Permit CITY OF TIGARD BUILDING PERMIT
•
PERMIT #: BUP2005 -00128
1 ,11 l DEVELOPMENT SERVICES DATE ISSUED: 3/31/2005
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY J ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: TI, install bath room. .
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM /`4 SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N
f /00‘11‘. 0.14 : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: 1 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: $ 1,000.00
Owner: Contractor:
PACIFIC CROSSROADS PROPERTIES, I ROB MOORE CONSTRUCTION
BY WYSE INVESTMENT SERVICES CO 465 NE 181ST SUITE 503
200 SW MARKET ST STE 345 PORTLAND, OR 97230
PPhRTLAND, OR 97201
Phone: 503 - 754 -8814
FEES Reg #: LIC 76259
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 3/31/2005 $62.50
[TAX] 8% State Surchari 3/31/2005 $5.00
[BUPPLN] Pln Rv 3/31/2005 $40.63
[FLS] FLS Pln Rv 3/31/2005 $25.00
Total $133.13
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 ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 -101 -0010 9 ugh OAR 952 - 001 -0100. You may obtain a copy of these rules or direr q , e - -
'ailing 503 - 246 -669' or 1 -80 3 4.
sued By:� , /�.:� - 1,421"4 Permittee Signature: 10
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.
!
Building Permit Application `- . ` .FOR: OFFICE O 'w
CI of Tigard R eceived Aria �� /� P ermit No.: i r
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review `WIMP' ' / •
Phone: 503.639.4171 Fax: 503.598.1960 yix �l� Date/B : 0' Other Permit:
Inspection Line: 503.639.4175 r ;' II Date Ready /By: El See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: ' /, Supplemental Information
,.,.,,a �- ., -.,.a ::�,: + "n, =�;. .: � ,; .,�,K- , . _.• cc °� ..,;:a.;: »;: =:�. �*.s; a ^rwe,:: .rkr - E- I - - ..
.,�°.. - -. �,..�n. ::fir .<: ° „. ;;;- wze;;�•:. ::�. >.� =a ,:'�.s? .r. - vf; ° :
t; ; -a., f ,avN: ,?d :
,, . „ ,.r ;. ; , , ' .. x ,�- . sa :: A ;A: 3 T. D 2=FA lY D
> - ; :IItED ?: 1II WLL'IVG;
_,.. �,..., �;�:�.w, ,7 '� ,. - _ ,,..� , �. „ � TrXPEO' �'.O wrr „r ..�tr<. ,.�>
,�.°,Y- �,.��'� na .. es .. a � " fir :- _ s'r°�^. �a' ...�s' ,,..,.:,.. �'F'�. _... . �..r,.c, ��3bz... *� _°„.. >;vr.^ >�.. ,, 4ift'e 'i�' ,
f J New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
n = ". ;?: Er '.'y >,x — - r =,r.,>s.?' :zt- -,.�:° ,,,:vs. .,. 'a"u.°” =.:; �e�ak m;'s a
4. + CA' irea lV ' dFr i IGTI, s * 4 , ': W rR work indicated on this application.
s. °..
Valuation: $ i4
❑ 1- and 2- family dwelling {t Commercial /industrial
C3 Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
'q �;:" " "JOrB SXTE INFC RMATTC)IY I AND T � 2 ; Total number of floors:
Job site address: i 0 os sw po c fi c 144,u y # New dwelling area: square feet_
T l
City/State /ZIP: •(,, Oa c r 23 Garage /carport area: square feet
Suite/bldg. /apt. no.: l " Project name: 5 ` H aA Covered porch area: square feet
Cross street/directions to job site: 5 Deck area: square feet
Other structure area: square feet
,,, it IREA D k,Iled MII CIA i CHEC`ia iS7i, .'; .
R:,.Q.
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
�_ .. � . �.. °, n � -.. �
F �;.� Wit, ° s equipment, materials, labor, overhead, and the profit for the
" �'` 141 "4 '* 1 I , pTION A OF OgK ' S * i s� g � i work indicated on this application.
��... ...� a ,a �n�: ! ��s:_,� ,`. . �� �
Mew ` �C Loos- rc "S ��.G4? v - v... - .. Valuation: $ �QQ 0.• O d
Existing building area: /:e7A square feet
New building area: (� • square feet
+�. ; 3:,;°a 3 P,:-. - :" i.::4 � a
, , - M'' ; ;t :F � > : z�:, " : ". ; `. °. ^k: ,a..» . » .._ v- v-,y?�„,
, , ® gOPERTa °, O - � 'a ii1r .,.rfl° � `t .� .. . �TEI T , .. <.,`_, 1, Number of stories:
Name: CASi f 1_,1 v,„\ Type of construction: 6 16 (S K J
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
PL)CANT ® C®NTACT�PERSON i {;<M'''''::'1'''''''
, .: _. '1 : ,,.. a v . . ,:n l �� , NO
T A .:,° ,'-
fi ;'.. =� , .,ri rr�.: arm ,,-.,. , ... -y s ..., . -
Business name: All contractors and subcontractors are required to be •
Contact name: licensed with the Oregon Construction Contractors Board
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: ( ) Fax:: ( )
E -mail:
p '. ' " .4 't ir; l s C O O .x ` " u ', -v NO
.rt14, .. .,. -4 oaf = a: ;.. ,. s s, <;_ . , . ; , s s v st, % . ,.; _.: , q
Business name: - - ti� (14:. 4 4 - -z; .a.,. _M ...
��� _�.,� 'Lit '`' r ', . B *"
Address: r ` �d - l t5 ► r
r Please refer to fee schedule.
City/State /ZIP: - ■ - y
, ��IIIr� . M Fees due upon application
Phone: 5- o3) j 6 _- sQ Fax: ( ) /33 L3
Amount received
CCB lie.: ice _ - -,;-,[
-- Date received:
Authorized signature: `) � : Ph d7 This permit application expires if a permit is not obtained
�' within 180 days after it has been accepted as complete.
Print name: D ate: * Fee methodology set by Tri County Building Industry
Service Board.
i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11/02/COM/WEB)
•
Building Division
•
*NANO I I ' � Plan Submittal Requirement Matrix
=--• Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
`` < r `� �.. '.sue 2 3 a,
4 $ Typ e�of.Sumital # of Plaus
(Ine udesnew; additions and la terati Requi e fd
1 4 :�,�_ Sub:mittal
� < v :,.,,
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
Q
k)O M o Building 1*
W . 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,
.s ington o -, _. • • . _ a_ - - - • - - - -
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans, s ear i e on!' u ; • an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
;',* Pi 57
i:\Building \Forms \COM- P1anSubReq.doc 12/24/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP200S -00128
13125 SW �ii(all Blvd., Tigard, OR 97223 DATE ISSUED: 3/31/2005
Phone: (503) 639- 4171pn�PollI�I'i‘t\
Inspection Requests (24 Hrs.): (503) 639 -4175 ...,..I
INSPECTION WORKSHEET FOR DATE: 7/7/2005 TIME: 7 :10AM PAGE: 21
SITE ADDRESS: 11705 SW PACIFIC HWY J CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: SUSHI HANA
DESCRIPTION: TI, install bath room.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: SRS CONSTRUCTION LLC PHONE #: 5Q3- 608-4094
Inspection Request Scheduled For: Date: 7/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection - 010937 -01 503 - 984.6655 Y , !
Corrections /Comments /Instructions: ,
Epti i' A-M
, 1 Ilr , .
I
, „„„,,,,...., _Aim
PASS ❑ PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION ❑ ADDITI NAL EES ASSESSED
'''3e..L_______________ Inspector: Date: Phone #: (503) 718-