Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2003 -00677
� 1 � DEVELOPMENT SERVICES DATE ISSUED: 2/24/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 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: 3N : 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: $ 1,000,000.00
Remarks: TI
Owner: Contractor:
TIGARD CENTER KENDALL CONSTRUCTION
9777 WILSHIRE BLVD. 17436 SE KENDALL CT.
#609 PORTLAND, OR 97236
BEVERLY HILLS, CA 90212
Phone:
Phone: 503 - 661 -3577
Reg #: LIC 29680
FEES • REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require Final Inspection
[BUPPLN] Pln Rv 12/5/03 $2,652.52 Electrical Permit Required
[FLS] FLS Pln Rv 12/5/03 $1,632.32 FoF Permit Required
F000 t/Foo uu nd lnsp
[BUILD] Permit Fee 2/24/04 $4,080.80 Framing Insp
[TAX] 8% State Surchart 2/24/04 $326.46 Gyp Board Insp
Susp Ceilng lnsp
Total
$8,692.10 Susp Ceilng Insp
Bolts in concrete final repot
Structural welding final reps
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By:
Pe Signature: �r
Signur y a ll 75 b 7 .m. for an inspection the next business da
Y p P day
1
4 W
FOR OFFICE. US..E ONLY
Builda<n Permit Appl,� cat io n Received , Building •
Dat :: a 9 03 , • PemtitNo.; 0 - i, - 00 ,
City of Tigard RECEIVED a Other
permit
13125 SW Hall Blvd Plan Review S d3 �! Other
Ti Oregon 97223 Datel$yx itY ,
D . Permit No.:
Phone 503 - 639 -4171 Fax: 03 DEC 9 • 0 ,; ,r,_5,:}�,.,;r,1l , +•\ Po -Review Case No �'
Internet www.citigarcl.or.us C . T F I A' = -(" ' Contact Juris.: el See Page 2 for
24 -hour Inspection Request: k LI 1 ISION Name/Method: �' /� I Supplemental Information •
�. �: I; ... •• •:... . � F.. a • a; ... :. : � , . f ;'.: �i�twf -�. ,.4:.. `',:'
:,:. a G•.•_.,:...: .:..T�l� '; .: , . ,..,�;;' :" ;.bra '`:R'LQD!�Di��" � ��:�: • :; ---z---
❑ New construction El Demolition i r :: ' E i :i' ; (- i & Z '.lt YiDW L N :: " _ • El Addition/alteration/replacement
111 Other: :' ' 4 - ;
i .V irl iTi • _ -. ", �:'la NS'p'RUCmION ;; ;d I ii. •,„ :.'= °:I :`? Note: Permit fees' are based on the total value of the work performed. Indicate ,
❑ 1 & 2- Family dwellin: ®.CounnerciaVlndustrial (�
J the value (rounded to the nearest dollar) of all equipment, materials, labor, (,J ,
overhead and profit for the work indicated on this application --t.;'
• Accesso Buil• _ • 1
❑ Master Builder 111 Other: Valuation $ • k'
'a i .._ . . - o $,; ii! a�3Y' i ON a>id•,'Y (1 TID I':. ,,, No of bedrooms: No of baths _ . .
Job site address:15510 S G W New dwelling rc loors i
Suite #: Bldg- /Apt. #: Garage/carport g ((s it)
ge/carport arcs (sq. �)
Project Name_Sa .1&Y # 14145 l .EW10.) EL— Covered porch area (sq. R)
Cross street/Directions to job site: Deck area (sq. It)
Other structure area (sq. ft.)
is :.:'.`. ° ry 'I ..
) F Q��
• Lot #: r..•I. . . .r..ri: .: ,.... I:i
Subdivision: _
Tax map/parcel #: c5 1 10 D - 02.7-00 Note; Permit fees' are based on the total value of the work performed. Indicate •' .i'11 t 1. l'�: .ir:� ' _, . . ; . . the value (mrmded to the nearest dollar) of all equipment, materials, labor,
.. ".'1 :.!:x:7::1 .. ! `i:`� >' +:I?TT� !Z i v • �. : ; ; L § i ::r... . _ . .:.. overhead and profit for the work indicated on this application.
1Kt e.>Z•lCfz- 1Mpg:tec cTL6AS: I7e + '
L. L 12E Valuation $ ( O DO 1 Q DQ OD
UPC- 12Ac ■ t . NSTACLI_. - NI 61D Existing building area (sq. ft.) � y t l42
New building area (sq. ft.) • No eq rk,N t rE
1 L .a � - y - ,,.�I1�w� Number of stories _ I
•I 1XPER'�i!'tWWNER -.4 ; ENA!N'ir•:•I
i� � ;: I : fa'PI I. �"�' ,...a.� - . -. ..:::::'ii. Type of conswction ll l - NI
Occupancy group(s): Existing: M
New: IA
Address: Up Soo SE gNlEL'SN sT'•
Ci /State /ZiES..trovc. Mn,s de.. 910 l S
NOTICE: All contractors and subcontractors are required to be
P11one:L�3�57 - 4 l �D Fax: 5D'1,45-7-1,91-1A.6) li censed w ORthe Orego7an d may Co nstructi req on Contractors
be Board under
H ( • `. :.• . •': t ' ' .` 111 ' 31 I ' " p O i ' ':') provisions of S 01 n b t uired to li cens ed in the
Business Name: t j. v4,1N C 2. ii-/ jurisdiction where work is being performed. If the applicant is exempt
Contact Name: ,n►q -s -silt e7 -l6-/0 from licensing, the following reason applies:
Address: (oD/ S "n' ,t 1/ # /7.00
City/State/Z jp RtRaz.4 Ni. ne. 9724
50 220 :I_ ; ;I:,;; .: ,;: : ; : r ' i
Phone �3b ax•�3 Z�r3 83� F ri: ;. - • ' ,;: , ; .'� •:���..'��• .. :h;.,.
E-mail: hN ilfs N'r'Pe. wt., 1.Y/kt.'I1J�2. • CONI h . !:I. r;:: ° :, : ' G . _ •
,7:1.:.'! dI , •.::.1:041;i1IIaICt1ON�? 'JlAC['eXt ... .... . ,0rfE l
Business Name: t mda,il 0 ,,,+ . T re. Fees due upon application $ ;
Addres 17V34 K{�d��L -G.L- o .
Ci /State/Zi .: Por+ /e , of i 97a 36 Amount received $
:: i j0.3 - 661 - 3 577 I -E Date received
CCB Lic. #: 029680 Ao - v 027 .
Authorized .7 Notice: This permit application expires if permit is not obtained within
1 Signature: V ' ' 1 '- Dom: °Z is i aY 180 days after it has been accepted as complete.
jecd - .Svc c : n __ ' *At methodology set by Tri-Couuty Building industry Service Board.
(Please print name)
(?E • a(05.5
i:\Dsta\Perntit Forms\BldgPermitApp.doe 01/03 Q a .33—
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION- DIVISION Business Line: (503) 639 -4171 MST
BUP 7g 6t6 a 445
Received Date Requested /1 / Jo AM PM BUP .246, 3 - O C)G 7
Location 15576 Suite MEC
Contact Person faL(L Ph ( ) 7G - 9 19 7 -- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: fl/t,„ CZ) - SIT
Post & Beam �,, Q
Shear Anchors C ry„ ®Q PaaiExt Sheath/Shear �`�. 4tLryi_jz
Int Sheath/Shear
Framing
Insulation
•
Drywall Nailing 16/ —
Firew
ire S rin
Fire Alarm
Susp'd Ceiling 1
Roof
.'1 l
Oth
PASS' PART FAIL ► /.
PL :ING
Post & Beam
Under Slab
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 D Please II for rei pection RE: _ El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date a Li Inspector A Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL