Permit " _r�� BUILDING PERMIT
A CITY OF TIGARD
PERMIT #: BUP2003 -00680
SSUED: 12/17/03
�1� DEVELOPMENT SERVICES DATE I
� ' � " �� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15570 SW PACIFIC HY PARCEL: 2S110DC -02200
W
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: B 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: $ 1,200.00
Remarks: Modifications to ATM area. (Wells Fargo area.)
_Owner: Contractor:
TIGARD, CENTER LP B J. CUMMINGS COMPANY
9777 WILSHIRE BLVD #609 2330 SE CLATSOP ST
BEVERLY HILL, CA 90212 PORTLAND, OR 97202
Phone:
Phone: 235 -1282
Reg #: LIC 23230
FEES MET REQOQIZE�IN
SPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 12/9/03 $62.50 Framing lnsp
[TAX] 8% State Surchart 12/9/03 $5.00 Gyp Board Insp
Final Inspection
[BUPPLN] Pln Rv 12/9/03 $40.63
[FLS] FLS Pln Rv 12/9/03 $25.00
•
Total $133.13
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 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.
ri,!' i f � / Issued By: 1CJ(.(�t Q l�2b./0
Pe rm ittee " _
Signature: d)'1 0(.4:24) U
Call 639-4175 by 7 p.m. for an inspection the next business day
W Y 7v 5 1 rAo rlG Ilia i .
. �. o' AgEIVED
4
Y
o tl Building Permit Application,, OFFICE USE ONLY
s't Date received: b_ Q Permit no.: �i(J d.op3— OO(v i� /
�; j ' `' d CITY OF TIGARD 1:1.111MIMMIIIIIIIMIll
/�/� 1900 SW 4th, Ste 5000, PO BoxglJQcgp a 1201 e
/L✓LJ► Phone: (503) 823 -7363, Fax: (503) 823 -3018 I�P/��eP/�.50 /12 -/e-0)
'�� TDD: (503) 823 -6868, Website: www.bds.ci.portland.or.us
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ommercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: /S5 O 5 ♦ '' G I C.i tf IV Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: E1.4,6 • L .-• - /v6 G ` N OAF SLR,
Description and location of work on premises /special conditions: / /PGA 77O 7 TO A7714 A, &4Q •
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
(Floodplain, septic capacity, solar, etc.)
Mailing address: ! D . tO 3(5/ 1 & 2 family dwelling:
City: State: ZIP: 97 we, Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
_ Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
CM �� Covered porch area (sq. ft.)
Mailing address: 0 5 CLA • — Deck area (sq. ft.)
City: 70,0 • No State:Q,( ZIP: _I Other structure area (sq. ft.)
Phone: JC- ZS Z., Fax: /35 0, ,z E -mail: Commercial /industrial /multi - family:
CONTRACTOR Valuation of work $ /Zoo
Existing bldg. area (sq. ft.) 3/80
Business name: a J , _ v , ` New bldg. area (sq. ft.)
Address: 0 G G • Number of stories
City: • ° • ( j State:QA' ZIP: 97292 j ►
Phone: — �, E -mail:
Type of construction • IT /y
CCB no.: 2 Zap Occupancy group(s): Existing: 5
New: iv
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIII•l ECT /DP :SIGNER 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: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER OFFICE USE ONLY
Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: . E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the
attached checklist. All provisions of laws and ordinances governing this
work will be complied ' wh ether J specified herein or not.
Authorized signature: � i ( Date: 129/03
Print name: (C../c, / T JAS ) for Cbiv k /sS,EA)
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. LT- famisWpp Building 0303.pmd
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP 'moo (p $O
Received Date Requested 3 AM PM BUP
Location /5 7 v Suite MEC
Contact Person Ph ( ). ?/ R- / T PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner _ • / ' C
Footing ■ /
Foundation ELC
Ftg Drain Ac . .i �� V �� ELR
Crawl Drain U Coe
Slab Inspection Notes: IT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
■: PART FAIL
PL U ' BING
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA �c c
Approach/Sidewalk Data /2/� ! /v y Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL