Permit PERMIT #: BUP2001 -00109
l '4 W r 4 ` DEVELOPMENT SERVICES DATE ISSUED: 4/2/01
�� I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15660 SW PACIFIC HY A -2 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: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 47 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 20,500.00
Remarks: Tenant improvement Dining room with less than 50
Owner: Contractor:
TIGARD, CENTER LP OREGON RESTAURANT EQUIPMENT IN
9777 WILSHIRE BLVD #609 PO BOX 2560
BEVERLY HILL, CA 90212 OREGON CITY, OR 97045
Phone: 503 - 579 -3958 Phone: 503 - 720 -6380
Reg #: LIC 75858
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Mechanical Permit Require
PLCK CTR 3/28/01 $159.19 27200100000 Electrical Permit Required
Sprinkler Permit Required
FIRE CTR 3/28/01 $97.96 27200100000 Plumbing Permit Required
MENU CTR 4/2/01 $244.90 27200100000 Framing Insp EXPIRED
5PCT CTR 4/2/01 $19.59 27200100000 Gyp Board Insp
Susp Ceilng Insp
Total $521.64 Final Inspection
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 -1987. You
may obtain a copy &f tfiese. les or direct questions t o OUNC by calling (503) 246 -1987.
Perm itee
Signature: ttp AIMIll'AZ
,� ,As
Issued By: _
Call 639 -4175 by 7 p.m. for an inspection the next business day
•
t 0-T-c,,
i
/ - A Building Permit Application
Date received: 3 Permit no.: ) f �DO
C of Tigard . 14 '' .1 1 1I '
,1• ,L` II! City g Project/appl.no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
"11 PE OF PERM! I
O 1 & 2 family dwelling or accessory O Commercial/industrial O Multi- family O New construction O Demolition
O Addition/alteration/replacement • enant improvement O Fire sprinkler /alarm O Other.
JOB SITE INFORMATION
Job address: 19 _ O • Ns sLa PAGF•1G ,„AW Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.: (�
Project name: a A. ' 40 `1 ' ~ AWL} t _.A.3111W LIMMIENIMIIMMI.11.1
/ ( /
Description and location of work on premises/special conditions:
1C- 'Or' ' r 'Skes . _ .. : eh... 42. ,- -
v
_ OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
` `, (Floodplain, septic capacity, solar, etc.) r_D
Mailing address: -1 . - •- , r ..14, 'per y-a 1 & 2 family dwelling:
City: l.Cdtte 0S e_ i Stater ZIP: 1 - Valuation of work $
Phone: , - .4 iffilIMIE 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.)
11212
• . C-as.e Covered porch area (sq. ft.)
Mailing address: ( , 1) l - 204- Deck area (sq. ft.)
m d. 1 EMEM Zip: -Tact Other structure area (sq. ft.)
Phone: - Y, et_ f ax: -Musa E- mail: Commercial/industrial/multi- family:
CONTRACLOlt Valuation of work $ ZO ti
- • ��!' h , ` Existing bldg. area (sq. ft.) \
Business name: ba 0
�' a�'drrf ".∎- New bldg. area (sq. ft.) I , 1.0"0
Address: • 0 t " , b
Number of stories cv'v•
State: at ZIP: " '104 Type of construction V NiSQ CU\
Phone: - 1105 . ' E-mail:
Occupancy group(s): Existing: lb.
CCB no.: -1S935% New: Q
City/metro lic. no.: a 0 e, O 5 3 2 -4 Notice: All contractors and subcontractors are required to be
ARCH! FECIMESIGNER licensed with the Oregon Construction Contractors Board under
Name: g e tsONq O.. • • 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
R
Name: • 1 tact person: Fees due upon application $
Address: V /rte Date received:
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 Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this o Visa U MasterCard
work will be complied + i it._,.. . • fled herein or not. Credit card number: / /
I Expires
Authorized signature: ��F�_ 1 _ Date: '/ I " - X 1 0 1 Name of cardholder as shown on credit card
CC $
Print name: • S.+¢• cardholder signature • Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as con XI) I R FTo.4613 (6.0m)
1 '
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
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 plan sets for distribution purposes (for Contractor, City of
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
Total # of
TYPE OF SUBMITTAL Plans KEY:
Submitted
S = Site Work (must include
S (New, Add or Alt) 4 location of all accessible parking)
B (New, Add or Alt) 1* B = Building
F (New, Add or Alt) 3 ** F = Fire Protection System
M (New, Add or Alt) 2 M = Mechanical
P (New, Add or Alt) 2 P = Plumbing
E (New, Add, or Alt) 2 E = Electrical
New = New Building
Add = Addition
.Alt = Alteration to existing
building
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" requires that plans bear the original seal of an Oregon licensed fire
suppression engineer, or NICET level "3" technicians.
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