Permit BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2003 -00040
DEVELOPMENT SERVICES DATE ISSUED: 1/23/03
Ail DATE
1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11705 SW PACIFIC HWY K PARCEL: 1 S136CD 00100
SUBDIVISION: ZONING: C -G
BLOCK: LOT: 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: 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: $ 1,000.00
Remarks: Addition of back door to tenant space.
Owner: Contractor:
PACIFIC CROSSROADS PROPERTIES, I PACIFIC CREST STRUCTURES INC
•
BY WYSE INVESTMENT SERVICES CO 7233 SW KABLE LN STE 900
200 SW MARKET ST STE 345 PORTLAND, OR 97224
PORTLAND, OR 97201
Phone:
Phone: 503 - 968 -8949
Reg #: LIC 66915
FEES REQUIRED INSPECTIONS
Description Date Amount Misc. Inspection
[BUILD] Permit Fee 1/23/03 $62.50 Final Inspection
[TAX] 8% State Tax 1/23/03 $5.00
[BUPPLN] Pln Rv 1/23/03 $40.63
Total $108.13
•
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 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.
•
^� JJ � 4
Issued By: /ta' _ Y�� -e/')
Pem1itSignature: �'�'
ur
Call 639 -4175 by 7 p.m. for an inspection the next business day
Wilding Permit Application 3 FOR OFFICE USE ONLY
Received ,/ •�� 03 Building
\• Date /By: 17j v- Permit No.: jL - 000 4
Planning Approval Other
City of Tigard Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ./ ,rw�di�i, 'phi\ Post - Review Land Use
"'
Internet: www.ci.tigard.or.us c-ti w o Date /By: Case No. ° Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information
n , : , TiYPE' OF WORX. '44'; N , l . - fl 4
REQUIRLD DTA 1 _ " w
.1' & 2 FAMILY-DWELLING
❑ New construction ❑ Demolition ,; $
. Addition/alteration /replacement ❑ Other:
tE MVM CAT "EGQRY ,O,F "CONSTRUCTION'; i :7: Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building Multi- Family
❑ Master Builder ❑ Other: Valuation $
t '>' 4` =.4JOB,`SITE INF and'LOCATtONk , . _ _, : No of bedrooms: No of baths: •
Job site address: // 70,5 /( stv, /4ti/=G t/[ Total number of floors
� � New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name;P,gt/ytjG e/147/ eco-esS /70o____ Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
7 , ' 4 11 47 66 tED DATA. ` E
. ` Z 9N�I 1 , CIAL FUSE GHECKL g
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
.
- ;�DESCRIPTION'OFW..,,C1RK ..W F:x
a .. ,. . ,
the value (rounded to the nearest dollar) of all equipment, materials, labor,
eia�/ /,, `i / overhead and profit for the work indicated on this application.
o 7 !/ Valuation $ /OOO -
3 ac 7 ° �� - �2�o.Z gLo
No--7-74-c__- //'� q0 � Existing building area (sq. ft.) /�/01/(c7 � New building area (sq. ft.) • Number of stories /
P w .t W � z Type of construction ' e V
,iPROPERTY�OWNER� k ,, �,T,ENAN`I..; �� z�. _.�3 � ,,� YP
Name: 40V54_7.- / ,1hiee7s 'ptIGzi7 Goo,_ Occupancy group(s): Existing: G
New: (r
Address: Zp) S. r& � / / 3,
City /State /Zip: j p /LT e2,-- 1
Phone: Fax NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
tl• •i:APP.-LICi1NT ... t: El Z:00 provisions of ORS 701 and may be required to be licensed in the
Business Name:/ /G �j&�T 57?244c.7 jurisdiction where work is being performed. If the applicant is exempt
Contact Name: Ai-44 -n/ jL,?) from licensing, the following reason applies:
Address: 7 5, i& k4 -&& ,<4t go-0
City /State /Zip: po, .7 g e 9'7 Z24 1
, i BUILDING PERMIn EES* 4 M
E-mail:
'` Please Yefer to fe s �'
s� .. ,, . �,.;;� � .�. � ��.�:CONTRAC'GOR. �� 2_�� �...�F- . v. .. .._ a,..
Business Name: te4G e., 6t&-.137 We/a' Fees due upon application $
Address: 71.33 '&c4'/ ze9oa
City /State /Zip: A 2,r, ® &_- q 7 Z?,y Amount received $
PhoneBD3 -9( -4609 Fax :,157j3 -S gg_4'('S ' Date received:
CCB Lic. #: (p . 9/S
Authorized / Notice: This permit application expires if a permit is not obtained within
Signature: � , .L ._ -_il, late; ZZ 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
..
i Commercial Plan Submittal
�� Requirement Matrix
City of Tigard
` TYPE4OF
(Includes NewAdditionsorA Required at
i Submitta`I
Site Work 4
(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.
is \dsts \forms \COM- matrix.doc 9/24/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST JJ`
BUP �L�O j .— ex e i t 1
Received Date Requested 2- ` (°-4 " AM PM BUP
Location / l 7 o Suite MEC
Contact Person �� Ph ( ) -15 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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
Susp'd Ceiling
Roof
Ot er:
,d FAIL
.11177 :r G
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
.ELECTRIC AL
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 El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date 21 67/0 � j Inspector Ext
Approach /Sidewalk / p
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL