Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2005 -00361
�,�, DEVELOPMENT SERVICES DATE ISSUED: 8/1/2005
A -- " 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11513 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: VILLA RIDGE LOT: 007 JURISDICTION: TIG
Project Description: TI: New wall and exercise room
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: A3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 32 BASEMENT: sf AREA 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: $ 15,000.00
Owner: Contractor:
SMITH, EDITA M ROBERT TODD CONSTRUCTION INC
833 NW 170TH DR 4080 SE INTERNATIONAL WAY #D -1
BEAVERTON, OR 97006 MILWAUKIE, OR 97222
Phone: Phone: 653 -5704
FEES Reg #: LIC 98517
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 8/1/2005 $187.30
[TAX] 8% State Surchari 8/1/2005 $14.98
[BUPPLN] Pin Rv 8/1/2005 $121.75
[FLS] FLS Pin Rv 8/1/2005 $74.92
Total $398.95
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 -6 99 or 1- 800 - 332 - 344.
Issued By: Permittee Signature;����
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
R
mit
Building Per Ann 'cation FoR OFFICE Hsi ONLY
City of Tigard AUC 1 2005 Receives = . �
131 SW Hall Blvd., Tigard, OR 97223 1 p ha e0 � I ,� "� K/e/ •
Phone: 503.639.4171 Fax: 503.5 9¢IJF TIGARD ii• ,, a �`'. j , Date/B . : " ...05. i Other
Inspection Line: 503.639.4175 s 1 ^! Date Ready/By: • See Attached Checklist for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method - ® 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
ddition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling xi Commercial /industrial Valuation: $
12 Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: `15111 /)/4-<,/ � - /-717./.1/ - New dwelling area: square feet
City /State/ZIP: 7 » t v tL- 2 Garage /carport area: square feet
Suite/bldg. /apt. no.: 7 p i Project name, ! i f A �� r ,/ [L,.,� Covered porch area: square feet
Cross street/directions to job site: 7 ''! / " Deck area: square feet
Other structure area: square feet
• REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: I 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.
ll Valuation: $ / 5"040 •
• Existing building area: square feet
New building area: square feet
ROPERTY OWNER I ❑ TENANT Number of stories:
Name: a1 -1� f f ew.l f Type of construction:
Address: 2 / p . 4, C� Occupancy groups:
City /State /ZIP: j Q 2 Existin :
Phone: (S713 23 - 3/7/ Fax: (5-25/ ) 2ZS - 213 6 New:
PLICANT ❑ CONTACT PERSON NOTICE
Business name: n All contractors and subcontractors are required to be
• Contact name: / /� / II licensed with the Oregon Construction Contractors Board
jjj«G I under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) I Fax::( )
E -mail: `
`4/ CONTR / ACTOR / .
Business name: K o lie - p ✓ei CJ° eur! BUILDING PERMIT FEES*
Address: ki p 90 � - KKK '
• A•air , 4 Please refer to fee schedule.
City /State/Z P: /44/ WPfp,,i / (: CE 9 7 ZZ
Phone: (503) (S 3 — 57o Fax: (563) ( 3 - 572 q Fees due upon application
CCB lic.: 9 gS`i / Amount received
Date received:
Authorized signature: This permit application expires if a permit is not obtained
I within ISO days after it has been accepted as complete.
Print name: X09 Q f� G ' S I Date: �� /- t 3 • Fee methodology set by Tri -County Building Industry
• ( Service Board.
i:\ Building \Permits\BUP- TI- PenniLApp.doc 12/03 4404613T(II/02/COM/WEB)
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Building Division
'I r4.ti l 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.
1:0300ding \Pennin\BUP- T1- PennitApp.doc 12/03 440-4613T(11/02ICOM/WEB)
ling TIGARD
BUILDING DIVISION PERMIT #: BUP2005 -00361
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8!112005
Phone: (503) 639 4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 ° s'I � �
INSPECTION WORKSHEET FOR DATE: 9/2212005 TIME: 7:12AM PAGE:
SITE ADDRESS: CLASS OF WORK:
11513 SW PACIFIC HWY
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PACIFIC TERRACE 007
DESCRIPTION: FAMILY MARTIAL ARTS
TI: New wall and exercise room
OWNER: SMITH, EDITA M.
PHONE #:
CONTRACTOR: ROBERT TODD CONSTRUCTION INC PHONE #: 653 -5704
Inspection Request Scheduled For: Date: 9122/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 016351 -01 603- 381 -5101 Y
Corrections /Comments /Instructions: -� p(�b
1 2-48
Alf ' „
. N - W. V
❑ ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I LLVA Date: 22 /QS — Phone #: (503) 718 -
uII •■•