Permit BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2003 -00430
��y, DEVELOPMENT SERVICES DATE ISSUED: 7/15/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102C6 -07300
SITE ADDRESS: 10400 SW PARK ST
SUBDIVISION: MLP97 -0019 CHILDREN'S VILLAGE ZONING: R -3.5
BLOCK: LOT: 001 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: peg 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: E3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 18 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: $ 5,000.00
Remarks: Infill existing pool with joist/deck. ..
Owner: Contractor:
FERNANDO, ANIL NIHAL KANWAR + JOHN KLUNE CO.
ANNE ELIZABETH 12370 SW DUCHILLY CT.
17549 OAK MEADOW LN TIGARD, OR 97224
LAKE OSWEGO, OR 97034
Phone:
Phone: 503 - 639 -4359
Reg #: LIC 2804
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 7/15/03 $91.30 Plumbing Permit Required
rm
[TAX] 8% State Tax 7/15/03 $7.30 Framing Insp
Final Inspection
[BUPPLN] Pln Rv 7/15/03 $59.35
[FLS] FLS Pln Rv 7/15/03 $36.52
Total $194.47
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: �%7,i.,,., L11,.e
Pe rrn ittee / /71---e=' -
Signature: •
•
Call 639 -4175 by 7 p.m. for an inspection the next business day
,
IlU11d1I1g Per ]j FOR OFFICE USE ONLY
Received Building
Date/By: 2- /5".0 3 Z./j Permit No.•.� pap, 3 -oo 1 7 1 3.0
City Planning Approval Other
of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. JUL 1 5 2003 Plan Review , Other
Tigard, Oregon 97223 CITY OFpTII DateBy: ?-/ W i J Permit No.:
�,UnvL1IJ717f�IO1 b �raFdR. pd a �� Post - Review Land Use
Phone: 503 -639 -4171 � Date/By: Case No.
Internet: www.ci.ti d
ar.or.us ' °' -
g Contact Case Juris.: El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition I & 2 FAMILY DWELLING
[it Addition/alteration /replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling I Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi - Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: /0 '0O � I p4-44L sr New Total number dwelling a a floors
I New rea (sq. ft.)
Suite #: Bldg. /Apt Garage /carport area (sq. ft.)
Project Name: ( ea, 7 V' c i-- Covered porch area (sq. ft.)
Cross s et/Directions to job site Deck area (sq. ft.)
, y Ta / Sr Other structure area (sq. ft.)
REQUIRED DATA: .
C 5 +a'sto D TOGO 1.4.? COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
e ' ✓eIler Cx /ST; Ali. 5w,A4 w.i0-'a ,oD4.- /? •+a
!w/ A G,4iic 44614 D/* Cri -IA. c PA-g4 A..17, 7b Valuation $ _<
Existing building area (sq. ft.) 632)
. p .0.)wA-4 ' e.--a.. r !mod'`' New building area (sq. ft.)
Number of stories
Ii PROPERTY OWNER I ❑ TENANT . Type of construction 4 5 — i✓
Name: 4 , pe .�•,9�D0 Occupancy group(s): Existing: e3
New: E 3
Address: /0y co S. /49i1 rx
City/State /Zip: 77
Phone: 6.39 y G / 0 Fax: 7 2. y 2.-2-7 NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Ig APPLICANT' lia CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: 0 ii-,.. ,1[ L w, co, jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 0-42A040o Al t.A "i 1--- from licensing, the following reason applies:
r
Address: /z3 7O S'— .11),ee1 , `at► Gr.
City /State /Zip: A 4 * 71. y
Phone: 639 4.35 I Fax: $ t..-
- BUILDING PERMIT PFEES* : ` ._ '
E-mail: Please refer' to fee schedule.,
CONTRACTOR
Business Name: IV et,. ,IC`k..• dr [,p Fees due upon application $
Address: / .2.a, 7 p 5 ,,O a eht.4- s, y Cr..
City /State /Zip: 7, ,q A...d * 72,7,y Amount received $
Phone: 6 3 4 93y`9 Fax: 54-4.1e Date received:
CCB Lic. #: y q - / 5 .
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: /� Date: 7�/ 2.0=0 180 days after it has been accepted as complete.
75 .✓ 0/11.1.4 Ai 6 --- *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
•
• V
A ltk Plan Submittal Requirement Matrix
Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(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 \PlanSubMatrix.doc 04/03
CITY OF TIGARD _ 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION , Business Line: 1503) 639 -4171 MST
Bu — 003 0
Received Date Requested /o — AM PM BUP
Location l O `'E 0 (o -t K S+-. Suite MEC
Contact Person J O Ph ( ) 639 — S PLM
Contractor Ph (C —ems 30 r 99 g5 SWR
B UILDI
Tenant/Owner � � 7iii�i_��i'� 7
moot ing LC
Foundation Access:
Ftg Drain C (4 tte-A4 cif/(9f LR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
' '1 PART FAIL
:ING . /fe
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
FAIL
R• gh -In"
ye Slab'
r V . e
•
"�`" Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA D /0 Z Z b 3 Ins ector Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL