Permit `,.
,,,,
A 'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00044
14, 1 1j1 I DEVELOPMENT SERVICES DATE ISSUED: 2/14/03
a �=-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD -04301
SITE ADDRESS: 11475 SW PACIFIC HWY
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: M 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: $ 1,500.00
Remarks: F
Owner: Contractor:
SHAPIRO ENTERPRISES LLC HUSER SALES + SERVICE INC
BY MIKE LEVY 1313 NW 17TH AVE
17310 SE 45TH ST PORTLAND, OR 97209
BELLEVUE, WA 98006
Phone:
Phone: 503 - 227 -6688
Reg #: LIC 116821
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 1/28/03 $62.50
[TAX] 8% State Tax 1/28/03 $5.00
[FLS] FLS Pln Rv 1/28/03 $25.00
Total $92.50 •
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 • e : - . • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
callin• 503) 246 -66 • ' • r 1- 800 -332 -2 4.
IssuBy: k_ ' / „ 4 't 1
Pe rmittee
Signature: ?C 0......4
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System - .....^
∎ l 5 3-H 101,
A - Building Permit Application
Date received: Permit no. rg() Z700 � j __welt/
i � „ City of Tigard Mt ' _ /
,, i r Project /appl. no.: Expire date:
City of Tigard By: I Receipt no.:
Address: 13125 SW Hal v aga ,
Phone: (503) 639 -4171 Date issued:
Fax: (503) 598 -1960 1JAN 2 8 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGARD l &2 family: Simple Complex:
. TYPE OF PERMIT
O 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
)11Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: 1 1 q 7 r sc..., Pfra.t+ t_ L h e, t+ h ' ( riAmil i o12. q 7z.13 Bldg. no.: Suite no.:
Lot: I Block: 'Subdivision: I Tax map /tax lot/account no.:
Project name: Ca /F -rogs p Gt e di E.4-T' i. Icy
Description and location of work on premises/special conditions: t1 PtSreAi) G kiln-Fe N livOn Pt2 E S UP3S3SfoN
Sys A4 ► o u L 300 .5 - TA A1U)S
OWNER - FOR SPECIAL INFORMATION, USE CHECKLIST •
Name: *
(Floodplain, septic capacity, solar, etc.)
Mailing address: (1 s w Pie a 414wA -` 1 & 2 family dwelling:
City: 71 ft A./2.4) I State:Ot ZIP: i Valuation of work $
Phone:Sb3.0 -O5, Fax: IE -mail: No. of bedrooms/baths
Owner's representative: 3-re pt} -A/ I t' A44 7 ff Ef& Total number of floors
Phonef03 -? 3-03 Sb Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: -D.4t, E„ - Covered porch area (sq. ft.)
Mailing address: 2_31 A i, z u... 5T. Deck area (sq. ft.)
City: poixTLA F I State: q/Z I ZIP: 9 7 Ax? Other structure area (sq. ft.)
Phon • . • -,0119-/ ' 9 Fax8- 70 E- mail: Commercial/industriaUmulti- family:
CONTRACTOR Valuation of work $ I � , c O
_ Existing bldg. area (sq. ft.)
Business name: iltfyek � �aCKU!(t,k New bldg. area (sq. ft.)
Address: A3 f N• ' l 1 u-AA4ObJL S 1 Number of stories
City: P TI A- /O I Statep. I ZIP: I 7 2- .2''y Type of construction
Phone:,Zq$- jc/q I Fax: I E-mail: Occupancy group(s): Existing:
CCB no.: t16)32,j New:
City /metro lic. no.: 1 74 (CeL) 4 34o8g (CtS' Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: I Plan no.:
Phone: .. Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application , $
Address: Date received:
City: 'State: 'ZIP: Amount received $
Phone: 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 o Visa 0 MasterCard
work will be complied with, whether specified herein or not. Credit card number:
Expires
Authorized signature: Date: Name of cardholder as shown on credit card
Print name: bt.r 14. t F t2 $
C ardholder 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 (6100/COM)
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation I $ 1 sop o pc,
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
Plan review requires a completed application and 3 sets of plans at submittal.
Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon
licensed fire suppression engineer, or NICET level "3" technicians.
•
is \dsts \forms \FPSchecklist.doc 11/21/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection, Line: ,(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP 00 0 41 •
Received ' � ate Reque ed v AM PM BUP
Location //q7/5
'[ Suite MEC '
Contact Person 2 5 - Ph ( ) 9-1 {C l C 1 `CO PLM
Contractor Ph ( — SWR
C LDING4 Tenant/Owner � . %l� ELC
Foun• - *on Access: ELC
f
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /0:o U -
Shear Anchors (_ - _ ' - _�/
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof : ' 1
V 1.
•
N ap PART FAIL
• ! = 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
Final
Reinspeclion 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 3 12 t ( oJ5
Approach/Sidewalk D ate ( / Inspector Est
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL