Permit . 1
• CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00584
s . �•I!I:' DEVELOPMENT SERVICES DATE ISSUED: 12/16/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S135DD -00600
SITE ADDRESS: 11831 SW PACIFIC HWY
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 040 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: 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: $ 3,731.00
Remarks: Sign.
Owner: Contractor:
ALDERWOODS GROUP, INC MARTIN BROS INC
311 ELM ST #100 3165 COMMERCIAL ST SE
SALEM, OR 97302
Phone:
Phone: 364 -2211
Reg #: LIC 000647
SUP ..
FEES REQ i PECTIONS
Description Date Amount Foot/Found Insp
[BUILD] Permit Fee 12/16/2004 $81.70 Final Inspection
[BUPPLN] Pin Rv 12/16/2004 $53.11
[TAX] 8% State Surchari 12/16/2004 $6.54
Total $141.35
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.
Issued By: ,v
Permittee
Signature: \ p,p
Call 639 -4175 by 7 p.m. for an inspection the next business day
un ( Scw Raclf,� G ED
Building �'ermit Ap ion �j �j FOR omci use ONLY
`7 g
City of Tigard 1 6 LO04! Received
DaleB : _ 1 / . /
i • Permit No. 6 ti p_ o ak-
13125 SW Hall Blvd., Tigard, Old. - , 9,4, Plan Review IIr�
Phone: 503.639.4171 Fax: 50A59101910 o OF TIGA • 1 Date/B : a Other Permit:
Inspection Line: 503.639.417BUILD11VG DIVISI _ ` i I Date Ready /By: ® See Attached Checklist for
Internet: www.ci.tigard.or.us • 1 Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING
',New construction 12 Demolition Permit fees" are based on the value of the work performed.
I` l Indicate the value (rounded to the nearest dollar) of all
El Addition/alteration/replacement Other: S t _) equipment, materials, labor, overhead, and the profit for the .
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling Commercial /industrial Valuation: S
•
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder N Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 1 8 31 Slz ; d •/. ` y New dwelling area: square feet
�;
City /State /ZIP: Q � / 464.,.../.
C� .� '� • aa '� 9, 2
3 � ' .� Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: , v ur TU-ller�.Q Covered porch area: square feet
Cross street/directions to job site: i ) -1.0c1, JJ r � '' fkU4, • Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 1 - i - s Mo. a.. I Lot no.: pr 40 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: ,� -7 -0 44- 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.
— no.mtsva_ dlr." is loco e y (Jew, z
Valuation: $ 3,1 3 1 .
_ AD 13 [a C Q (.4 1 _, 1 e ��� �� u Existing building area: square feet
' � 7 New building area: square feet
J ROPERTY OWNER I 0 TENANT Number of stories:
Name: pi. ld0.A.ujoe .� h c , Type of construction:
Address: . 3 ( ( E i S4:-. „..-f (c o Occupancy groups:
City /State /ZIP: C. 1 l` t, Y1 11 R 1 O s,4 S-a 0 a Existing:
Phone: ( sl '3( ct_ ( Fax: ( , ,)) New:
APPLICANT Ey CONTACT PERSON NOTICE
Business name: Llry c , 1i• 6�r �� All contractors and subcontractors are required to be
Contact name: e r. 7C 1 licensed with the Oregon Construction Contractors Board
��t]�iie he- 1.�(�..5 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 a empt from licensing, the following reasons
^ � apply: Vol* S I. O
Phone: 6b3) 36 ct ' a r.1 i' Fax: : (a3) 36. - Z �/ 3/s-
p ( . 53 . II
E -mail: Ji 4.I4ld.S ) r l &r-i-ir 1,rbS -s tins • com TX ( `f 41a1.36”
CONTRACTOR -t0-- vi — 4
Business name: d ,„ ADS . j b t . c.... BUILDING PERMIT FEES*
Address: 3 t( S C .., , h' -- &' .19.0 S e.. f f
Pl ease refer to fee schedule.
City /State /ZIP: ,S
V11 61(� 780 Z Fees due upon application
Phone: 53 3( - i Fax: (93 36 Y -5/3!S
ccB lie.:
6 f 7 b Amount received
Date received:
Authorized signature: _ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: No •• Date: igiy( d * Fee methodology set by Tri- County Building Industry
Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440 -4613T(II /02/COM/WEB)
MK
CITY OF TIGARD
BUILDING'-DIVISION 1 9 , 6 , 4 6 q - - #:6i 00S Cei
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 " ° --
INSPECTION WORKSHEET FOR DATE: 3 .,y TIME: PAGE:
SITE ADDRESS: / / F 3 / ` CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER:
CONTRACTOR: l_ al_ ?5e_A-d,e.e.z4,_- 1 _ � PHONE #: 3&e--f- /
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
0 2 g -oa
Corrections /Comments /Instructions:
F Rg - 6( � Z - Z
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑- FAIL El CALL FOR INSPECTION ❑ ADDITIO AL F ES ASSESSED
lib _A
Inspector Date: OS Phone #: (503) 718-