Permit F TIGARD BUILDING PERMIT
CITY OF PERMIT #: BUP2003 00043
Ai--.01 �DEVELOPMENT SERVICES DATE ISSUED: 3/10/03
13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103DD -00900
SITE ADDRESS: 13855 SW PACIFIC HWY
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: S1 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: $ 21,400.00
Remarks: Add mezzanine storage, adult classroom and future kitchen
Owner: Contractor:
COMMUNITY OF CHRIST CHURCH OWNER
5321 WINDSOR TERRACE
WEST LINN, OR 97068
Phone:
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUPPLN] Pln Rv 1/27/03 $165.43 Electrical Permit Required
[FLS] FLS Pln Rv 1/27/03 $101.80 F Permit Required
[ Framing Insp
[BUILD] Permit Fee 3/10/03 $254.50 Shear Wall Insp
[TAX] 8% State Tax 3/10/03 $20.36 Gyp Board Insp
Total Final Inspection
$542.09
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: , 6' �i
Perm ittee
/2;4--->
Signature: / /(
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application
j y a 7-i ?) J > 3 -0645' 4 43
�."�....,, �° City of Tigard Date received Permi no.
Address: 13125 SW Hall Blvd, Tigard, V ED Date issued el. no.: Expire date:
City njTigard Phone: (503) 639 -4171 e issued: By: /3 I Receipt no.:
Fax: (503) 598 -1960 CJAN 2 7 1003 Case file no.: Payment type:
Land use approval: CITY of r l &2 family: Simple Complex:
tll • , _ � QAHD
1, ,.=; '.. • - iv v (Air PERMIT
❑ 1 & 2 family dwelling or accessory 0 CommerciaUindustrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
p . JOB SITE INFORMATION
Job address: /37S-"S" S ?ad, I fi t:,/ l Bldg. no.: Suite no.:
Lot: - pQ Block: Subdivision: Tax map /tax lot/account no :. j 4 , Ala A lp
Project name: 0, O a ,.
Description and location of work on premises/special conditions: i • • , O .- id I A f re . - L e
DSS • • a/ a/'`t'.Ol
:' gi p;: .., OWNER . FOR SPECIAL INFORMATION, USE CHECKLIST
Name: Co,n,„ k „; of eif"VS f- (Flood plain, septic capacity, solar, etc.)..' .
Mailing address: •p 0. V ox 1 & 2 family dwelling:
City:7,a .-q/ 'State: 04 IZIP: 972,24/ Valuation of work $
Phone:, :el 6 41 p J Fax:Gj-0 0 I E -mail: No. of bedrooms/baths
Owner's representative: 4, S''jar.9- Total number of floors
Phone S7 Fax: GSb 0 E -mail: /ls , ®aW ; . - 4lew dwelling area (sq. ft.)
. APPLICANT Garage /carport area (sq. ft.)
Name: /qn/) (.5X,, -70• Covered porch area (sq. ft.)
Mailing address: • 3a / tfli = - ar T r/aG� Deck area (sq. ft.)
City: y - , ; , State:, ' ZIP: . , , , Other structure area (sq. ft.)
Phone as 7 - Fa . a 61," , ommerciallindustriaUmulti- family:
s t - E-mail. E - mail•
CONTRACTOR Ma nation of work $ e?/ 4 /00P O
Business nar . Existing bldg. area (sq. ft.) ‘ d tie, $
l
`un `e r- New bldg. area (sq. ft.)
Address:
Ci., • ii State: Zi Number of stories
Phone Fax: E -mail: Type of construction 1/ -A/
CCB no.: Occupancy group(s): Existing: .ALI rcyt
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: • jurisdiction where work is being performed. If the applicant is
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: I Plan no.:
Phone: Fax: E -mail: •
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa 0 MasterCard
work will be complied Nether spec' h r in or not. Credit card number: / /
- / ,, Expires
Authorized signature: Date: 1 �2// Name of cardholder as shown on credit card
Print name: fl /�/1 t >j di r Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 ys after it has / been acce / pted as complete. 440 -4613 (fvooicOM)
fzs /0 / . 542
a &7•a3
Commercial Plan Submittal
4141 Requirement Matrix
City of Tigard
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.
is \dsts \forms \COM- matrix.doc 9/24/01
•
Accessibility:
Barrier Removal Improvement Plan
City of Tigard
•
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty -five per -cent (25 %).
VALUATION: of all renovation, alteration or modification being done
excluding painting, wallpapering. [1] $ a 4 61 -- °
multiply: 25% Barrier removal requirement. .25
BUDGET FOR BARRIER REMOVAL [2] $ •� 3 SD . OD
In choosing which accessible elements to provide under this section, priority shall be given to those
elements that will provide the greatest access. Elements shall be provided in the following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for $
each sex or a single unisex restroom:
(e) Accessible telephones: $
(f) Accessible drinking fountains: and $
(g) When possible, additional accessible
elements such as storage and alarms: $
TOTAL: Shall equal line 2 of Value Computation $
i:\dsts\forms\Accessibility.doc 09/24/01
.25-2002 05 : - 51.1 FROM-COMM' AL PEA 71 ADYI SOPS 5032740905 T-780 P 002/001 F-428
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Accumulative Sewer Tally
Tenant Name: Community of Christ Church This SWR# N/A
Site Address: 13855 SW Pacific Hwy This PLM# N/A
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 1 4 1 4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 3 6 3 6
- 3 inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 1 16 1 16
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 2 4 2 4
Sink - Bar /Lavatory 2 0 0 5 10 5 10
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 5 30 5 30
Urinal 6 0 0 2 12 2 12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 21 93 21 93
Current Fixture Value 93 divided by 16 = 5.8 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 93 divided by 16 = 5.8 over (under) $ -
Enter EDU Change Here
HISTORY
Notes: 3/12/03 owner provided PLM# EDU# SWR#
current fixture count as PLM# EDU# SWR#
approved by finance dept. P. # EDU# SWR#
N e: dr' / Date: ( *A-
Signature of person that calculated this tally sheet and date perfromed is required
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
. INSPECTION pSION Business Line: (503) 639 -4171 MST
41
f
BUP
Received Date Re j gge ted l A M PM apa
S S 1/� Gf �. //� A •
Location 3 � ;--c W-t�U Suite MEC
Contact Person 0/1AB '2 Ph (_ l PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C?441L44,t - t�C &ELC
Footing
•
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post t& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear _ .r-• - .
. cling -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ott -�
M
PART FAIL
• - - ING Co cJ / (V ce c./' !/.}- SS�iy � a /e ce-e9.- r
Post & Beam /�
Under Slab �� � U /�-Q�G /-i -, wrJK.-
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
ELECTRICAL
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 ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line /�.�.
ADA D �d ti /o J Ins ector (� " 1 Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DlVISSON Business Line: (503) 639 -4171 , 7 7 _ ODD cz3
�-- c 7Oc)39 l /
. Received Date Requested 9'1 7 AM PM � ,"
Location - A SS ) 1 ., , ti MEC
� � �
Contact Person t � Ph ( A y
) • I PLM
Contracto h�"Ph (V7 ) ��- 'V9 ?4�S
ILD Tenant/Owner - �� ELC
F oo ing
Foundation ELC
Ftg Drain Access: q F.5._ ELR
Crawl Drain
Slab Inspection Notes:. s A3t 444.e.4 , , Lacks SIT
Post & Beam /}�
Shear Anchors +AM& 1 ,44 t7 .0 qv ......d c
Ext Sheath/Shear - .
Int Sheath/Shear
Frami
Drywall Nailing
•
ire prinkler 0 "b e ���,�; '
Fire Alarm G C
Susp Ceiling � ■
Roof ., r I, z Lrt-T.� 6 _-,
etf
- ( \ — f
PASS FAIL y
MBI
e am /400 7'7 a// / U aaAGe
Under Slab
Rough -In q €/`Y 1 ...
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pa / / 149- y r ,t1 " S re rt. 4 7/0 w
, 4 l� 7 " ''�� ' PART FA �J q
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final P/LA e - ,crf--e- 5✓1-, S TO C G... 1-1 %
)
PASS PART FAIL
ELECTRICAL C q ( y / 9 2 g / X IV (t c 5 --- 0 ,-./� C vv rf
Service ((ff !!
Rough -In s (•f or-- a.. r te, A /Z cr. l4-5 ti‹) E C Ccry ty..►-i 'n
UG/Slab
Low Voltage
Fire Alarm
Final Q Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line �s /
ADA Dat 7// 7/v 3 Ins actor l Ext
P
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL