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Permit L A j CITY O TI GARD BUILDING PERMIT PERMIT #: BUP2004 -00491 �Ljl1 DEVELOPMENT LOP Tigard, SERVICES I CES 1639 -4171 DATE ISSUED: 10/11/2004 SITE ADDRESS: 11507 SW PACIFIC HY A PARCEL: 1S136AD -04000 W SUBDIVISION: VILLA RIDGE ZONING: C -G BLOCK: LOT: 007 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 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 10 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: $ 6,500.00 Remarks: New walls for TI. Owner: Contractor: SMITH, EDITA M ROBERT TODD CONSTRUCTION 833 NW 170TH DR 4080 SE INTERNATIONAL WAY B -11 BEAVERTON, OR 97006 MILWAUKIE, OR 97222 Phone: Phone: 503 - 653 -5704 Reg #: LIC 98517 FEES REQUIRED INSPECTIONS Description Date Amount Electrical Permit Required [BUILD] Permit Fee 10/11/2004 $110.50 Plumbing Permit Required TAX 8% State Surchar 10/11/2004 $g 84 Framing dsp [TAX] � Gyp Board Insp [BUPPLN] Pin Rv 10/11/2004 $71.83 Final Inspection [FLS] FLS Pln Rv 10/11/2004 $44.20 Total $235.37 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 -00 1 • - • OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by calling ;.3) 246 -6699 0 - 800 - 332 -23 �i� , / Iss ed By: , , , i � ��� j / �/ ' / Perm". - e Wli Signature: V Call 639 -4175 by 7 p.m. for an inspection the next business day • . Building Permit Application , FOR OFFICE USE ONLY City of Ti and Received r !0 Tr- :� ,� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review D � Phone: 503.639.4171 Fax: 503.598.1960 //azolp l' Date/B : - - / -0 as-5 Other Pe .'t: Inspection Line: 503.639.4175 Date Ready/By: El See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: Wird Supplemental Information . TYPE OF WORK . : _ ,. - REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all jg Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION ' work indicated on this application. • Valuation: S °' ❑ 1- and 2- family dwelling ❑ Commercial/industrial 7"'f _ ❑ Accessory building ❑ Multi-family Number of bedrooms: ❑ Master builder Of Other: 0N #1 Nr IMpRo .err Number of bathrooms: ' JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: l / ! s G wt' 4 New dwelling area: square feet City/State/ZIP: P e I V / O/ ' �l7�Z 3 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: lM A, &a )v,eti S Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST`; Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Pa Z t•liAlrS C�UO/ 6 M 2/ G ) Valuation: $ S OS o` 4 b `' l A1 E t - /. Existing building area: � 024 square feet W New building area: N square feet /�aGiit!,�17 SotitE L'X�S'T(f�ll� /�.(,IiNt3t�r.1!v U/vES • ❑ PROPERTY. OWNER J TENANT ' Number of stories: I Name: /M G.v A.A.fis /t/1,'( N & U Y J 1 Type of construction: V — /f Address: 11 3 0 7 sk p� � r J Occupancy groups: City/State/ZIP: 7(4\j) / pA 97223 Existing: 8 Phone: (503) 2 4 ,3- , & y 4 Fax: ( ) New: ❑ APPLICANT ,1K CONTACT PERSON NOTICE Business name: W F 57 G i' 7 q- All contractors and subcontractors are required to be Contact name: / � , ���� licensed with the Oregon Construction Contractors Board E under ORS 701 and may be required to be licensed in the Address: 82,1 iv (Ai , �j ' / _ / .-- ¢ � 2�( jurisdiction in which work is being performed. If the City/State/ZIP: �p applicant is exempt from licensing, the following reasons T .0 �p 'A�fl ) q72-e) ' apply Phone: ( 22/ f t ( Fax:: ( ) /r E -mail: 0 Oh /G © .7-7` 6 6,i, CONTRACTOR • Business name: / `D �r 7V/7A a usrR. (/41 m- r f, 44 ) , ..:. B PERMI •FEES* , ' • . Address: 4.,„ �� /��- �jy� - � ����/ �j;.�) Please refer to fee schedule. City/State/ZIP: /✓lit Lthetu / /G- ((r . f , / . 7Z'Z -L. / I ' (` Fees due upon application Phone: 603 ) &53 - ! f 7 0 1..., Fax: (r!o3) 6O ,53- 7 Z CCB lic.: / so * / -'7 4 aa-ra Amount received / Date received: Authorized signatur This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board. i:\BuildingTermits\BUP- PermitApp.doc 12/03 440- 4613T(11/02/COM/WEB) • Building Division Plan Submittal Requirement Matrix Commercial & Multi - Family - New, Additions or Alterations City of Tigard Type of Submittal # of Plans - (Includes new, additions and alterations.) Required at Submittal Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* • Fire Protection System 3 ** Mechanical 2 • Plumbing (building fixtures) 2 • Electrical 2 • 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 sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i:\ Building \Forms \COM- PlanSubReq.doc 12/24/03 CITY OFTIGARD 24 -Hour BUILDING Inspectidn Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST � BuP- DQy o ° , 1 Received Date Reque, d r 1 AM A M BUP Location —7 / - - Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner c - rrl .P A-)02--e° ELC Footing ELC Foundation Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam /4 d Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm ' Susp'd Ceiling .a1111, Roof `.LT Mr. I V PART FAIL Fy N • .. 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Ei Please cal r reins ection RE: 111 Unable to inspect — no access Fire Supply Line ADA / C f Approach/Sidewalk Date " Inspect° Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL