Permit 411,, CITY OF TIGARD PERMIT #: BUP2005 -00501
Ai' BUILDING PERMIT
DEVELOPMENT SERVICES DATE ISSUED: 9/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135DD -05000
SITE ADDRESS: 11975 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: T.I. walls (used for display).
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: M 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 •
Owner: Contractor:
DORN, FRANK D + RHODAJANE TRS TENANT
do TRENARY, BRYAN W /JUDITH A
WEST, ROBERT C
�
AVERTON, OR 97007
one:
Phone:
FEES Reg #:
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 9/28/2005 $62.50
[TAX] 8% State Surchari 9/28/2005 $5.00
[BUPPLN] Pln Rv 9/28/2005 $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 d - s. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. ) ho -e rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rulep or • irec • , -iis to • UNC by
calling 503 - 246 -6699 or 1-800- 332 -2344. , +/
Issued By: � I1,/ Permittee Signature: G, , , A ,
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.
1
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�
r
' I Building Permit Application FOR order use ()Nix
City of Tigard Receives • ��
Date/B . I -1, Permit No'3 , , a f - -�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ~ � ' Date/Date/13 . Other Permit:
Inspection Line: 503.639.4175 � '' � _ Date Ready/By: ��.t+t ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: �" M Supplemental Information
TYPE OF WORK REQUIRED DATA: I AND 2 FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
At Addition /alteration /replacement ❑Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this - application.
❑ I- and 2- family dwelling b0 Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / J 9 7.E" 'gbh L kilo-- New dwelling area: square feet
City /State/ZIP: - 7144/ OA- L7 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: C4 a/ ae.,,, 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: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
J DESCRIPTION OF WORK work indicated on this application.
- r(411-77710P- 1 (.. -MLlS rot l.Aailr (Vj jeiAt'S Valuation: $ I' 000•00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER Ca TENANT Number of stories:
Name: .D4 JZ) c, )01 SGIAat CtligiNCIS Type of construction:
Address: 3 g g g c g A )p-) Ems . Z Occupancy groups:
City /State/ZIP: 5 D ft- 976 / / / Existing:
Phone: (C ) 4pbt�069q f Fax: e�o3)(� �" 06yS� New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: (4 CAL bA OS All contractors and subcontractors are required to be
Contact name: 1:346,1.1 Ir j 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
applicant is exempt from licensing, the following reasons
City /State /ZIP: apply:
Phone:( ) I Fax::( )
E -mail:
CONTRACTOR
Business name:( g),..)er3„ BUILDING PERMIT FEES*
Address: Se A&
Please refer to fee schedule.
City / State/ZIP: Fees due upon application /el 13
Phone: ( ) Fax: ( )
Amount received
CCB lic.:
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: 77 N I,b gipsi I Date: 9--2. S • Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Pennits\BUP- TI- PennitApp.doc 12/03 440.4613T(II /02/COM/WEB)
`a -
. �.
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 \Pertnits\BUP- 11- PennitApp.doc 12/03 4404613T(11/07/COM/WEB) - '
CITY - O F G A R D BUP200 00601
BUILDING DIVISION y PERMIT #: 9/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 u �
oh_
Inspection Requests (24 Hrs.): (503) 639 -4175 Au.
10/24/2005 7:02AM 1
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
11975 SW PACIFIC HWY
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: CASCADE CABINETS LOT #: TYPE OF USE:
PROJECT NAME: T.I. walls (used for display).
DESCRIPTION:
DORN, FRANK D + RHODAJANE TRS,
OWNER: TENANT PHONE #:
CONTRACTOR: PHONE #:
10/24/2005
Inspection Request Scheduled For: Date: Pour Time:
C c g # IflS aeicinospelaion ription 0gig -Q1 �$n�t 79 Menage
Corrections /Comments /Instructions:
(Ak
e t,
•
/A
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED
Inspector: '
, /, Date: C5 'W�crt� #: (503) 718
CITY: OF,•GARD
BUILDING DIVISION ' PERMIT #: BUP2005 -00501
13126 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/28/2005
Phone: (503) 639 -4171 *1 it
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/3/2005 TIME: 7:07AM PAGE: 30
SITE ADDRESS: 11975 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CASCADE CABINETS
DESCRIPTION: 1 .I . walls (used for display).
OWNER: DORN, FRANK D + RHODAJANE TRS, PHONE #:
CONTRACTOR: TENANT PHONE #: • Inspection Request Scheduled For: Date: 10/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 017236-01 503 - 9368479 N
Corrections /Comments/ Instructions:
......,
Al AP
PMI!IiIIWA._O�
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONA FEES ASSESSED
t �` j
el
4 I) 3e3
i Inspector: Date: Phone #: (503) 718-