Permit r• CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00459
I
DEVELOPMENT SERVICES DATE ISSUED: 9/28/2004
;.� ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10300 SW NIMBUS AVE P PARCEL: 1S134AA -02100
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK : sf N: S: E: W:
OCCUPANCY GRP: 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: $ 67,700.00
Remarks: re -roof.
Owner: Contractor:
ROBINSON, CONSTANCE A + GRIFFITH ROOFING
ROBINSON, LYNN + BELL, KAY ET 6815 SW 111TH AVE
BY INSIGNIA COMMERCIAL GROUP BEAVERTON, OR 97005
BEAVE TON, OR 97008
Phone: 643 -1596
Reg #: LIC 00000925
FEES MET REQSfRED51NSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 9/28/2004 $569.26
[TAX] 8% State Surcharl 9/28/2004 $45.54
Total $614.80
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: 1 _ _ `/ /�
Permittee
Signature: J _A
639 -4175 by 7 p.m. for an inspection the next business day
•
Building Permit A �� \�� !. ' 'on 01-1:1( I- I_ tiI: t
• �+ Date received: — ■ -
Y Permit no.: r ?....1)(P4/ • A 1
� City of Tigar eC
y. °'__ . Project/appl. no.: I fV 1 11 Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti ard NIA
Phone: (503) 639-4171 S !.• V Date issued: By: Receipt no.:
Fax: (503) 5 -1960 G1i Of TIGAN ON Case file no.: Payment type:
Land use app t o val: Bv�lD1N 1 &2 family: Simple Complex. I�
111%. Ol' I'E1ti'II
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm Other: o •
.IOII sill: INI.OIti\I:A I ION
Job address: • b b , it 6 ,►_` l . . — it • Bldg. no.: ' Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: t • 1 ; • - ig
Descrip • in and locatio' of work on premises /special conditions: • •. • g in1T. • t► l . ■ A
DA 'CC 1 -• Da
OWNER FUIt SI'I::( IAI, INFORM . IIOiN. (SI: (III.:('KI.IS
Name: ( I. Iuudplain .,epticcapacitV. 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: • 1 • , U _ t _ • i t , otal number of floors
Phone5C3 -59 1980 Fax503 , ' New dwelling area (sq. ft.)
‘19,.1.1t k N I Garage /carport area (sq. ft.)
E Covered porch area (sq. ft.)
Mailing address .81 w 111 , • , Deck area (sq. ft.)
'F'aIEVNTLIIM State° C ZIP: • GOB Other structure area (s s. ft.)
Phon - o3.. - I5 • (, Faxsp,3 52-3=11 Commercial/indust riaUmulti- family:
('ON i lt: t i ()it Valuation of work $ (o7, Job
• ' ■ Existing bldg. area (sq. ft.) 2 l9
■ r• •t New bldg. area (sq. ft.)
Address: , ; 1 Number of stories
•_ .� • • 3 r C ZIP: • 008
Phone (043- J5% Faa�3 -(,y4- Z q ' Type of construction
Occupancy group(s): Existing:
CCB no.: -25 New:
City/metro lic. no.: 4,5y (o Notice: All contractors and subcontractors are required to be
; \ RCM 1 :(' "1/D FS I (. N 1. :It licensed with the Oregon Construction Contractors Board under
1 C •' • provisions of ORS 701 and may be required to be licensed in the
Address: p ` a • ■ jurisdiction where work is being performed. If the applicant is
� t
l state: 0 , moan= exempt from licensing, the following reason applies:
Contact person. ; ' A Plan no.:
Phone5Q3- -L80-575' Fax5-Q4- ;.-;;5102E111111111111111 _
I.:N(IN[I: OFIlCI: VS 0Nl.\
EMELP PEREMPININ Contact person: • 0 , Fees due upon application $
IEMF Address: , 6 , v e Ammon • 00 Date received: / /1( Amount received $ O
Phone: Please refer to fee schedule.
. y -3 co F�Q3 43 7t 1 ►
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 U MasterCard
work will be complied with, whether specified herein or not. Credit card number: / Fxp;n a
Authorized signature: Date: Name of cardholder as shown on credit card
$
Print name: e-, re C N(' 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)
CITY OFTIGARD 24 -Hour
BW' G Inspection Line: (503) 639 -4175 MST
INSPE D VISION Business Line: (503) 639 -4171 �� �q
1 BUP aDU Z61
Received �-4 Date Requested / (' -- AM PM BUP
Location ` 0 3 Od .i)t.Lr Suite OP P MEC
Contact Person � Ph ( ) 6 73 - / S�J� PLM
Contractor Ph ( ) SWR
BUILDING 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
Fire Sprinkler
Fire Alarm
Su 1 Ceiling
oo `i
Other
PASS PART FAIL
I PLUM ' ING '1 kr
• 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 or reins- , ection RE: n Unable to inspect — no access
Fire Supply Line
ADA •
Approach/Sidewalk Date ' " Inspector � ' U Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
•