Permit •
ii. _ BUILDING PERMIT
CITY O F TIGARD PERMIT #: BUP2003 -00690
lI/ek DEVELOPMENT SERVICES DATE ISSUED: 12/16/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 18 SW PACIFIC HWY PARCEL: 2S102CC -00600
SUBDIVISION: /35 L1.' ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
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REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM 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: $ 5,000.00
Remarks: Demo existing 5,428. sf structure. Sewer is to be capped and inspected.
Erosion to be done under the SIT permit per Gary. Fees waived per Gary. All debris to be removed.
Owner: Contractor:
KOCH, KELLY + MEALUE EXCAVATING
DAVIDSON, JENNIFER 3933 SW KELLY
13565 SW PACIFIC HWY PORTLAND, OR 97239
TIGARD, OR 97223
Phone:
Phone: 503 - 222 -4453
Reg #: LIC 60340
FEES REQUIRED INSPECTIONS
Description Date Amount Sewer Insp
Cap sewer line
Total
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: 4.1-‘4.4....4_ Ze...,729-1.-/---d
Permittee a y
Signature: a / ,
II v
0 I Call 639 -4175 by 7 p.m. for an inspection the next business day
P Eiv1
IF Building Permit Application Received FOR OFFICE USE ONLY
Building on_ ,. Date/By: ' Permit No.�uraC 'CEO 0'0
City of Tigard Planning Approval Other
y g Date/By: Permit No.:
13125 SW Hall Blvd. + vED Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 us. 1503-5984960 U o f 1 'z� Post - Review Land Use
4 u 4�,J r ; ,.f II Date/By: Case No.
Internet: www.ci.tigard.or.us " - Contact Juris.: ® See Page 2 for
24 - hour Inspection RlTstpf5 639 - 4175 Name /Method: Supplemental Information
G
B UILDIN L A RD
D IVISION
TYPE OF WORK REQUIRED DATA: ,
❑ New construction Demolition 1 & 2 FAMILY DWELLING
I: Addition/alteration/replacement Other:
CATEGORY OF CONSTRUCTION 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 S
JOB SITE INFORMATION OR agt1 LOS ATION� No. of bedrooms: No. of baths:
Job site address: . J ✓ .� O�v v/ ti C, /6 Total number of floors
Bld /A t. #: New dwelling area (sq. ft.)
Suite #:
4 I g p Garage /carport area (sq. ft.)
..... Project Name: Q4 ( t 1A �•G Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: I Lot #:
Tax map /parcel #: u.r., 951 01-0:, 'Ft_ (gocri (, ZNote: Permit fees' are based on the total value of the work performed. Indicate
DESCRIPTI N OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
j overhead and profit for the work indicated on this application.
I 1 Valuation $ 5" ODO..00i Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
(PROPERTY OWNER I ❑ TENANT Type of construction
Name: 17M-I- ).. LAi G Occupancy group(s): Existing:
Address: 1 (d) f-L New:
City /State /Zip:1- 1.410 t"( ( 02- - 1 7149
Phone -. -�i ( 2- Fax: ( -7/ NOTICE; All contractors and subcontractors are required to be
PPLICANT ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under
(( __ provisions of ORS 701 and may be required to be licensed in the
Business Name: VI.M/1 e jurisdiction where work is being performed. If the applicant is exempt
Contact Name: n/1 f/1 I P(4/ 141 14 t.r from licensing, the following reason applies:
Address:
T W --,- , S r.
City /State /Zip: (2-il CePP ' 771
Phone: n7- 4 Fax: f� -up 3 . .
0 � � V ) - � -n-- BUILDING PERMIT FEES•,..- E -mail 0 ` I CONTRACTOR r ,,� Please refer'to fee schedule.
Business N�: Ft tc..4.,/ (4 aye t, ij I � Fees due upon application $
Address: 6 3 f/t) 14
City /State /Zi :: i gA 7 Z 77 Amount received $
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Phone: 2- 3 Fax: 9-44(3'-'71/(0%. Date received:
CCB Lic. • : (_00 U .5 -- 5— 5
Authorized, c ' /
,ei Notice: This permit application expires if a permit is not obtained within
Signature: �1 ,) il ate:
180 days after it has been accepted as complete.
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4 .d I / 1 ' V t *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
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Plan Submittal Requirement Matrix
.011 Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
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.
i:\ Building \Forms \PlanSubMatrix.doc 04/03
GENERAL NOTES -
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ROAMING WALL ZCTION A -/,..,e S
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