Permit •
A. • CITYOFTIGARD BUILDING PERMIT
PERMIT #: BUP2000 -00085
s . l!IAr DEVELOPMENT SERVICES DATE ISSUED: 04/10/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CD -00104
SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST 105
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
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: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 16 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: $ 7,313.00
Remarks: Commercial TI. New office walls and partitions.
Owner: Contractor:
MEDAK, JOHN D + ROSEWAY PLASTERING CO
VIUHKOLA, JENNIFER PO BOX 19639 ORIGINAL
4029 NE SANDY BLVD PORTLAND, OR 97280
P Phone ND, OR 97213 Phone: 245 -4537
Reg #: LIC 43328
•
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Framing Insp
PRMT KJP 04/10/200C $105.50 0001275 Gyp Board Insp
5PCT KJP 04/10/200C $8.44 0001275 Susp Final Inspection
PLCK KJP 04/10/200C $68.58 0001275
FIRE KJP 04/10/200C $42.20 0001275
Total $224.72
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 -1987.
Pe rm itee •
Signature: `
Issued By:
/5 -'-'
Call 639 -4175 by 7 p.m. for an inspection the next business day
• CITY OF Ti.ARD Commercial Building Permit Application Plan C
13125 SW HALL BLVD. Tenant Improvemen
TIGARD, Date Rec'd _ oO
OR 97223 ��1+� 9.-/ Date to P.E. 3 /,a' 60
(503) 639 =4171 �- �`�" _ Date to DSJ � g �
Print or Type 1" / ' Permit* 00
Related SWR # ,
Incomplete or illegible applications will not be accepted Called 3/,.;5/00 5? / /PM•
Name of Development/Project Existing Buildin New Building ❑
Job M cDc It li3 0 rLnito C
Address Street Address Suite Building
I ) - 13r sw Qyir . �� Data
1. 1 zA (IV'b /41.06-
Bldg # City /State Zip Existing Use of Building or Property:
R ) CI /UIZIrG 0 F 4 -E- 1
Name
Property Proposed Use of Building or Property:
Pro y 3A-C1 M �D
p . 9X
Owner Mailing Address Suite 0 E - ri c.g 5
q U1e) N E SP tsibv t tt ux No. Of Stories:
City /State Zip Phone Ce NC---
„- --22-673 Sq. Ft. Of Project:
PUeTL,a�Dlt�re °►7Z► z s 7—y -- 7; C
Occupant Name
Occupancy Class(es)
V,c9"
Name
Contractor i osi wqy PLJ4-5Te2.1t-,6 Type(s) of Construction
Prior to permit Mailing Address Suite —
issuance, a copy Will this project have a Fire Suppression System?
G
of all licenses P U. I) 1 I 6 Yes ❑ No
are required if City /State Zip Phone
expired in C.O.T. Americans with Disabilities Act (ADA)
database f't1 1R,Tt_AN7 1 ? 8D =9S- 0310 Valuation X 25% = $ Participation
Oregon Const. Cont. Board Licit Exp. Date Complete Accessibility Form
2 ( 7 ,L. c— 4537 V3328 &9o-c/ " Project $ _ _ ,.
Name Valuation 3 - rFr S , -
Architect Plans Required: See Matrix for number of sets to submit
Mailing Address Suite on back
City /State Zip Phone I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and
that plans submitted are in compliance with Oregon State Laws.
Engineer Name
Signature of Owner /Agent Date
Mailing Address Suite � l l� � 7-) -,) —U 0
D4��rr ff < J`
Contact Person Name Phone
City /State Zip Phone N 1 )re g NA ED41< 'Z-7 3—.0 3 3 5
FOR OFFICE USE ONLY
Indicate type of work: New 0 Addition 0 Demolition 0 Map/TL# Land Use:
Accessory Structure 0 Foundation Only 0 Alteration 0
Repair 0 Other O Notes: �j 7 �jQ
Description of work: - I' ! - /'� o pSO� i
✓n NFW TE-f'7, _ pfF► c_ w.ot_� ! t✓ TIF: F /.3
rAGzT► ?i ,N--) c `` ' . I a
Note: Site Work Permit Application must precede or accompany Building 2 63 C 3 V -'//71 X T Loy Awe De(L Wit) Wit) E, )
Permit Application 'G ✓ge. Ty� , L'O t
It iM/T. "lore" Pf 4417 4)2E cletfibuLf b Mo/J 7-7141.
/tT ? /5
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<-L 11 - 7z 63
A /JMe 2_ y / -0
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependant u ;o s of BOTH plans A D a C #P E 'E <: `
application. ; For an elect cal s bmittal, the applicat on m ust contain' the
signature of the supery €sing electrician efore parr r v ew:will be :ond;ucted : <':
After plan review approval, Plans Exam will contact the a t request ::::
ad i tional plan sets for' distr ibution ; purposes (Cop for Con Opt
Washington Coun Tualatin Valle F r ;& Rescue )
:o
KEY:
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
*B&M &P(Att) 3
NOTES:
*Shaded areas designate ALT submittals only.
I: \dsts \forms \matrxcom.doc 10/30/98
, . . ,
. i+
KING CITY
Viii 11
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
e Phone: (503) 639 -4082 • FAX (503) 639-3771
Notice To Contractors Workin In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval..
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: / . / 111 _ -.Ji J
located at: //73,-C az
/r
Kin/ity Representative of / —Cd
I: 'DSTS\ICCIMST.DOC
OVER- THE - COUNTER () PERMIT PLAN REVIEW
COMMERCIAL (STRUCTURAL) BUILDING PERMIT CHECKLIST
DESCRIPTION OF PROJECT: i I
CLASS OF WORK: PA — FLOOR AREAS: EXTERIOR WALL CONSTRUCTION
TYPE OF USE: FIRST SQ. FT. N: S: E: W:
TYPE OF .)
CONSTR: v r" SECOND SQ. FT. PROTECT OPENINGS ?:
OCCUPANCY GRP: l' THIRD SQ. FT. N: S: E: W:
OCCUPANCY LOAD: ( Lo TOTAL SQ. FT. ROOF CONSTR: FIRE RET:
STOR: HT: FT: BSMNT: SQ. FT. AREA SEP. RATED:
BSMNT?: MEZZ ?: GARAGE: SQ. FT. OCCU.SEP.RATED:
FIRE FIRE SMOKE HANDICAP
SPRINKLER: ALARM: DETECTOR: ACCESS:
I COMMERCIAL INSPECTION ACTIONS FEE MENU I
Foot/Found Post/Beam $ 10 Permit Fee
Masonry ramin $ FOR Plan Review ii
Insulation Shear Wall
119r)- $ g 8% State Surcharge
Firewall Gyp Boa • `$ 4 77 FLS Plan Review
Su pended C ' • Sprinkler Rough -in $ Add'I Permit Fee
Sprinkler Final Fire Alarm $ Add'I FLS PIn
Smoke Detector Approach /Sidewalk $ Inspection
Miscellaneous' $ MIS Fee
FOR OFFICE USE ONLY:
TYPE OS USE OPTIONS (COM= commercial; CMS = commercial manufactured structure)
CLASS OF WORK OPTIONS FOR ALL PERMITS (NEW =new; Add = addition; ALT= alteration; ACS= accessory;FND- foundation;
OTR= other; DEM= demolition; REP= repair; FPS =fire protection system, NOTE: USE OTR FOR FENCES, RETAINING
WALLS, DETACHED DECKS, SIGNS, AWNINGS, CANOPIES)
I: \ovrcntr2.doc (DST) 9/99 -
5/23/00 Acti for Case #: BUP2000 -00085
4:56:20 PM
Assigned Hold Updated
Activity Description • Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPC005 APPlication received 3/21/00 DEB RECD No Hold DEB 3/22/00 Has planning approval letter
from King City.
BUPC008 Permit created 3/22/00 DEB DONE No Hold DEB 3/22/00 .
BUPC012 Plans routed to Plans Examiner 3/22/00 DEB DONE No Hold DEB 3/22/00
BUPCO24 Plans checked /approved by PE 3/22/00 RDP .APPR No Hold DEB 3/22/00 •
BUPCO26 Approved plans routed to DSTs 3/22/00 RDP DONE No Hold DEB 3/22/00
BUPC090 Ready to issue 3/22/00 DEB DONE No Hold DEB 3/22/00
BUPC740 Framing Insp 4/14/00 TLP PASS No Hold AKJ 4/16/00
BUPC760 Gyp Board Insp 4/18/00 TLP PASS No Hold AKJ 4/18/00
BUPC762 Susp Ceilng Insp No Hold DEB 3/22/00
BUPC799 Final Inspection 5/11/00 TLP PASS No Hold AKJ 5/11/00
BUPC100 (F) Issue permit 4/10/00 KJP DONE No Hold KJP 4/10/00
BUPA990 (F) Issue Cert. of Occupancy 5/11/00 TLP DONE No Hold ST 5/23/00 5 /24 /00- mailed to
owner/tenant/TVFD/file
BUPA995 File sent to records 5/23/00 ST DONE No Hold ST 5/23/00
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP 7e fb 2S
Date Requested 5/i KW AM PM X BLD
Location /(7 S Q 4)) 7, Suite /OS MEC
Contact Person QC Ph S/(D -7211 3 PLM
Contractor Ph 2-(7 " S / t SWR
�iCDING� Tenant/Owner ELC
Retaining Wall ELR
Footing Access: /^
Foundation S (0-7 FPS
Ftg Drain � SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
ofTrIlb
) PART FAIL
ING
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
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line /( ' J(I . ADA
h oach /Sidewalk Date 5 / Inspector )471 Ext
�l
Final -
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.