Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00571
Agri *Ver DEVELOPMENT SERVICES DATE ISSUED: 12/8/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11945 SW PACIFIC HWY 248 PARCEL: 1S135DD -03301
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 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: UNK : 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: $ 3,000.00
Remarks: Installation of suspended ceiling.
Owner: Contractor:
TIGARD PROPERTIES INC J C REMODELING
2106 SE OCHOCO ST 1325 SE 87TH
MILWAUKIE, OR 97222 PORTLAND, OR 97216
Phone:
Phone: 503 - 774 -3686
Reg #: LIC 125678
FEES REQUIRED INSPECTIONS
Description Date Amount Susp Ceilng Insp
[BUILD] Permit Fee 12/8/2004 $72.10 Final Inspection
[TAX] 8% State Surchari 12/8/2004 $5.77
Total $77.87
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: Jaili
Permittee
Signature:
- /.l
Call 639 -4175 by 7 p.m. for an inspection the next business day
IF . . 0
Building Permit Application OFFICE USE ONLY Receiv
City of Tigard 0\1 SVA j Deceived ( : '/ 13125 SW Hall Blvd., Tigard, OR 9722 � Plan Re ew
Phone: 503.639.4171 Fax: 503.598.1 �V � , . 1 1i Date/B : / y y ') A Other Permit:
Inspection Line: 503.639.4175 ��` ` "` 0 . c = • _ W Date Ready/By: ® See Attached Checklist for
Internet: www.ci.tigard.or.us �S I Notifced/Method: Supplemental Information
S(� of w�PRs�°
TYPE NF 13TrQ[�[a ' , REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El New construction / 3� �] Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
JaAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
- CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ W
El 1- and 2- family dwelling kJ Commercial /industrial �o
❑ Accessory building CI Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION -AND LOCATION - - . Total number of floors:
Job site address: 1 1 9(+.g S ` , o ) p ci � Z�e New dwelling area: square feet
City/State/ZIP: - 7 - 164 , 44)
ale c� • 77-3 Garage /carport area: square feet
Suite/bldg. /apt. no.:2fe g Project name: J 6A < r, ,/' � 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.
`igrAt d • 6 w Brb ciL Valuation: $
`" Existing building area: square feet
New building area: square feet
.. ❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: ! , oo pg0 ppz T ES ho L . Type of construction:
Address: oG .c 42 ,01 0 Co <1 Occupancy groups:
City/State/ZIP: A(fLWgf.ki E Ok 77/2.2- Z-ZZ Existing:
Phone: ( ) Fax: ( ) New:
- ❑ APPLICANT • . - ❑ CONTACT PERSON NOTICE
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:
CONTRACTOR ,, •
Business name: 'Iii, QT btiAJA j = '- :
..BUILDING PERMIT FEES*
Address: -� r te`- (/
3 `-7 ,^, r s.P fq Please refer to fee schedule.
P
City/ State/ZIP: t:4 Ok 17o)t'4
Fees due upon application
Phone: (n3) 7 7 y - y 6 i, Fax: ( )
CCB lic.: �k 1.-7- Amount received
l2447 r I v i 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: C-4 Date: • Fee methodology set by Tri -County Building Industry
Service Board.
i:\ Building \Permits \BUP- PennitApp.doc 12/03 440- 4613T(l1 /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 OF TIGARD
BUILDING DIVISION PERMIT #: BUP2004 -00571
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/8/2004
Phone: (503) 639 -4171 1 A � A
Inspection Requests (24 Hrs.): (503) 639 -4175 , A_
INSPECTION WORKSHEET FOR DATE: 5/17 /2005 TIME: 7 :11AM PAGE: 72
SITE ADDRESS: 11945 SW PACIFIC HWY 248 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: FISH MARKET
DESCRIPTION: Installation of suspended ceiling.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: J C REMODELING PHONE #: 503 -774 -3686
Inspection Request Scheduled For: Date: 6/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 006968 -01 503.460.7434 N
Corrections /Comments /Instructions:
( � �tfl " (0 ehukto ocut ' -(mil
l LJC - CS ' (� �� 1 i Sl - t&. ' ' tr r-b
(
a l e i f
rV
WCOP,--- I
1 " I �
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR I, SPECTION ❑ ADDITI NAL F ES ASSESSED VA
Inspector: 419k Date: I 1 V Phone #: (503) 718-