Permit 4 //‘(0
Building Permit Applicati ®u fs
`'y' +�(I:i City of Tigard Datereceived: j/ r 0/ Permit no.;Bl , ( /o1QQ -DD //
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Projecdappl.no.: Expire date:
City of Tigard Phone: (503) 639 -4171 Date issued: 12 Receipt no.:
Fax: (503) 5984960 • Case file no.: Payment Y type:
Land use approval: _ I &2 family: Simple Complex:
TI PE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration/replacement gTenant improvement 0 Fire sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: /553 2 S • (.0 , PA l I C {j t,(� /. Bldg. no.: C Suite no.: C - 1B
Lot: Block: 'Subdivision: I Tax map /tax lot/account no.:
Project name: V A - C ANT Ul7S
Description and location of work on premises/special conditions: DI UI Si 0/.1 CT (-A I i232_ So n
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
Name: 11.6Af2d P(20rna.UA (Floodplain, septic capacity, solar, etc.)
Mailing address: 9}}1- WI L6{}I t?x f51-013 609 1 & 2 family dwelling:
City: y I Lt.S 'State: GA I ZIP: CO212 Valuation of work $
Phone: 310 _ _n811 I Fax: I E -mail: — No. of bedrooms/baths
Owner's representative: S"Ml./ maw EMAN Total number of floors
Phone: 50 . Z43. ; 65 I Fax: 63, 24 • ' e mail: — New dwelling area (sq. ft.)
, • APPLICANT Garage/carport area (sq. ft.)
Name: At l p M MO I SAN A550ClATED trI204-ITCCc Covered porch area (sq. ft.)
Mailing address: 6.g20 S. t.0 • -1ACAoArn . Sf,I r l GO Deck area (sq. ft)
City: 1)012:1 I State: cn ZIP: q R-2_19 Other structure area (sq. ft.)
Phone:p3 245 3 Fax: S03Z45441 E-mail: SA. bl he,ean t2 4. • Commercial/industrial/multi-family:
Va nation of work $
Business name: Existing bldg. area (sq. ft.)
Address: New bldg. area (sq. ft.)
City: I State: I ZIP: Number of stories
Phone: I Fax: I E -mail: Type of construction
Occupancy group(s): Existing:
CCB no.: 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: x41.1 IGPOTh ley) 0)SAN ,4-5 cc /ATeo -4QCi+Itecr c provisions of ORS 701 and may be required to be licensed in the
Address:002p Su) m ,4CA C>aln SO 1 ICD- jurisdiction where work is being performed. If the applicant is
City: pp2T(_ A %4x) State: c i2-4 ZIP: 9 Zt 9 exempt from licensing, the following reason applies:
Contact person: 54t311.1E O'fWca Plan no.:
Phone:5 )3.245. MOO Fax: 04.5-13.1 E-mail: gAbineoi Mao
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 wi hether specified herein or not C redit card number
Expires
13
Authorized signature: Date: 4 Name of cardholder as shown on credit card
•
Print name: ,54B I�1� n 4 �tr4(-(O12y/i .J • 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 (6itlO OM)
1/16/02 Activities for Case • .: UP2001 -00119
7:38:57 AM
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPC005 Application received 4/4/01 DLH DONE No Hold BLD 4/4/01
BUPC008 Permit created 4/4/01 DLH DONE No Hold BLD 4/4/01
BUPC012 Plans routed to Plans Examiner 4/4/01 DLH DONE No Hold BLD 4/4/01
BUPCO24 Plans checked /approved by PE 4/5/01 RDP DONE No Hold RDP 4/5/01
BUPCO26 Approved plans routed to DSTs 4/5/01 RDP DONE No Hold RDP 4/5/01
BUPC520 Mechanical Permit Required No Hold RDP 4/5/01 �e42-0 0 I - 06 / 2.. (F)
•
BUPC530 Electrical Perm' squire No Hold RDP 4/5/01 e44 2.60/ - 0003+4 / (r)
BUPC540 Sprinkler Permit Required ----3 No Hold RDP 4/5/01 Ai In
BUPC565 Plumbing Permit Required c" ----- 3 No Hold RDP 4/5/01 ici 4✓u, SIG
BUPC740 Framing lnsp r----) No Hold RDP 4/5/01
BUPC760 Gyp Board lnsp C - - - - - - " S ) No Hold RDP 4/5/01 S G ' 2. O f —
BUPC762 Susp Ceilng lnsp C ---.-- ) No Hold RDP 4/5/01 00 10?
BUPC799 Final Inspection C No Hold RDP 4/5/01 .
BUPC090 Ready to issue 4/6/01 GWL DONE No Hold GWL 4/6/01 Contractor info needed prior to _
permit issuance
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1/16/02 Fees Associated with Cas - • = UP2001 -00119
7:39:57 AM
Fee Case Start End Trans. Create Created
Type Type Date Date Case No. Dept. Description Code Revenue Account No. Date By Amount Due
PLCK BUP 1/1/90 12/31/05 BUP2001 -00119 [BUPPLN] Pin Rv 245 - 0000 - 433000 4/4/01 BLD $40.63 • $0.00
FIRE BUP 1/1/90 12/31/05 BUP2001 -00119 [FLS] FLS Pln Rv 245 - 0000 - 433020 4/4/01 BLD $25.00 $0.00
PRMT BUP 1/1/90 12/31/05 BUP2001 -00119 [BUILD] Permit Fee 245 - 0000 - 432000 4/5/01 RDP $62.50 $62.50
5PCT BUP 1/1/90 12/31/05 BUP2001 -00119 [TAX] 8% State Tax 100 - 0000 - 207020 4/5/01 RDP $5.00 $5.00
$133.13 $67.50
Page 1 of 1
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1/14/02 Activities for Case #: BUP2001 -00119
1:51:59 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPC005 Application received 4/4/01 DLH ' DONE No Hold BLD 4/4/01
BUPC008 Permit created 4/4/01 DLH DONE No Hold BLD 4/4/01
BUPC012 Plans routed to Plans Examiner 4/4/01 DLH DONE No Hold BLD 4/4/01
BUPCO24 Plans checked /approved by PE 4/5/01 RDP DONE No Hold RDP 4/5/01
BUPCO26 Approved plans routed to DS s 4/5/01 RDP DONE No Hold RDP 4/5/01
BUPC520 Mechanical Permit Required No Hold RDP 4/5/01
BUPC530 Electrical Permit Required No Hold RDP 4/5/01
BUPC540 Sprinkler Permit Required No Hold RDP 4/5/01 .
BUPC565 Plumbing Permit Required No Hold RDP 4/5/01
BUPC740 Framing Insp No Hold RDP 4/5/01
BUPC760 Gyp Board Insp No Hold RDP 4/5/01
BUPC762 Susp Ceilng Insp No Hold RDP 4/5/01 •
BUPC799 Final Inspection No Hold RDP 4/5/01
BUPC090 Ready to issue 4/6/01 GWL DONE - No Hold GWL 4/6/01 Contractor info needed prior to
. permit issuance
V O,, 2 ---
i 2 e-eeZ 74 .&;e2A-vi A Q/✓).,-) .
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1/14/02 Fees Associated with Case # BUP2001 -00119
• 1:52:06 PM • •
Fee Case Start .End Trans. Create Created Amount Due •
Type Type Date Date Case No. Dept. Description Code Revenue Account No. Date By
PLCK BUP 1/1/90 12/31/05 BUP2001 -00119 [BUPPLN] Pln Rv 245 - 0000 - 433000 4/4/01 BLD $40.63 $0.00
FIRE BUP 1/1/90 12/31/05 BUP2001 -00119 [FLS] FLS Pln Rv 245 - 0000 - 433020 4/4/01 BLD $25.00 $0.00
PRMT BUP 1/1/90 12/31/05 BUP2001 -00119 [BUILD] Permit Fee 245 -0000- 432000 4/5/01 RDP $62.50 $62.50
5PCT BUP 1/1/90 12/31/05 BUP2001 -00119 [TAX] 8% State Tax 100 - 0000 - 207020 4/5/01 RDP $5.00 $5.00
$133.13 $67.50
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4/6/01 Fees Associated with Case # BUP2001 -00119
2:45:58 PM .
Fee Case Start End
•
Trans. • Create Created
Type Type Date Date Case No. Dept. Description Code Revenue Account No. Date By Amount Due
PLCK BUP 1/1/90 12/31/05 BUP2001 -00119 [BUPPLN] Pln Rv 245 - 0000 - 433000 4/4/01 BLD $40.63 $0.00
FIRE BUP 1/1/90 12/31/05 BUP2001 -00119 [FLS] FLS Pln Rv 245 - 0000 - 433020 4/4/01 BLD $25.00 $0.00
PRMT BUP 1/1/90 12/31/05 BUP2001 -00119 [BUILD] Permit Fee . 245 - 0000 - 432000 4/5/01 RDP $62.50 $62.50
5PCT BUP 1/1/90 12/31/05 BUP2001 -00119 [TAX] 8% State Tax 100- 0000 - 207020 4/5/01 RDP $5.00 $5.00
$133.13 $67.50
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 41002001 _
Date Requested AM PM p� a), FPS) -_ N ,
Location 5 GJ‘t - Suite e — ��! X00 / — 00/4)-
/
Contact Person Ph dilr N eTht (Tr
Contractor Ph SWR
BUILDING ' Tenant/Owner S C . FA «— gro /J (rr)
Retaining Wall E Q
Footing • Access: ^
Foundation O5 '7 7�0�� k FPS ik
Ftg Drain
Crawl Drain Inspection Notes: ,/`` II �Q ■
�2( I OW 07
Slab �v ����' �^-� 2--eq/1 SIT
Post & Beam
Ext Sheath /Shear / y►� / /, J � �'
Framing ' �� Q ac26 1 O _ 0 I � 9 l \ ° 5 !( ..5 , 4e_ 47. s
g /EL ti7�
Insulation , / - '• n kj �., � /�
Drywall Nailing ( T��( �--r�
Fire Sp lives /� / _ 'er /� TT-.
Fire Sprinkler 'LC,C' 7 't
Fire Alarm * /( / �
I � j ► (., .
Susp'd Ceiling ^^�� L L . �- � ✓ � �7/
Roof o2• LC b0 I I 0 _ ' f /• / / /
Misc: _
Final
PASS PART FAIL S >00) -00/67 C S� )
PLUMBING - E� -y -e -e-of t - S7./ 4 J 4
Post & Beam n �
Under Slab £ •J r A.: , d- 6.4/1 S• � C•V'_
Top Out 611,S- S'z - S ,i
Water Service V FY-4/144 � l
Sanitary Sewer I /
/
Rain Drains ` .Q,( /Cw. �,_ ��1/�
Final rY7 / I
PASS PART FAIL V L-< S C_3- -t_ d i
MECHANICAL / 1 ��� �Ji1 W
Post & Beam S
Rough In
Gas Line
Smoke Dampers 0-, / 7 �O b j-- Q /� / -� A 4 j '
Final V
PASS PART FAIL , L i �1 _o 4, x p 4 , /ai
ELECTRICAL '
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
Other Date Inspector E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.