLOCK: LOT: 004 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: 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: $ 18,000.00 Remarks: Tenant Improvement No Change in Occupant Load Owner: Contractor: MBM MEDICAL BNK CONSTRUCTION INC 9495 SW LOCUST 10730 SE HWY 212 TIGARD, OR 97223 PO BOX 66 Phone: C vho MAS., - 8 97015 • Reg #: LIC 107555 FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Framing Insp PLCK CTR 7/18/01 $140.47 27200100000 Gyp Board Insp Susp Ceilng Insp FIRE CTR 7/18/01 $86.44 27200100000 Final Inspection PRMT CTR 7/25/01 $216.10 27200100000 5PCT CTR 7/25/01 $17.29 27200100000 Total $460.30 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 -6699 or 1- 800 - 332 -2344. Pe mi ittee / Signature: • Issued By: , �G��i� , =11 .1 .//.-) / Call 639 -4175 by 7 p.m. for an inspection the next business day { At 0` 67 &'?2 Building Permit Ap 'on��. �T Date received: `7 p / Permit no., 0 7, 0/ _ W $11( City of Tigard ��' "` ' o _.. Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tig d, OR 97 Phone: (503) 639 -4171 Date issued: By: Receipt no.: 0 Fax: (503) 598 -1960 Case file no.: Payment type: 16 Land use approval: 1 &2 family: Simple Complex: L TYPE OF PERMIT • ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition ■ ❑ Addition/alteration/replacement ►= enant improvement ❑ Fire sprinkler /alarm • ❑ Other: JOB SITE INFORMATION Job address: 7 9f h" 1. ® 4 yT Bldg. no.: Suite no.: A . ` Lot: Block: Subdivision: Tax map /tax lot/account no.: Project name: C/j / y/f 7 ® G ©( y ,q fciC .f /y7 /' *IF .teS7i 0 C�/�7 Description and location of work on premises/special conditions: /t1 ®/ X it 7 .4 - /b94 ,L P 0 sr OWNER FOR SPECIAL INFORMATION, USE CHECKLIST �ii /3/7 � (Floo s capacity, solar, etc.) Name: E �' C � c Mailing address: q !( 9 y- C a C y S 7 1& 2 family dwelling: i---„, City: T G el /( p State: ®/( I ZIP: A' 7 Valuation of work $ ED Phone:). i y/ 4 I Fax: I E -mail: No. of bedrooms/baths Owner's representative: /24 /f /i 7,,v4 - . Total number of floors • Phone: — 7� Fax: E -mail: New dwelling area (sq. ft.) APPLICANT Garage /carport area (sq. ft.) Name: B 2 K GPA. f �� Covered porch area (sq. ft.) I__, Mailing address: • Deck area (sq. ft.) City: State: ZIP: Other structure area (sq. ft.) Phone: Fax: E - mail: Commercial /industriallmulti- family: _ CONTRACTOR Valuation of work $ 1 D O d 0 Business name: �- / l C �! Existing bldg. area (sq. ft.) Address: p0 6 © )e 6 - New bldg. area (sq. ft.) City: 6 / 6 ) ✓(1 /1d f State: 044.ZIP: q7 00" Number of stories 93 4 - fi L Type of construction Phone: Fax: E -mai 199�.T G CCB no.: / P 75 f 4i/ f( Cd of TM: `me Occupancy group(s): Existing: New: City /metro lic. no.: '' . C /t/ Notice: All contractors and subcontractors are required to be ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Name: to A s it„. _ 7 I K "-A/5 .- provisions of ORS 701 and may be required to be licensed in the Address: a f5 / / W 6%2 TA / of Y ip26j jurisdiction where work is being performed. If the applicant is City: # jY ,4 > B State: d/u.ZIP:q 7 ®(� exempt from licensing, the following reason applies: Contact person: 9' 4 a Plan no.1 2//® 024 . Phone: j;9/ . 2 -/77q' Fax:e a--e7 J/ E -mail: • Name: Contact person: Fees due upon application $ Address: Date received: City: State: IZIP: Amount received $ Phone: 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 o Visa o MasterCard work will be complied with, w eth- • • • : fled herein or not. Credit card number: _ / / J� � / Expires Authorized signature: 'Y G. Date: ,e / Name of cardholder as shown on credit card Print name: lil/,.t LLX:ii! % $6 I r- L''f.4v, t i $ 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 (6/00 /COM) �, 4 Li 9(�I j1 P�� ` q t . RI - - CO MM ERCIAL PLAN -SU BM I-T -T-AL REQUIREMENT MATRIX 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 plan sets for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). Total # of TYPE OF SUBIU{ITTAL 4 € Plans ° KEY: t x ESu omitted S = Site Work (must include S (New, Add or Alt) 4 location of all accessible parking) B (New, Add or Alt) • 1 B = Building F (New, Add or Alt) 3 ** F = Fire Protection System M (New, Add or Alt) 2 M = Mechanical P (New, Add or Alt) 2 P = Plumbing E (New, Add, or Alt) 2 E = Electrical New = New Building Add = Addition Alt = Alteration to existing building *For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" requires that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. I: \dsts\forms \matrxcom.doc 10/27/00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 6 4175 Business Line: 639- '1 ',_ G / 1a/ d�l od Date Requested 6 - I I AM PM BLD 2(05- Location / L N 1, A MEC Contact Person , Ph 3 2" a - 7--35 - PLM Contractor Ph SWR BUILDING , r. . Tenant/Owner j ;0}1 /YK- t ELC Retaining Wall ELR Footing Access: , �,�— Foundation ��G �� FPS Ftg Drain SGN Crawl Drain Inspection Notes: O r G-�, Slab l SIT Post & Beam _ n Ext Sheath /Shear .4: (a. Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm V ' Susp'd Ceiling - -No Roof M Id ma PART FAIL UMBINGm'; , .' / . c Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELyECTRICA_ L,, , ; " • Service Rough In • UG /Slab Low Voltage , Fire Alarm . Final . PASS PART FAIL SITE'.., %M- '... Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access • ADA Approach /Sidewalk Other Date ) l Inspector E Final I PASS PART FAIL DO NOT REMOVE this inspection record from the job site.