Permit BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2004 -00188
#�'* DEVELOPMENT SERVICES DATE ISSUED: 4/28/04
Ail 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15532 SW PACIFIC HWY C -5 PARCEL: 2S110DC -02200
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 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 12 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:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 3,500.00
Remarks: new walls for rooms.
Owner: Contractor:
TIGARD, CENTER LP TNT CONSTRUCTION CO
9777 WILSHIRE BLVD #609 PO BOX 86265
BEVERLY HILL, CA 90212 PORTLAND, OR 97286
Phone:
Phone: 503 - 516 -0406
Reg #: LIC 65408
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 4/28/04 $81.70 Sprinkler Permit Required
[TAX] 8% State Surcharl 4/28/04 $6.54 Framing Insp
BUPPLN Pln Rv 4/28/04 $53.11 Gyp Board Lio
[BUPPLN] Final Inspection
[FLS] FLS Pln Rv 4/28/04 $32.68
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 -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: _ A _ , � / 1' -
Pe mt ittee V
Signature: 1
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application FOR OFFICE USE ONLY
•
City of Tigard Received / / /
DateB /M / �j 9O [ . Q
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review v
Phone: 503.639.4171 Fax: 503.598.1960 /r,e„; ,ik"` I ; ;\ Date/8 : , ' 2 I Other Permit:
Inspecti Line: 503.639.4175 A r'f I Date Ready :y: Jur ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK . . REQUIRED DATA: 1- AND 2- FAMILY DWELLING.
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
0 Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
• CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial/industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE ,INFORMATION AND LOCATION • ' Total number of floors:
Job site address: / 3 4.0 gee • '' /v 9 e New dwelling area: square feet
City/State/ZIP: ��.,,/ ,2 9 -7s/ Garage/carport area: square feet
Suite/bldg. /apt. no.: 1 Project name: , V,e e ) Z �r 5�,,,,. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECELIST ,
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
• . DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 3, sa-c, • N..11
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER TENANT Number of stories:
J
Name: 1) j jt •
,L z ftc Type of construction:
Address: A3.f 5'- ' c<". "e e @ - S'
G Occupancy groups:
City/State/ZIP: �■-e -ii ° 9 . 7° 12 `ee,/ Existing:
Phone: (;SAS) 6 s', ^ , .22 7ct' Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE =
Business name: All contractors and subcontractors are required to be
Contact name: !..)<..A., \/e.i. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / 0. ,�eJ--6ar d'6 � ..S" -- jurisdiction in which work is being performed. If the
City/State/ZIP: � 7 D� , 9 7,24r6- applicant is exempt frog' licensing, the following reasons
apply: ?P 7 '/. 10
Phone: (SOS S7 a6 Fax: : (c3) 77,r— .r-/S$ 7 r&-1/
5‘, 11
E -mail: 7'Xisr i1 tea, 6- c27,.. 6 P
• CONTRACTOR F 3Z � g ` ^ � ro
Business name: 7:AJ 7 k4°7z G°J
. BUILDING PERMIT FEES*
Address: p . fa'9/Y 6P6..e5, — .
Please refer to fee schedule.
City/State/ZIP: p,-, - 7
Fees due upon application
Phone: ( ) Sr ol— 6 Fax: (4 77.5 1. f133 7
lj,S�/p� Amount received
CCB lic.:
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: .-9*l V Date: e9- /�3 / /e z i • Fee methodology set by Tri County Building Industry
Service Board.
i:t Building \Permits 'BUP- PermitApp.doc 12/03 440- 4613T(1 I /02/COM/WEB) .e
•
• r
0
Building Division
/'y " "' Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
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)
* 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.
i:\ Building \Forms \COM- PlanSubReq.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP.==2o0 V —ad v2 ?7
Received • �— Date Requested n - - T AM PM BUP A - 00 (erg
Location / J `S 3 �- P L _, Suite a -5- MEC
Contact Person A Ph ( ) 576: - 04O(, PLM
Contractor Ph( ) SWR
Q i
BUILDING Tenant/Owner
-c 4 T betl. ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing CO rew 13
'�.
' JI J ( PA-L-
(
Fire Alarm 1 ` ¢--� O 1 /
Susp'd Ceiling J
Roof
Other:
iisio FAIL
Post &
Under Slabm Bup 4- - % C(524-5 5 l ►� (u i- L__1,
Water Rough-In Service
(� �,,( „ (53___--
Water Service \ kl 4k��
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final Al, . - 0 f .4 � � t:/
PASS PART FAIL
MECHANICAL l (9r
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL —, k,
Service �,j
Rough -In A.'�glaWEVAL f
Low Voltage
IJ' IWWW-
Low Vo
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL