Permit BUILDING PERMIT
CITY TIGARD PERMIT #: BUP2001 -00419
A � DEVELOPMENT SERVICES DATE ISSUED: 11/9/01
s `� '� JI� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S110DC -02200
SITE ADDRESS: 15660 SW PACIFIC HWY A -5
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: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 27 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: $ 3,500.00
Remarks: TI
Owner: Contractor:
TIGARD, CENTER LP THOMAS NGUYEN
9777 WILSHIRE BLVD #609 DBA RELIABLE CONTRACTOR
BEVERLY HILL, CA 90212 4907 SE HOOL
Phone: Pone N
h503= 319938QT
Reg #: LIC 135032
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Mechanical Permit Require
PLCK CTR 11/5/01 $53.11 27200100000 Electrical Permit Required
Framing Insp
FIRE CTR 11/5/01 $32.68 27200100000 Gyp Board Insp
PRMT CTR 11/9/01 $81.70 27200100000 Final Inspection
5PCT CTR 11/9/01 -$6.54 27200100000
Total $174.03
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 of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Permittee /�
Signature: / ,
Issue By: \ �t !� ,'� - .I I :' ', `
Call 639 -4175 by 7 p.m. for an inspection the next business day
iiir . . . . l tt ` Q
Building Permit Application
��a 1 `� t Date rece l 1 0 Permit no �? 4
J � y o
Citf Tigard F
' 0- Project/appl. no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: By Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
1
Land use approval: I &2 family: Simple Complex:
'V TYPE OF PERMIT
U 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi -family ❑ New construction ❑ Demolition
"(Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
\ JOB SITE INFORMATION
Job address: - . EQ tJ delkelnELPWEIMIEMINIM Bldg. no.: Suite no.: a ss
Lot: Block: _ Subdivision: Tax map /tax lot/account no.: r\
Project name: A r
Description and location of work on premises/special conditions: A AA t.7et k 5 i r. S u .44 4 S 4.5 J (rA PicchS
1 OWNER FOR SPECIAL INFORMATION, USE CHECKLIST d
(Floodplain, septic capacity, solar, etc.)
Mailing add ss: r- - 0 ij 15 ,: t - 13 I i t, S -' 100 I & 2 family dwelling: v`
EZIEUVIN State:cm ZIP. 1)2 12 Valuation of work $
Phone: 3/0 2 .. — p / Fax: 3 o -27t - d87- E -mail: No. of bedrooms/baths
Owner's representative: 54. Dcw.e w.v+" . Total number of floors
Phone: 57;3 ).43 465 I Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: A, . (,J, I vv.- _ Ptz.Ze, R %.45(.•N Covered porch area (sq. ft.)
Mailing address: SL O SW + t� ,,,) - sq s - Deck area (sq. ft.)
City: , - State:OR ECM= Other structure area (sq. ft.)
Phone: Co 3 ya G 5ti'1 Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $ 3/ 500
Business name: • PA W �� 1, Existing bldg. area (sq. ft.)
Address: a g�raira New bldg. area (sq. ft.)
Number of stories
_INIM�� ZIP: e •
Type of construction
Phone: ) - c - S` ax: a. -Jlq E -mail:
Occupancy group(s): Existing:
: no.: C New: 5o0
City /metro lic. no.: s-,3 Notice: All contractors and subcontractors are required to be
ARC! IITECI7UESIGNER 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:
EN( INFER
Name: 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 Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ visa ❑ MasterCard
work will be complied with, whether specified herein or not. Credit card number: e t i /
P
Authorized signature: Date: Name of cardholder as shown on credit card
• $
Print name: Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6roOICOM)
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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 sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
TYPE OF SUBMITTAL Total # of
(Includes New, Additions or Plans
Alterations) Submitted
Site Work (must include location of 4
all accessible parking)
Plumbing - Site Utilities 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
*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 9/4/01
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CITY OF TIGARD
. Approved (Y):
-- - - - - - -- - - - - - - - - _ - . — ' Conditionally Approved
For only the �S escribed in: �.
PERMIT NO sr Z� B, - &d• 14/ r
See Letter to: ollow
1 Attach ( )'
Job ddresel ( )' „5"
I _ ,_ ey: Date;
of4icc
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. • __ _ _
CITY OF TIGARD BUILDING INSPECTION DIVISION
24iHour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP 0),00/
Date Requested / / — / 3 ee // AM PM BLD
Location L �c (Q Co C P A Try Suite if ` s MEC
Contact Person � ph c i& E ea 9 `/ PLM
Contractor SWR
BUILDING Tenant/Owner �� ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
PASS ART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
i
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk Date `� / 3 - Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST,
BUP DO /' CU Lf /?
Date Requested / 1 S AM PM BLD''
Location • S , , Suite MEC •
Contact Person Ph ? 6.5 q? PLM
Contractor Ph SWR
BUILDING Tenant/Owner - � ,� I a - � ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Ins tion ;,(c)
ailin
ire
'Fire-Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
( PART FAIL
+4 BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
BackfilUGrading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk � I
Other Date Inspector ( Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MSS
3-s" AM P-00( 00 g 161
Received Date Requested AM PM BUP, j
Location / - .e Suite i far°
Contact Person Ph ( ) 6 : PLM
Contractor Ph ( ) SWR
•
ILDING Tenant/Owner 4? x l „ Qt ELC
in v o ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 9 441 l SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
(/ 0•ART FAIL
:ING 5 �
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer �
Rain Drains o0
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 J 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
Approach/Sidewalk Date 3/C/ /
v Inspector 1 Ent
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL